Tan Jie-Chao, Lin Pei-Shuang, He Li-Xian, Lin Yong, Yao Yun-Tai
Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Anesthesiology, Shunde Hospital of South Medical University, Foshan, China.
Front Surg. 2022 Oct 28;9:1033349. doi: 10.3389/fsurg.2022.1033349. eCollection 2022.
To summarize the anesthetic management of patients undergoing mediastinal mass operation.
Electronic databases were searched 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.
Seventy-seven case reports with 85 patients aging from 34 days to 81 years were included. Mediastinal masses were located in anterior ( = 48), superior ( = 15), middle ( = 9) and posterior ( = 9) mediastinum, respectively. Clinical manifestations included dyspnea ( = 45), cough ( = 29), chest or radiating pain ( = 12), swelling ( = 8), fever ( = 7) and chest distress ( = 4). Most patients ( = 75) had signs of compression or invasion of vital structures. General anesthesia ( = 76) was the most commonly used method of anesthesia. Muscle relaxants were administered in 35 patients during anesthesia induction and spontaneous respiration was maintained in 37 patients. Mediastinal mass syndrome (MMS) occurred in 39 cases. Extracorporeal circulation was utilized in 20 patients intraoperatively. Three patients experienced cardiac arrest after ventilation failure and two patients died intraoperatively and one postoperatively.
Peri-operative management of patients undergoing mediastinal mass operation could be challenging. Pre-operative multi-disciplinary discussion, well-planned anesthetic management and pre-determined protocols for emergency situations are all vital to patient safety.
总结纵隔肿物手术患者的麻醉管理。
检索电子数据库以识别所有纵隔肿物手术患者的病例报告。提取并分析临床特征、围手术期管理及患者结局等信息。
纳入77篇病例报告，共85例患者，年龄从34天至81岁。纵隔肿物分别位于前纵隔（48例）、上纵隔（15例）、中纵隔（9例）和后纵隔（9例）。临床表现包括呼吸困难（45例）、咳嗽（29例）、胸痛或放射性疼痛（12例）、肿胀（8例）、发热（7例）和胸闷（4例）。大多数患者（75例）有重要结构受压或侵犯的体征。全身麻醉（76例）是最常用的麻醉方法。35例患者在麻醉诱导时使用了肌肉松弛剂，37例患者维持自主呼吸。39例发生纵隔肿物综合征（MMS）。20例患者术中使用了体外循环。3例患者在通气衰竭后发生心脏骤停，2例患者术中死亡，1例患者术后死亡。
纵隔肿物手术患者的围手术期管理具有挑战性。术前多学科讨论、精心规划的麻醉管理以及针对紧急情况的预定方案对患者安全至关重要。
