Case ReportAnesthetizing a child for a large compressive mediastinal mass with distraction techniques and music therapies as the sole agents

- Thorough assessment of feasibility through discussion with the family, child, and medical team.
- Extensive communication and planning with the entire perioperative team are paramount to success.
- Topical local anesthetic cream should be applied 45 minutes prior to procedure for maximal benefit.
- Distraction techniques with audiovisual aids to increase engagement.
- Utilization of child life and behavioral health support when possible.

Anesthetic management of the child with an anterior mediastinal mass is challenging. The surgical/procedural goal typically is to obtain a definitive tissue diagnosis to guide treatment; the safest approach to anesthesia is often one that alters cardiorespiratory physiology the least. In severe cases, this may translate to little or no systemic sedatives/analgesics. Distraction techniques, designed to shift attention away from procedure-related pain (such as counting, listening to music, non-procedure-related talk), may be of great benefit, allowing for avoidance of pharmaceuticals. In this report, we present an approach in children where the anesthetic risk is deemed excessive.