Anesthetic management during anterior mediastinal mass resection in a pediatric patient. A case report

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Pediatric Oncology

Background:

• Anterior mediastinal masses (AMM) can cause severe airway compression, leading to respiratory and cardiovascular complications during anesthesia.
• General anesthesia (GA) and neuromuscular relaxation (NMR) can exacerbate these risks by altering respiratory mechanics and hemodynamics.
• Spontaneous ventilation is often preferred for AMM resection to mitigate these risks.

Observation:

• A pediatric case involving a patient with severe orthopnea due to AMM and lymphoblastic lymphoma experienced respiratory arrest and cardiovascular collapse during sedation.
• Medical treatment was ineffective, necessitating surgical resection under GA with NMR.
• The patient required a multidisciplinary approach with careful preoperative evaluation and planning.

Findings:

• Resection surgery under GA with NMR was ultimately required for the patient.
• The case highlights the critical need for preparedness and stepwise procedures when GA/NMR are unavoidable.
• Preparedness included strategies like rescue positioning, bronchoscopy, and sternotomy.

Implications:

• This case underscores the importance of thorough preoperative assessment and meticulous planning for AMM resection.
• A multidisciplinary team approach is crucial for managing complex cases of AMM.
• Developing and preparing rescue strategies are vital for patient safety during AMM resection under GA with NMR.