title: Thoracic epidural catheter in the management of a child with an anterior mediastinal mass: a case report and literature review.
abstract: We describe a case of an anterior mediastinal mass compressing the right main bronchus that required a biopsy through a thoracotomy incision. The anesthetic management of these patients is associated with several risks and challenges, including potential airway compression and cardiovascular collapse. Inhalation induction and maintenance of spontaneous respiration is recommended to preserve normal transpulmonary pressure gradient and improve flow through conducting airways. We placed a thoracic epidural catheter under general anesthesia as the main analgesic technique in order to maintain spontaneous breathing. The use of regional anesthesia, especially continuous epidurals in pediatric cardiothoracic anesthesia have many theoretical advantages including attenuation of the neuroendocrine response, facilitation of rapid extubation and improved ventilatory mechanics secondary to decreased narcotic requirements. The absolute risk of nerve injury and epidural hematoma for this procedure is unknown and hard to define in this patient population. We reviewed multiple studies and case reports addressing its safety and reported side effects. Finally, we emphasize that a thoracic epidural anesthesia is a reasonable choice that can be applied carefully in special situations even for children under general anesthesia.
authors.affiliation: Department of Cardiothoracic Anesthesia, Division of Anesthesia and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Loran M
authors.initials: LM
authors.lastname: Soliman
authors.forename: Emad B
authors.initials: EB
authors.lastname: Mossad
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000295:instrumentation*; D000768:Anesthesia, General / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001706:Biopsy / Q000379:methods; D002045:Bupivacaine / Q000008:administration & dosage; D002404:Catheterization / Q000295:instrumentation*; D002648:Child; D005283:Fentanyl / Q000008:administration & dosage; D006221:Halothane / Q000008:administration & dosage; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008479:Mediastinal Neoplasms / Q000601:surgery*; D013902:Radiography, Thoracic / Q000379:methods; D012119:Respiration / Q000187:drug effects; D013908:Thoracotomy / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008012:Lidocaine; D005283:Fentanyl; D006221:Halothane; D002045:Bupivacaine