Anesthetic managements of the patients with giant mediastinal tumors--a report of two cases.
Anesthesia for patients with a huge anterior mediastinal tumor is a well-known challenge and trial to all the anesthesiologists. The tumor mass which directly compresses the trachea and bronchus induces hypoxia and asphyxia, eventuating in cardiac arrest or even fatality in the process of general anesthesia. In selection of anesthetic technique, general anesthesia is deliberately avoided if not mandatory or spontaneous respiration should be strictly preserved by all means if obligatory. Our surgical colleagues are usually not so familiar with this potentially life-threatening situation as are the anesthesiologists, and bad communications and interactions between the two may court disaster. Here we reported 2 cases: the former was an immediate mortality in a youth with a giant anterior mediastinal tumor undergoing excisional biopsy of a neck mass under general anesthesia, and the latter was a successful anesthetic management in a woman with a giant mediastinal tumor receiving abdominal total hysterectomy for cervical cancer in situ under spinal anesthesia. The hazards of general anesthesia in these patients and the importance of comprehending preanesthetic preparations were reviewed and discussed. Moreover, we address that whenever one has shot his bolt still futile to improve the respiratory crisis in a case with mediastinal tumor, try to ventilate the patient in a prone position as it has clinical importance in ventilation and oxygenation.
Lin
S H
SH
Department of Anesthesiology, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Su
N Y
NY
Hseu
S S
SS
Ting
C K
CK
Yien
H W
HW
Cheng
H C
HC
Lee
T Y
TY
D000293:Adolescent; D000402:Airway Obstruction / Q000517:prevention & control; D000758:Anesthesia / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications*; D008875:Middle Aged