Anaesthesiological management of mediastinal tumors

Erdös, Gabor; Kunde, M; Tzanova, I; Werner, C (2005). Anaesthesiological management of mediastinal tumors. Anaesthesist, 54(12), pp. 1215-1228. Springer-Medizin-Verlag 10.1007/s00101-005-0895-1

[img] Text
art%3A10.1007%2Fs00101-005-0895-1.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

The perioperative management of patients with mediastinal masses is a special clinical challenge in our field. Even though regional anaesthesia is normally the first choice, in some cases it is not feasible due to the method of operation. In these cases general anaesthesia is the second option but can lead to respiratory and haemodynamic decompensation due to tumor-associated compression syndrome (mediastinal mass syndrome). The appropriate treatment begins with the preoperative risk classification on the basis of clinical and radiological findings. In addition to anamnesis, chest radiograph, and CT, dynamical methods (e.g. pneumotachography and echocardiography) should be applied to verify possible intraoperative compression syndromes. The induction of general anaesthesia is to be realized in awake-fiberoptic intubation with introduction of the tube via nasal route while maintaining the spontaneous breathing of the patient. The anaesthesia continues with short effective agents applied inhalative or iv. If possible from the point of operation, agents of muscle relaxation are not to be applied. If the anaesthesia risk is classified as uncertain or unsafe, depending on the location of tumor compression (tracheobronchial tree, pulmonary artery, superior vena cava), alternative techniques of securing the respiratory tract (different tubes, rigid bronchoscope) and cardiopulmonary bypass with extracorporal oxygen supply are prepared. For patients with severe clinical symptoms and extensive mediastinal mass, the preoperative cannulation of femoral vessels is also recommended. In addition to fulfilling technical and personnel requirements, an interdisciplinary cooperation of participating fields is the most important prerequisite for the optimal treatment of patients.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Erdös, Gabor

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0003-2417

Publisher:

Springer-Medizin-Verlag

Language:

German

Submitter:

Jeannie Wurz

Date Deposited:

23 Feb 2015 16:22

Last Modified:

23 Jan 2018 12:18

Publisher DOI:

10.1007/s00101-005-0895-1

PubMed ID:

16091923

BORIS DOI:

10.7892/boris.63835

URI:

https://boris.unibe.ch/id/eprint/63835

Actions (login required)

Edit item Edit item
Provide Feedback