Anesthetic Management of Patients With Anterior Mediastinal Masses Undergoing Chamberlain Procedure (Anterior Mediastinostomy)

Patients with mediastinal masses, particularly masses in the anterior or superior mediastinum present unique problems for the anesthesiologists which are during general anesthesia, which are usually the consequence of extrinsic compression of the airway, obstruction of the venous return or obstruction to the output of the heart (1-4). The aim of our study was to describe the anesthetic management of patients who underwent anterior mediastinostomy to biopsy masses or lymph nodes in the center of the chest (Chamberlain Procedure). 50 consecutive patients scheduled for Chamberlain Procedure were enrolled in the study. Patients with severe orthopnea, morbid obesity and concomitant asthma were excluded. Complications were classified as mild (abnormality noted but no significant change in practice required e.g. mild elevation in measured ETCo2), moderate (abnormality noted requiring change in practice or additional therapy e.g. moderate airway obstruction responding to change in patient position) or severe (abnormality requiring rapid intervention to avert potentially dangerous deterioration e.g. airway obstruction requiring intubation or passage of a rigid bronchoscope) (5). Anesthetic management: After 3 minutes of preoxygenation, in all patients, anesthesia was induced with midazolam (1-2mg), fentanyl ( 1-1.5μg/kg), propofol (1.5-2mg/ kg) and it was maintained with continuous infusion of propofol( 50μg/kg/min) and sufentanil (0.01 μg/kg/min). An appropriate size laryngeal mask airway (LMA) was inserted for all patients, and assisted mechanical ventilation was accomplished. Routine monitoring including ECG, pulse oximetry, NIBP, ETCo2 and monitoring of airway pressure were applied to all patients. The main anesthetic challenge of this procedure is intraoperative collapse of the tracheobronchial tree which may lead to severe hypoxia and even death. 10 Patients had no respiratory or cardiovascular problem before operation. Table 1 shows the respiratory symptoms and signs in 40 patients.