From the Research
Anesthetic management of patients with anterior mediastinal masses requires careful preoperative assessment and preparation due to the risk of life-threatening airway and cardiovascular compromise, and the most recent evidence suggests that maintaining spontaneous ventilation and avoiding general anesthesia with muscle relaxation is crucial, as seen in the study by 1. When managing patients with anterior mediastinal masses, it is essential to consider the following key points:
- Maintain spontaneous ventilation whenever possible, as positive pressure ventilation can worsen compression of vital structures.
- Avoid general anesthesia with muscle relaxation if feasible; instead, consider local anesthesia with sedation, regional techniques, or awake fiberoptic intubation.
- If general anesthesia is necessary, use a rigid bronchoscope and have emergency equipment readily available, including materials for establishing an emergency surgical airway.
- Position patients semi-upright or in lateral decubitus position to minimize compression effects.
- Preoperative radiation or chemotherapy to shrink the mass should be considered before elective procedures.
- Preoperative evaluation should include CT or MRI imaging to assess the degree of airway and vascular compression, pulmonary function tests, and echocardiography to evaluate cardiac function, as recommended by 2. The study by 1 highlights the importance of using 3D virtual bronchoscopy as an aid to airway management in patients with anterior mediastinal masses, allowing for a more informed decision on the use of general anesthesia with muscle relaxation. In terms of specific anesthetic techniques, the study by 3 emphasizes the importance of considering radiological signs, such as mediastinal mass ratio and cross-sectional area of the trachea, in evaluating the safety of induction of general anesthesia. Overall, the anesthetic management of patients with anterior mediastinal masses requires a careful and individualized approach, taking into account the patient's specific condition and the potential risks and benefits of different anesthetic techniques, as discussed in the studies by 4, 5, and 2.