General Anesthesia
Perioperative anesthetic management of patients undergoing resection of huge mediastinal mass and recommendations for enhanced recovery after surgery protocol pathway
Zhang Mingzhu, Lou Zhichao, Shen Le, Li Hong, Zhang Xiuhua, Huang Yuguang
Published 2017-09-20
Cite as Chin J Anesthesiol, 2017,37(9): 1037-1042. DOI: 10.3760/cma.j.issn.0254-1416.2017.09.003
Abstract
ObjectiveThe mediastinal mass usually posed higher risk of anesthesia and surgery due to its especial anatomical position, and this study aimed to analyze the perioperative anesthetic management of 3 patients undergoing resection of huge mediastinal mass, to identify the potential risks for this type of surgery and to summarize the corresponding perioperative anesthetic management protocol.
MethodsThree cases recently underwent resection of huge mediastinal mass in our hospital were reviewed.Their preoperative assessment and preparation, intraoperative anesthetic management, postoperative pain management and special interventions needed in the perioperative period were summarized and analyzed retrospectively.The enhanced recovery after surgery (ERAS) protocol was established for this type of surgery based on the analysis mentioned above, evidence reported at home and abroad and currently available ERAS protocols for other surgeries.
ResultsPleural malignant solitary fibrous tumor, thymus squamous cell carcinoma and malignant mixed germ cell tumor were the three mediastinal masses.The preoperative assessment focused on the impact of tumor on other vital organs within the mediastinum; anesthesiologists focused on massive hemorrhage and severe complications such as cardiac insufficiency and respiratory insufficiency; all the three patients were sent to the intensive care unit after surgery for further treatment, successfully recovered and were discharged; improving postoperative analgesia was helpful for recovery after resection of huge mediastinal mass.
ConclusionPerioperative anesthetic management of patients undergoing resection of huge mediastinal mass is related to high risk, and establishing specific ERAS protocol is helpful in reducing complications and in promoting recovery after surgery based on the currently available evidence and characteristics of this type of surgery.
Key words:
Mediastinal masses; Perioperative managements; ERAS
Contributor Information
Zhang Mingzhu
Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
Lou Zhichao
Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
Shen Le
Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
Li Hong
Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
Zhang Xiuhua
Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
Huang Yuguang
Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China