Anesthesia in children with anterior mediastinal masses: Аnesthetic algorithm and perioperative considerations

Introduction. Mediastinal masses in children encompass a broad spectrum of histopathological and radiological entities. Anatomy and Physiology. The mediastinum is traditionally divided into three compartments, without discrete anatomical barriers between them, allowing lesions to extend across compartments. Physiological compromise results primarily from compression of the airway, heart, or major vessels. Signs and Symptoms. Clinical presentation varies widely depending on the size, location, and growth rate of the mass. Preoperative Testing. Preoperative evaluation typically includes radiography, contrast-enhanced computed tomography, pulmonary function testing, and transthoracic echocardiography. Anesthetic Management and Procedure Location. Operative procedures should be performed in an operating room. In extremely high-risk cases, extracorporeal bypass may be considered. Monitoring and Vascular Access. Large-bore intravenous access should be secured. Arterial monitoring may be required for continuous hemodynamic assessment. Anesthetic Technique. Anesthetic techniques include local, regional and general anesthesia. In many cases, general anesthesia is unavoidable. Inhalational induction with sevoflurane is commonly employed in pediatric patients. Management of Intraoperative Complications. In the event of impaired ventilation, management strategies include increasing inspired oxygen concentration, applying continuous positive airway pressure, and advancing the endotracheal tube distal to the site of obstruction. In cases of cardiovascular collapse, immediate interventions include rapid intravenous fluid administration and reduction of anesthetic depth. Postoperative care. Early communication with the intensive care unit is recommended when complications are anticipated. Extubation should be performed only when the child is fully awake. Conclusion. Comprehensive preoperative evaluation is essential to assess cardiopulmonary compromise and ensure safe anesthetic management in children undergoing diagnostic or surgical procedures.