Anesthésie pour médiastinoscopie chez les patients ayant une masse médiastinale

The anterior mediastinum is a space were tumors may develop and may induce and or intrathoracic vessels compression. Anaesthetist should be prepared to the occurrence of complications during mediastinoscopy in as much as anaesthesia can affect the degree of compression and could lead to life threatening complications. A preoperative evaluation of airways obstruction has to be performed before anaesthesia, based on clinical symptoms, upright and supine flow-volume loops and pulmonary function tests, chest radiograph and CT-scan. When mediastinal mass causes compression, patients should be intubated awake and in spontaneous ventilation, with a fibre optic bronchoscope to ensure a correct placement of the endotracheal tube. As haemorrhage may occur, a large intravenous cannula must be inserted, occasionally in a lower limb vein, in patients with superior vena cava obstruction. Thymoma, myasthenia gravis or myasthenia-like syndrome, prevent from administration of muscle relaxants. As a cardiovascular collapse may also occur when there is a great vessel compression, a preventive volume loading should be performed before anaesthetic induction. In some patients, extracorporeal femoral bypass could be necessary.