A Pregnant Patient With a Large Anterior Mediastinal Mass for Thymectomy Requiring One-Lung Anesthesia.

Seminars in Cardiothoracic and Vascular Anesthesia
Anthony M-H HoGlenio B Mizubuti

Abstract

Anesthetic management for anterior mediastinal mass resection is often challenging. The main concern being that the tumor might, on reduction in muscle tone, cause circulatory and/or airway collapse. In the setting of pregnancy, the expected physiologic changes (eg, increased oxygen demand, decreased functional residual capacity, and aortocaval compression) may further increase the risks. The objective of this report is to present a challenging case of a pregnant woman undergoing an anterior mediastinal mass resection with the additional rare requirement for one-lung anesthesia, and to describe the perioperative considerations and the plan executed to ensure a successful outcome. A 30-year-old pregnant (23 weeks) patient with a large anterior mediastinal mass and evidence of significant cardiovascular and tracheobronchial compression presented for thymectomy requiring one-lung ventilation. Anesthesia consisted of preoperative preparation, thoughtful selection of vascular access sites, preservation of spontaneous ventilation until sternotomy was accomplished, use of bronchial blocker and readily reversible pharmacologic agents, availability of backup airway and oxygenation plans, standby high-frequency ventilation, and anticipat...Continue Reading

References

Oct 1, 1988·Anaesthesia·R E John, V P Narang
Jun 1, 1993·Anaesthesia and Intensive Care·R A VictoryF Breatnach
Apr 6, 2004·Pediatric Surgery International·J C M LamV T Joseph
Jan 11, 2007·Current Opinion in Anaesthesiology·Peter Slinger, Cengiz Karsli
Mar 31, 2009·Journal of Clinical Anesthesia·Ursula GalwayThomas Gildea
Apr 23, 2009·European Journal of Anaesthesiology·Gabor Erdös, Irene Tzanova
Jul 23, 2011·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Randal S Blank, Duncan G de Souza

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Citations

Feb 9, 2021·Seminars in Cardiothoracic and Vascular Anesthesia·Nirvik PalMiklos D Kertai
Mar 8, 2021·Journal of Cardiothoracic and Vascular Anesthesia·Brian RadvanskyMichelle Capdeville

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Methods Mentioned

BETA
sedation

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