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, Mission Viejo, California., Popescu WM; Thoracic Anesthesia, Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut., Detterbeck FC; Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut. Electronic address: frank.detterbeck@yale.edu., Li AX; Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut., Blasberg JD; Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2024 Sep 21. Date of Electronic Publication: 2024 Sep 21.
DOI:	10.1016/j.athoracsur.2024.09.011
Abstrakt:	Background: Anesthesia administered to a patient with a large mediastinal mass engenders concern that it may precipitate catastrophic acute hemodynamic or respiratory decompensation. A review of the available evidence is needed to define the degree of risk, 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. Competing Interests: Disclosures Wanda M. Popescu reports a relationship with Ambu Inc that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu