Abstract Anesthetic induction in patients with an anterior mediastinal mass is associated with a significant risk of life-threatening airway and cardiovascular compromise, particularly in the pediatric population. Loss of airway tone following induction of anesthesia and initiation of positive pressure ventilation may precipitate critical airway collapse. Therefore, preservation of spontaneous ventilation is widely recommended. We report the anesthetic management of an 11-year-old child with a large anterior mediastinal mass scheduled for chemoport insertion in nonoperating room setting. Contrast-enhanced computed tomography revealed a large anterior mediastinal mass measuring 8.6 cm × 5.7 cm × 10 cm, encasing and compressing the trachea, extending up to the suprasternal notch and infiltration into the anterior chest wall. Anesthetic management was further complicated by the pediatric age of the patient, significant tracheal compression, and limited airway access in a remote procedural location. Anesthesia was induced in the lateral position, avoiding neuromuscular blockade. The trachea was successfully intubated while maintaining spontaneous ventilation after achieving adequate depth with intravenous ketamine and sevoflurane-based inhalational anesthesia. The procedure was completed uneventfully with stable respiratory and hemodynamic parameters, and the postoperative course was uncomplicated. This case highlights the importance of individualized anesthetic planning, optimal positioning, and preservation of spontaneous ventilation for the safe management of pediatric patients with anterior mediastinal masses undergoing procedures outside the operating theater.
Choppa et al. (Mon,) studied this question.