title: Awake cardiopulmonary bypass to prevent hemodynamic collapse and loss of airway in a severely symptomatic patient with a mediastinal mass.
abstract: Management of a large mediastinal mass causing respiratory and hemodynamic compromise represents a major challenge during induction of anesthesia and surgical resection. The hemodynamic changes associated with anesthetic induction and initiation of positive-pressure ventilation can lead to acute hemodynamic collapse or inability to ventilate, or both. Initiation of cardiopulmonary bypass before anesthetic induction represents a safe alternative. We present a 37-year-old woman who underwent successful resection of a large anterior mediastinal mass through sternotomy. Cardiopulmonary bypass was instituted using the right femoral vessels under local analgesia to allow safe anesthetic induction. Her postoperative course was uneventful. This represents an example of a team approach to the management of a complex patient to achieve a successful outcome.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sameh M
authors.initials: SM
authors.lastname: Said
authors.affiliation: Division of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Telesz
authors.affiliation: Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: George
authors.initials: G
authors.lastname: Makdisi
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Quevedo
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.affiliation: Division of Anesthesiology, Mayo Clinic, Rochester, Minnesota. Electronic address: mauermann.william@mayo.edu.
authors.forename: William J
authors.initials: WJ
authors.lastname: Mauermann
mesh_terms: D000328:Adult; D002315:Cardiopulmonary Bypass; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D056346:Sternotomy; D014463:Ultrasonography