A 15 year-old teenager comes to the operating room for mediastinoscopy and
tissue biopsy of a newly diagnosed anterior mediastinal mass. A CT of the chest
shows significant impingement of the mass on the trachea, and the patient has
plethora of the face. The oncologist has requested the tissue biopsy to guide
initial therapy. Which of the following is a mainstay of anesthetic management?
a) Assessment of severity of symptoms
b) Maintenance of spontaneous ventilation on induction
c) Contingency plan in the event of total airway obstruction
d) Both a and c
e) All of the above
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Answer
Answer e. Any anesthetic in a patient with an untreated mediastinal mass should
be considered high-risk. A careful preoperative assessment must be undertaken,
and an anesthetic plan must be constructed with care and a high degree of
suspicion for total airway and/or vascular compromise upon loss of airway tone.
Therefore, all answers listed are appropriate. Please see Book 8, Chapter 5 in
this series for additional information about mediastinal masses in children.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.
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