Pediatrics

Anterior Mediastinal Mass

Diagnosis

High Risk Factors

  • Etiology:
    • Hodgkin’s and non-Hodgkin’s lymphoma
  • Clinical signs:
    • Orthopnea, upper body edema, stridor, wheezing
  • Imaging findings:
    • Tracheal, bronchial, carinal, or great vessel compression
    • SVC or RVOT obstruction
    • Ventricular dysfunction
    • Pericardial effusion

Anesthetic Plan

  • Perform surgery under local anesthesia, if possible
  • Pre-treat with irradiation or corticosteroids
  • Maintain spontaneous ventilation and avoid paralysis
  • Ensure availability of fiberoptic and rigid bronchoscope
  • Cardiopulmonary bypass or ECMO
  • Type and cross and sternal saw (for surgeons) available

Diagnosis

High Risk Factors

  • Etiology:
    • Hodgkin’s and non-Hodgkin’s lymphoma
  • Clinical signs:
    • Orthopnea, upper body edema, stridor, wheezing
  • Imaging findings:
    • Tracheal, bronchial, carinal, or great vessel compression
    • SVC or RVOT obstruction
    • Ventricular dysfunction
    • Pericardial effusion

Anesthetic Plan

  • Perform surgery under local anesthesia, if possible
  • Pre-treat with irradiation or corticosteroids
  • Maintain spontaneous ventilation and avoid paralysis
  • Ensure availability of fiberoptic and rigid bronchoscope
  • Cardiopulmonary bypass or ECMO
  • Type and cross and sternal saw (for surgeons) available

  1. Airway collapse

    Increase O2 to 100%

  2. Add CPAP for spontaneous ventilation; add PEEP for controlled ventilation

  3. Reposition to lateral or prone

  4. Ventilate via rigid bronchoscope

  5. Cardiovascular collapse

    Give fluid bolus

  6. Reposition to lateral or prone

  7. Ask surgeon for sternotomy and elevation of mass

  8. Consider ECMO

  9. Crisis Management (If Severe)

    Notify surgeon, call for help and code cart

  10. Call for Transesophageal Echocardiography

  11. Start chest compressions

  12. Give epinephrine 10 MICROgrams/kg IV/IO

  13. If cardiac arrest, go to CARDIAC ARREST

  14. Consider ECMO

Patient weight

Between 0.5 kg and 120 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.