Anaes SAQs · Thoracic anaesthesia
Anaesthesia for anterior mediastinal mass
Final-examination SAQ for mediastinal-mass-anaesthesia.
On this page
Study tools
Target exams
ANZCAFRCAEDAICABAFCAI
Prompt
A 28-year-old with anterior mediastinal lymphoma has orthopnoea and 50% tracheal compression on CT. Outline preoperative assessment and your anaesthetic plan for cervical node biopsy, including management if complete airway obstruction occurs after induction.
Model answer
Assessment (4). Symptoms (orthopnoea/stridor), CT compression, echo, SVC signs, MDT.
[1] [2]Plan (6). Prefer local/awake strategy; if GA needed: semi-sitting, graded SV induction, no early relaxant, surgeon/rigid scope ready, lower-limb IV if SVC signs.
[1] [2]Collapse (5). 100% O2, reposition, rigid bronchoscope stent, wake if possible[3], emergency sternotomy/CPB if pre-planned for extreme risk.
[1] [2]References3ShowHide
- [1]Gothard JW Anesthetic considerations for patients with anterior mediastinal masses. Anesthesiology Clinics, 2008.PMID 18456215
- [2]Blank RS, de Souza DG. Anesthetic management of patients with an anterior mediastinal mass: continuing professional development. Canadian Journal of Anesthesia, 2011.PMID 21779948
- [3]Frerk C et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. British Journal of Anaesthesia, 2015.PMID 26556848