Navigating the anaesthetic maze: The VATS challenge in an infant with anterior mediastinal mass

The anterior mediastinal mass (AMM) is a rare but life-threatening entity in an infant. The symptoms mostly depend on the size and the extent of the tumour and its relationship with the surrounding structures. Anaesthetic challenges are multi-fold when such a child is posted for video assisted thoracoscopic surgery (VATS): risk of airway or cardiovascular collapse during anaesthesia, supine positioning, one lung ventilation in the setting of difficult airway, pneumo-mediastinum in a small child with a space occupying lesion in thorax leading to further lowering of venous return and cardiac output, development of hypercarbia and challenges in maintaining lung protective ventilatory strategy, risk of major bleeding and collapse. Definitive management requires a team of experts in a well-equipped centre with clear cut management strategy and open discussion with family members. We describe one such challenging case of infant AMM posted for VATS which was successfully managed at our institute.