Abstract
Anaesthesia for patients with mediastinal masses may be associated with significant respiratory and cardiovascular complications. In this review, we discuss the anatomical and pathological considerations in these adult and paediatric patients and the three types of intra-thoracic compromise that may be found: compression of the tracheobroncheal tree, compression of the pulmonary artery and heart and the superior vena caval syndrome. Patient evaluation by symptom history, computerized tomography and flow-volume loops is emphasized. Preoperative thoracic radiation therapy in severely symptomatic patients is associated with a decrease in postoperative respiratory complications and an improvement in risk. During radiation therapy a small window can be created to spare some tissue for adequate histological diagnosis. Anaesthetic management techniques for these patients are discussed. Life-threatening complications can occur at any point during anaesthesia for patients with mediastinal masses. Anaesthetists should have a high degree of awareness of the underlying anatomy, pathophysiology and anaesthetic alternatives when caring for these patients.
Résumé
Les enfants et les adultes qui ont une masse médiastinale sont à risque de complications respiratoires ou cardio-vasculaires tors de l’anesthésie. Nous en décrivons l’anatomo-pathologie et les trois types de problèmes intrathoraciques associés: compression trachéo-bronchique, compression du coeur et de l’artère pulmonaire et enfin, syndrome de la veine cave supérieure. Nous insistons sur l’évaluation par l’histoire, la tomodensitométrie et la courbe débit-volume. On peut diminuer le risque de complications respiratoires par une radiothérapie pré-opératoire chez les patients très symptomatiques tout en épargnant une fenêtre qui servira au diagnostic histologique. Nous décrivons aussi les techniques anesthésiques appropriées. Des complications graves peuvent survenir à n’importe quel moment de l’anesthésie chez ces patients. Dans ces cas la, l’anesthésiste doit être bien au fait de l’anatomie et de la pathophysiologie de la lésion et des alternatives qui s’offrent à lui.
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Pullerits, J., Holzman, R. Anaesthesia for patients with mediastinal masses. Can J Anaesth 36, 681–688 (1989). https://doi.org/10.1007/BF03005421
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DOI: https://doi.org/10.1007/BF03005421