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Anesthesia for Thoracic Surgery - Mediastinal Operations

Anesthesia for Thoracic Surgery - Mediastinal Operations is a topic covered in the Clinical Anesthesia Procedures.

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Mediastinoscopy is conducted to evaluate the extrapulmonary spread of pulmonary tumors and to investigate mediastinal masses. Mediastinoscopy is performed through an incision just superior to the manubrium. A rigid endoscope is then introduced beneath the sternum, and the anterior surfaces of the trachea and the hilum are examined. The patient is supine with the neck extended.

  1. Any general anesthetic technique may be used, provided the patient remains immobile. Although the procedure is not very painful, intermittent stimulation of the trachea, carina, and mainstem bronchi occurs.
  2. Complications include pneumothorax, rupture of the great vessels, and damage to the airways. Large-bore IV access is required, and the patient should have blood cross-matched in the case of hemorrhage. IV access should be placed in the right upper extremity as the left innominate vein may be compressed during mediastinoscopy. There is a risk of stroke from innominate artery occlusion by compression between the mediastinoscope and the posterior surface of the sternum. As stated previously, perfusion to the right arm should be monitored by pulse oximetry or blood pressure measurement. Blood pressure monitoring in the left arm is essential to monitor systemic blood pressure in the event of innominate arterial compression. Should innominate arterial compression occur and the surgeon be incapable of relieving the pressure (i.e., while managing hemorrhage through the mediastinoscope), the mean systemic pressure must be increased to encourage collateral flow to the right cerebral hemisphere. The trachea may be intermittently compressed by the mediastinoscope, and the position of the patient and surgeon increases the chance of accidental disconnection of the breathing circuit.

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Pino, Richard M., editor. "Anesthesia for Thoracic Surgery - Mediastinal Operations." Clinical Anesthesia Procedures, 9th ed., Wolters Kluwer, 2019. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/ClinicalAnesthesiaProcedures/728277/all/Anesthesia_for_Thoracic_Surgery___Mediastinal_Operations.
Anesthesia for Thoracic Surgery - Mediastinal Operations. In: Pino RM, ed. Clinical Anesthesia Procedures. 9th ed. Wolters Kluwer; 2019. https://anesth.unboundmedicine.com/anesthesia/view/ClinicalAnesthesiaProcedures/728277/all/Anesthesia_for_Thoracic_Surgery___Mediastinal_Operations. Accessed April 25, 2019.
Anesthesia for Thoracic Surgery - Mediastinal Operations. (2019). In Pino, R. M. (Ed.), Clinical Anesthesia Procedures. Available from https://anesth.unboundmedicine.com/anesthesia/view/ClinicalAnesthesiaProcedures/728277/all/Anesthesia_for_Thoracic_Surgery___Mediastinal_Operations
Anesthesia for Thoracic Surgery - Mediastinal Operations [Internet]. In: Pino RM, editors. Clinical Anesthesia Procedures. Wolters Kluwer; 2019. [cited 2019 April 25]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/ClinicalAnesthesiaProcedures/728277/all/Anesthesia_for_Thoracic_Surgery___Mediastinal_Operations.
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TY - ELEC T1 - Anesthesia for Thoracic Surgery - Mediastinal Operations ID - 728277 ED - Pino,Richard M, BT - Clinical Anesthesia Procedures UR - https://anesth.unboundmedicine.com/anesthesia/view/ClinicalAnesthesiaProcedures/728277/all/Anesthesia_for_Thoracic_Surgery___Mediastinal_Operations PB - Wolters Kluwer ET - 9 DB - Anesthesia Central DP - Unbound Medicine ER -