ANESTHESIA FOR MEDIASTINOSCOPY PDF

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PDF | On Feb 1, , Anjum Ahmed-Nusrath and others published Anaesthesia for mediastinoscopy. What the Anesthesiologist Should Know before the Operative Procedure The most common diseases diagnosed by mediastinoscopy include lung cancer and . Anaesthesia. Jan;34(1) Anaesthesia for mediastinoscopy. Fassoulaki A. PMID: ; [Indexed for MEDLINE]. Publication Types: Letter.

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Routine mediastinoscopy can be a fairly low-risk procedure; however, the close proximity to vital cardiovascular structures in the chest may lead to unexpected dilemmas. Ischemic cerebrovascular accidents CVAs can occur during mediastinoscopy, and predominantly in the right hemisphere. This is secondary to prolonged compression of the innominate artery caused by the mediastinoscope, precipitating malperfusion to the head.

This case report discusses a patient who, while undergoing mediastinoscopy, experienced a precipitous drop in blood pressure as evidenced by a dampened arterial waveform that was readily diagnosed as a mechanical obstruction of flow caused by the mediastinoscope. The surgeon was notified immediately and the scope repositioned, relieving pressure of the right-sided vessel and restoring appropriate flow to the right upper extremity and right cerebral hemisphere.

At our institution, it is standard practice to place all invasive arterial monitors in the right upper extremity as opposed to the left, since a right-sided monitor will more readily capture a mechanical compression of the innominate artery by the mediastinoscope.

considerations | Mediastinoscopy Considerations

Although rare during routine mediastinoscopy, CVAs can occur in patients who are not adequately monitored. When cerebral ischemia occurs intraoperatively, it is generally located in the right hemisphere and likely secondary to innominate artery compression caused by mechanical compression of the mediastinoscope.

The head vessels off mediastinodcopy aortic arch can vary anatomically, but the largest percentage of the population has 3 main vessels: Presented here is a case of a patient who while undergoing mediastinoscopy experienced a sudden drop in perfusion pressure detected on a right-sided invasive arterial line, which prompted the anesthesiologist to alert the surgeon to reposition the scope. Mediastinoacopy note, an arterial line was crucial in this speedy diagnosis, but the laterality of the invasive monitor—right-sided—proved decisive.

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The patient was scheduled for bronchoscopy, cervical mediastinoscopy, and lymph node biopsy mdeiastinoscopy general anesthesia. Intraoperatively, a right radial arterial catheter was placed for hemodynamic monitoring after the induction of general anesthesia and endotracheal intubation using standard American Society of Anesthesiologists monitors.

In particular, the pulse oximeter probe was placed on the left hand for oxygenation and hemodynamic flr.

Anaesthesia for mediastinoscopy.

During surgical biopsy of the lymph nodes, the patient developed acute arterial hypotension with no airway pressure changes or mediastinosocpy.

What is the diagnosis? The acute arterial hypotension, in the right radial artery, was concerning for compression of the innominate artery by the mediastinoscope due to anestyesia of the arterial waveform. Immediate repositioning of the mediastinoscope resulted in a rapid correction of the hypotension without the need for vasopressor therapy.

A CVA is a rare but devastating complication that may occur in patients undergoing cervical mediastinoscopy. To prevent this potentially fatal complication, adequate perfusion of the right cerebral hemisphere should be monitored with a right-sided arterial catheter.

Although a pulse oximeter may be useful for monitoring, anestheska fails to provide direct monitoring of innominate arterial pressure compared with a right radial arterial catheter, as described above. Hence, a right radial arterial catheter may be the best monitor for the timely detection of innominate artery compression, especially in older patients with atherosclerosis and possible poor circle of Willis collateral circulation.

Some may argue that a pulse oximeter on the right hand can achieve the same goal of detecting malperfusion, as a poorly perfused hand due to innominate artery compression can cause a decreased pulse oximeter reading. The benefit mediastinoscopj an arterial line over a pulse oximeter is the speed with which a clinician can view the dampened hemodynamic tracing of an arterial line and promptly diagnose an innominate artery compression; by contrast, a dampened pulse oximeter may not present mddiastinoscopy prolonged malperfusion has occurred.

To that point, the differential diagnosis of a dampened or poorly transduced pulse oximeter signal during mediastinoscopy is far more extensive than the sudden precipitous dampening of a right-sided arterial line, thus giving anesthesiologists the advantage of narrowing their differential diagnosis dramatically.

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This report clearly demonstrates the benefits of right-sided perfusion monitoring during cervical mediastinoscopy, including the rapid diagnosis of mechanical compression of the innominate artery and the potential reduction in CVA risk.

Rami-Porta R, Call S. Invasive staging of mediastinal lymph nodes: Cerebrovascular accident complicating extended cervical mediastinoscopy.

You must be logged in to post a comment. They have been very pro-active in meeting the increase volumes allowing us to keep our surgeons and patients very satisfied with our services. The prior management company was having a cancelled surgery per day.

I am happy to report there has not been one since they have taken over the department. Additionally we have seen a reduction if requested preop lab tests. The anesthesia department is now the very best hospital department in our entire facility. They have become a more valuable part of our facility and community.

They are available by phone whenever needed and will be on site for any need or request mediastjnoscopy has been on site to address issues before we can make the request. Our surgical volume has grown over cases per month and now our GI docs want to perform all of their endoscopies in our hospital instead of their GI lab that they own!

Anesthesia Experts swept in and brought order to our mess and our department was quickly redirected.

Mediastinoscopy: vascular compression

Introduction Although rare during routine mediastinoscopy, CVAs can occur in patients who are not adequately monitored. Discussion A CVA is a rare but devastating complication that may occur in patients undergoing cervical mediastinoscopy.

Conclusion This report clearly demonstrates the benefits of right-sided perfusion monitoring during cervical anexthesia, including the rapid diagnosis of mechanical compression of the innominate artery and the potential reduction in CVA risk. Leave a Reply Cancel reply You must be logged in to post a comment. What people thought about us.