Anesthetic management of pediatric patients with large posterior mediastinal tumor – a systematic review and two case reports
Carlos Darcy A. Bersot, Heloísa Leal Pires, Lucas Ferreira Gomes Pereira, Rafael Mercante Linhares, Vitório Moscon Puntel, Vinicius Caldeira Quintão, Bruno José Martini Santos, Anna Carolina Fontoura Machado, Rodrigo Zillig Gac dos Santos, José Eduardo Guimarães Pereira,
Abstract
Anesthetic management of mediastinal masses in pediatric patients is challenging for the anesthesiologist. There is abundant literature available on anesthesia management of anterior mediastinal masses. Posterior masses traditionally have been suggested to carry a low risk of anesthetic implications. However, our patient with a posterior mediastinal mass experienced hemodynamic and respiratory collapse typically associated with anterior mediastinal masses. The objective of this review was to evaluate the anesthetic management of children submitted to posterior mediastinum tumor resection and the respective postoperative outcomes. A systematic review was performed following PRISMA guidelines. Electronic databases were searched using multiple combinations of keywords to identify all case reports of patients undergoing mediastinal mass operation. Information such as clinical characteristics, perioperative management and patients’ outcomes were abstracted and analyzed. Six case reports encompassing six patients aged from 2.5 months to 10 years old were included. Three of them were on the right side, located in the paravertebral space, and one of them presented intraspinal involvement. One had an esophagus mucocele, and the remaining two were on the left side, one presenting main left bronchus compression, and the other located in the paravertebral space. General anesthesia was used in all cases. Muscle relaxants were administered to all patients during anesthesia induction and controlled respiration was maintained for all of them. Only one case used succinylcholine as a muscle relaxant agent. The remaining five cases were all conducted using non-depolarizing agents. Extracorporeal circulation was not utilized in any of the cases. There were no patients experiencing cardiac arrest, or death during surgery, and all patients were discharged from the hospital. Perioperative management of patients undergoing mediastinal mass operations is challenging. It is imperative that a preoperative multidisciplinary discussion, well-planned anesthetic management, and pre-determined protocols for emergency situations are adequate to ensure patient safety.
Keywords
References
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Submitted date:
03/19/2024
Accepted date:
06/19/2024
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