Comment contrôler les voies aériennes en présence de masses cervicomédiastinales ?

In patients with a cervical-mediastinal mass scheduled for surgery, there is a risk of airway obstruction especially on anaesthetic induction. The preoperative assessment seeks for symptoms of compression (dyspnea, coughing) related to patients' position. CT-scan is the cornerstone investigation, because it documents the cervical or thoracic localisation of the mass, and the extent of the compression including or not the carena and main bronchial trunks. A multidisciplinary evaluation is required to determine the opportunity of a presurgical treatment and to decide the most appropriate airway management for airway control after anaesthetic induction. The potentially difficult airway access and the risk of cardiovascular collapse caused by vascular compression should be considered. Induction of general anaesthesia has to be performed in the patients' most comfortable position (sitting, beach-chair). It is wise to have a venous access into the inferior vena cava network and to use a continuous monitoring of arterial pressure. The administration of anaesthetic agents should be titrated, the use of muscle relaxant should be prohibited, and whenever possible, spontaneous breathing should be maintained. Despite their low level of evidence, these recommendations should contribute to a decrease in the complications of this high-risk procedure.