Perioperative Anesthetic Management of Giant Mediastinal Tumors: Current Advances and Evidence-Based Strategies

Perioperative anesthetic management of giant mediastinal tumors presents significant challenges in cardiothoracic anesthesia due to the risk of mediastinal mass syndrome. This comprehensive review synthesizes recent evidence on risk stratification, evolving anesthetic techniques, and innovative support technologies. Contemporary evidence challenges traditional dogma, demonstrating that positive pressure ventilation and neuromuscular blockade can be safely applied under appropriate monitoring in selected patients. Risk stratification incorporating tumor size (≥0.5 ratio), airway compression (>50%), and hemodynamic parameters enables individualized management approaches. Extracorporeal membrane oxygenation has evolved from rescue therapy to prophylactic support, with clear guidelines for deployment. Tumor-specific protocols address unique challenges, including tumor lysis syndrome in lymphomas, myasthenic crisis in thymomas, and coagulopathy in germ cell tumors. The integration of advanced monitoring, prophylactic extracorporeal membrane oxygenation strategies, and evidence-based protocols provides a framework for safe management while expanding surgical feasibility for these complex cases.