Local anesthesia for mediastinoscopy: experience with 450 consecutive cases.

Mediastinoscopy has been widely applied in the evaluation of patients with suspected bronchogenic carcinoma over the past decade. Though there remain those who feel that such findings should not play a significant role in determining resectability, we have found a number of patients who have been saved from exploratory thoracotomy in obviously incurable situations. We have had a relatively high degree of success in the diagnosis of benign diseases. Wtih no mortality and a morbidity of 1.1%, we feel that mediastinoscopy under local anesthesia is applicable in many clinical circumstances in which the requirement for general anesthesia would preclude such evaluation. Though it is not necessary that local anesthesia be exclusively applied, we feel that our experience with over 450 cases in the last six years has demonstrated safety and efficacy in universal application of local anesthesia for cervical mediastinal exploration.