Management of the patient with a large anterior mediastinal mass: recurring myths.
OBJECTIVE
This editorial review summarizes the current anesthetic management of patients with anterior mediastinal masses.


RESULTS
With increased appreciation of the correct intraoperative management of these cases severe intraoperative respiratory or cardiovascular collapse is less likely to occur during general anesthesia. Maintenance of spontaneous ventilation is the anesthetic goal whenever possible. Major life-threatening complications now occur more frequently postoperatively.


CONCLUSIONS
General anesthesia is not safe in patients with severe positional symptoms from an anterior mediastinal mass. With modern imaging techniques, general anesthesia is rarely needed for diagnostic procedures in these patients. Preoperative flow-volume loops are not useful in the management of these patients and the concept of cardiopulmonary bypass on 'standby' is not appropriate during induction of anesthesia.
Slinger
Peter
P
Karsli
Cengiz
C
D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology; D000758:Anesthesia / Q000009:adverse effects*; D000768:Anesthesia, General; D002648:Child; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy*; D008479:Mediastinal Neoplasms / Q000150:complications* / Q000601:surgery*; D012769:Shock / Q000175:diagnosis / Q000209:etiology; D014057:Tomography, X-Ray Computed