title: Perioperative management of thymectomy.
abstract: Thymoma is the most frequent type of tumor in the anterior-superior mediastinum. The presentation of thymomas is variable; most are asymptomatic and others present themselves with local compression syndrome or parathymic syndrome; rarely thymomas appear as an acute emergency. Surgery is the treatment of choice for thymic tumors and complete resection is the most important prognostic factor. Surgery with adjuvant radiation is recommended for invasive thymoma. The anaesthetic management of patients with mediastinal thymoma undergoing thymectomy is associated with several risks related to potential airway obstruction, hypoxia and cardiovascular collapse. Patients at high risk of perioperative complications can be identified by the presence of cardiopulmonary signs and symptoms. However, asymptomatic thymomas have been occurred with acute cardiorespiratory complications under general anaesthesia. A careful preoperative evaluation of signs, symptoms, chest X-ray, CT scan, MRI, cardiac echogram and venous angiogram should be helpful to investigate neoplasm presence and the area of invasion; moreover, an adequate airway and cardiovascular management, such as performing an awake intubation in the sitting position, allowing spontaneous and non-controlled ventilation, a rigid bronchoscope available and a standby cardiopulmonary bypass, is suggested to prevent the main life-threatening cardiorespiratory complications.
authors.affiliation: Istituto di Anestesia e Rianimazione, Università Cattolica del Sacro Cuore, Roma.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Congedo
authors.forename: Paola
authors.initials: P
authors.lastname: Aceto
authors.forename: Alexander
authors.initials: A
authors.lastname: Cardone
authors.forename: Rosanna
authors.initials: R
authors.lastname: Petrucci
authors.forename: Alessandra
authors.initials: A
authors.lastname: Dottarelli
authors.forename: Germano
authors.initials: G
authors.lastname: De Cosmo
mesh_terms: D000758:Anesthesia / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000628:therapy; D006801:Humans; D012120:Respiration Disorders / Q000209:etiology / Q000628:therapy; D013934:Thymectomy / Q000009:adverse effects; D013945:Thymoma / Q000150:complications / Q000601:surgery*; D013953:Thymus Neoplasms / Q000150:complications / Q000601:surgery*