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The Management of a Patient With Tracheal Compression Undergoing Combined Resection of an Anterior Mediastinal Mass and Aortic Valve Replacement With Coronary Artery Bypass Graft Surgery: Utility of the Laryngeal Mask Airway and Aintree Intubation Catheter

2006; Elsevier BV; Volume: 21; Issue: 2 Linguagem: Inglês

10.1053/j.jvca.2006.03.002

1532-8422

Michelle Capdeville,

Thyroid and Parathyroid Surgery

IT HAS LONG BEEN recognized that the presence of an anterior mediastinal mass can lead to respiratory and cardiovascular collapse. Importantly, the severity of airway compromise may not be apparent in the awake patient. There have been numerous reports in the literature of life-threatening complications or death during anesthetic induction, maintenance, and emergence, as well as in the early postoperative period. 1 Todres I.D. Reppert S.M. Walker P.F. et al. Management of critical airway obstruction in a child with a mediastinal tumor. Anesthesiology. 1976; 45: 100-102 Crossref PubMed Scopus (28) Google Scholar , 2 Pullerits J. Holzman R.S. Anaesthesia for patients with mediastinal masses. Can J Anaesth. 1989; 36: 681-688 Crossref PubMed Scopus (127) Google Scholar Symptoms attributable to anterior mediastinal masses include airway compression with obstruction, obstruction of the major vessels and heart, and superior vena cava syndrome. 3 Amaha K. Okutsu Y. Nakamura Y. Major airway obstruction in a child with a mediastinal tumour A case report. Br J Anaesth. 1973; 45: 1082-1084 Crossref PubMed Scopus (21) Google Scholar , 4 Northrip D.R. Bohman B.K. Tsueda K. Total airway occlusion and superior vena cava syndrome in a child with an anterior mediastinal tumor. Anesth Analg. 1986; 65: 1079-1082 Crossref PubMed Scopus (68) Google Scholar Airway management in these patients can prove challenging and demands proper planning and communication on the part of the anesthesia and surgical teams. This case describes the airway management of a high-risk patient with significant tracheal narrowing and a large retrosternal goiter undergoing combined resection of this mass with major cardiac surgery.