ASSESSING THE RISK OF COMPLICATIONS DURING INDUCTION IN THE PATIENTS WITH LARGE MEDIASTINAL MASS

Abstract

Anesthetic management of surgery in patients with large mediastinal mass remains a topical issue of thoracic anesthesiology, since such patients often develop superior mediastinal compression (SMC) which results in a high risk of hemodynamic and respiratory disorders during induction. The degree of compression does not always depend on the mass size, and the prediction of SMC progression during induction becomes a challenge.The method to evaluate the degree of mediastinal compression through the functional orthoclinostatic test was developed – the patient is to be placed in Fowler position for 45 degrees in order to follow changes in the cardiac index.It was found out that the patients with SMC detected during the test (increased cardiac index in Fowler position) had their arterial blood pressure reduced after induction, and the number of critical incidents was statistically significantly higher. The test proved to be a non-invasive and safe method of pre-operative prediction of the risk of SMC development and progression during induction.

Keywords

• mediastinal mass
• anesthesia
• functional tests
• cardiac index