Perioperative management of patients with mediastinal mass syndrome.

Purpose of the review: The mediastinal mass syndrome (MMS) can occur after induction of anesthesia, intraoperatively or even days after the surgical procedure. The focus of this review is on the management of pediatric and adult patients with a significant mediastinal mass.

Recent findings: The age distribution of patients with mediastinal lesions suggests a bimodal shape, with an increased incidence among children under 10 years old and adults aged 60-70 years old. The traditional approach to avoid general anesthesia and mechanical ventilation has been challenged recently. Induction of general anesthesia may be achieved by a titrated intravenous infusion of propofol, with the patient positioned in a semi-sitting position. Mechanical ventilation with a prolonged I:E ratio, low respiratory rate and rigid or flexible bronchoscopy to stent the obstructed airway can facilitate expiration of tidal volume. Continuous video bronchoscopy recordings of the compromised portion of the airway have shown that positive pressure ventilation and neuromuscular blockade can induce an increase in the mean airway patency score.

Summary: Meticulous planning, implementation of anesthetic management protocols and protocols for emergency situations are essential to guarantee patient safety with a mediastinal mass.