Anesthetic Risk with Large Mediastinal Masses: A Management Framework Based on a Systematic Review.
| Autor: | Saffarzadeh A; Division of Thoracic Surgery, Department of Surgery, Providence Mission Hospital., Popescu WM; Thoracic Anesthesia, Department of Anesthesiology, Yale School of Medicine., Detterbeck FC; Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT. Electronic address: frank.detterbeck@yale.edu., Li AX; Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT., Blasberg JD; Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT. |
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| Jazyk: | angličtina |
| Zdroj: | The Annals of thoracic surgery [Ann Thorac Surg] 2024 Sep 20. Date of Electronic Publication: 2024 Sep 20. |
| DOI: | 10.1016/j.athoracsur.2024.09.011 |
| Abstrakt: | Background: Anesthesia administered to a patient with a large mediastinal mass engenders concern it may precipitate catastrophic acute hemodynamic or respiratory decompensation. A review of the available evidence is needed to define the degree of risk, the mechanisms, and preventative or reactive interventions to mitigate the risk. Methods: A systematic review of the PubMed database was conducted of studies involving adults with large mediastinal masses undergoing a procedure or anesthesia; all types of publications were included that provided data regarding risks, mechanisms, or techniques to address potential decompensation. This literature involves primarily case reports and small retrospective series; no quality assessment was deemed appropriate. Evidence was synthesized according to the consensus judgment of the writing panel. Results: Categories of low-, moderate-, high-, and very-high-risk emerged from review of the 72 included studies, based on the degree of symptoms, mass/chest ratio and degree of airway and/or vascular compression. This streamlines the preparation needed - minimal for low-risk and more extensive for higher-risk. Assessment of the impact of physiologic derangement stemming from the anatomic compression in individual patients provides a framework for anesthetic management, and back-up plans should decompensation occur. Conclusions: Despite limitations in the evidence inherent to a topic involving an uncommon but serious event, a framework was developed to streamline preparation for and management of patients with a large mediastinal mass requiring anesthesia in a rational manner. (Copyright © 2024. Published by Elsevier Inc.) |
| Databáze: | MEDLINE |
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