Periprocedural Complications in Adults with Mediastinal Masses

Respiratory and cardiovascular catastrophes are feared complications in patients with mediastinal masses undergoing anesthesia. Only a few of these events in the adult population have been noted in rare case reports, however. We aimed to investigate the complications related to surgical resection or biopsy involving mediastinal masses in clinical settings.

We performed a retrospective review of patients undergoing procedures related to their mediastinal mass and report on the perioperative outcomes.

In a 10-year span, we identified 122 patients who underwent procedures for mediastinal masses. The majority of procedures (78.8%) were performed under general anesthesia. The median mass size was 5.5 cm, and 62.1% of patients exhibited various degrees of airway obstruction and/or compression of cardiovascular structures. Intraprocedural complications were 5.2% and included six hypoxic events. Postprocedural complications occurred in 7.0% of patients and included six cases of respiratory failure and three cases of circulatory shock; however, we found no incidence of airway or circulatory collapse during anesthesia induction or in patients undergoing bronchoscopy. There were no differences in complications based on body mass index, compression of mediastinal structures, or atelectasis. There were no deaths.

We report a small number of complications in patients with mediastinal masses undergoing procedures despite the presence of structural compression and atelectasis. Large prospective studies are warranted to determine optimal patient management. Patients with mediastinal masses undergoing procedures require timely diagnosis and a multidisciplinary approach to periprocedural airway management.