Related Experiment Videos
Preanesthetic evaluation of children with anterior mediastinal masses
1Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Insights
Patients with anterior mediastinal masses face respiratory collapse risk during general anesthesia. Safe anesthesia is possible if tracheal area (CT scan) and peak expiratory flow rates are at least 50% of predicted values.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Anterior mediastinal masses can cause respiratory compromise.
- Respiratory collapse is a known complication of general anesthesia in these patients.
- Recent studies aim to define risk factors and safe anesthetic parameters.
Purpose of the Study:
- To identify risk factors for respiratory collapse in patients with anterior mediastinal masses.
- To establish safe lower limits for parameters during general anesthesia.
- To discuss diagnostic approaches for mediastinal masses.
Main Methods:
- Review of case reports and series on anterior mediastinal masses and anesthesia complications.
- Analysis of computed tomography (CT) scan measurements of tracheal area.
- Evaluation of peak expiratory flow rate (PEFR) measurements.
- Discussion of diagnostic techniques including pleural effusion aspiration and local anesthesia thoracotomy.
Main Results:
- Safe lower limits for general anesthesia include a tracheal area of at least 50% of predicted and PEFR of at least 50% of predicted.
- Computed tomography (CT) scans are crucial for assessing tracheal area.
- Alternative diagnostic methods are presented to avoid risks associated with prebiopsy treatment.
Conclusions:
- General anesthesia can be safely administered to select patients with anterior mediastinal masses.
- Tracheal area (CT) and PEFR are key parameters for risk assessment.
- Minimally invasive diagnostic procedures are recommended to obtain tissue samples.
Abstract:
Respiratory collapse is a well-recognized complication of general anesthesia in patients with an anterior mediastinal mass. Although numerous case reports document this occurrence, only recently have several series provided some guidance in defining which patients are at risk for respiratory collapse. Safe lower limits for two parameters at which general anesthesia can be used appear to be a tracheal area measured by computed tomography (CT scan), which is at least 50% of the area predicted for normals and peak expiratory flow rates, which are at least 50% of predicted. The problems with prebiopsy treatment are presented, and methods of obtaining diagnostic material by aspiration of a pleural effusion or performance of an anterior thoracotomy under local anesthesia are discussed.