Chapter 10 - Anesthesia for mediastinoscopy and mediastinal surgery

Summary

The prognosis for patients with mediastinal pathology has improved significantly in recent years as a result of better understanding of the impact of chemotherapy and radiotherapy on malignant mediastinal tumors. The signs and symptoms of mediastinal pathology range from trivial to life-threatening, and include airway compression, superior vena cava syndrome, compression of the right heart and pulmonary arteries, and dysphagia from esophageal compression. The surgical approach for diagnostic procedures of mediastinal surgery is via cervical mediastinoscopy or anterior mediastinotomy, while for tumor resection the usual approaches are via median sternotomy or lateral thoracotomy. Careful evaluation of the airway is necessary during pre-operative assessment for surgery within the mediastinum. Myasthenia gravis is commonly associated with other autoimmune disorders. In severe myasthenia, neuromuscular blocking drugs may be avoided completely, as the muscle-relaxing effect of volatile anesthetics is enhanced.