Mediastinal mass resection: Femorofemoral cardiopulmonary bypass before induction of anesthesia in the management of airway obstruction

Abstract

TOTAL OCCLUSION OF THE AIRWAY leading to fatal cardiopulmonary arrest is a well-known complication of mediastinal tumors. 1 Northrip DR Bohman BK Tsueda K Total airway occlusion and superior vena cava syndrome in a child with an anterior mediastinal tumor. Anesth Analg. 1986; 65: 1079-1082 Crossref PubMed Scopus (69) Google Scholar , 2 Neuman GG Weingarten AE Abramowitz RM et al. The anesthetic management of the patient with an anterior mediastinal mass. Anesthesiology. 1984; 60: 144-147 Crossref PubMed Scopus (198) Google Scholar The airway occlusion can occur during induction of anesthesia, extubation, surgical resection, or simply by a change of posture. The maintenance of the airway is a challenge to the anesthesiologist, particularly if the obstruction is at the lower tracheal level. In an extreme situation, femorofemoral cardiopulmonary bypass (CPB) can be kept ready before induction of anesthesia so that oxygenation can be maintained by initiation of CPB, if irreversible airway obstruction occurs. A patient with an anterior mediastinal mass and a superior vena cava syndrome in whom femorofemoral CPB was kept on standby before induction of anesthesia is described. The principles of airway management in patients with mediastinal masses are reviewed.