Mediastinal Mass Excision

Abstract

Mediastinal masses are rare tumors of the thoracic cavity. Although not all types require surgical intervention, resection of these masses provides a clinical challenge for the anesthesiologist due to both local mass effects, such as airway and vascular compression, and systemic effects, including paraneoplastic syndromes. A common example includes myasthenia gravis associated with thymoma. Preoperative assessment includes viewing imaging, obtaining a thorough history, performing a focused physical examination, and reviewing laboratory values. Medically optimizing comorbid conditions prior to excision, if possible, may reduce perioperative morbidity and mortality. Intraoperative considerations include planning for postoperative analgesia, establishing an airway, selection of invasive and noninvasive monitors, choosing intravenous access sites commensurate with tumor size and location, judicious fluid administration, and ventilator management. Postoperative considerations include intensive care unit transport, analgesia, and airway maintenance.