Saffarzadeh Areo, Popescu Wanda M, Detterbeck Frank C, Li Andrew X, Blasberg Justin D
Division of Thoracic Surgery, Department of Surgery, Providence Mission Hospital, Mission Viejo, California.
Thoracic Anesthesia, Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut.
Ann Thorac Surg. 2025 May;119(5):967-979. doi: 10.1016/j.athoracsur.2024.09.011. Epub 2024 Sep 21.
Anesthesia administered to a patient with a large mediastinal mass engenders concern that it may precipitate catastrophic acute hemodynamic or respiratory decompensation. A review of the available evidence is needed to define the degree of risk, mechanisms, and preventative or reactive interventions to mitigate the risk.
A systematic review of the PubMed database was conducted of studies involving adults with large mediastinal masses undergoing a procedure or anesthesia; all types of publications were included that provided data regarding risks, mechanisms, or techniques to address potential decompensation. This literature involves primarily case reports and small retrospective series; no quality assessment was deemed appropriate. Evidence was synthesized according to the consensus judgment of the writing panel.
Categories of low-, moderate-, high-, and very-high-risk emerged from review of the 72 included studies, based on the degree of symptoms, mass/chest ratio, and degree of airway and/or vascular compression. This streamlines the preparation needed-minimal for low-risk and more extensive for higher-risk. Assessment of the impact of physiologic derangement stemming from the anatomic compression in individual patients provides a framework for anesthetic management, and back-up plans should decompensation occur.
Despite limitations in the evidence inherent to a topic involving an uncommon but serious event, a framework was developed to streamline preparation for and management of patients with a large mediastinal mass requiring anesthesia in a rational manner.
给患有大纵隔肿块的患者实施麻醉时，人们担心这可能会引发灾难性的急性血流动力学或呼吸功能失代偿。需要对现有证据进行综述，以确定风险程度、机制以及减轻风险的预防或应对措施。
对PubMed数据库进行系统综述，纳入涉及患有大纵隔肿块的成人接受手术或麻醉的研究；纳入所有提供有关风险、机制或应对潜在失代偿技术数据的各类出版物。这些文献主要包括病例报告和小型回顾性系列研究；未进行质量评估。证据根据撰写小组的共识判断进行综合。
根据症状程度、肿块/胸部比例以及气道和/或血管受压程度，对纳入的72项研究进行综述后，出现了低、中、高和极高风险类别。这简化了所需的准备工作——低风险患者所需最少，高风险患者则需要更全面的准备。评估个体患者因解剖压迫导致的生理紊乱影响，为麻醉管理提供了框架，并且应制定在发生失代偿时的备用方案。
尽管涉及这一罕见但严重事件的主题证据存在局限性，但仍制定了一个框架，以合理简化对需要麻醉的大纵隔肿块患者的准备和管理。
