///2015 Abstract Details
2015 Abstract Details2019-08-02T16:54:43-06:00

Anesthetic management of a patient with symptomatic anterior mediastinal mass presenting for cesarean delivery

Abstract Number: T-20
Abstract Type: Case Report/Case Series

Diana Feinstein DO1 ; Sumita Bhambhani MD2; Dimitrios Mastrogiannis MD, PhD, MBA, FACOG3; Yoshiya Toyoda MD, PhD4; Morewood Gordon MD, MBA, FACE5; Ihab Kamel MD6

A 25-year-old 33 weeks pregnant Hispanic female was admitted to the ICU with worsening shortness of breath, cough, wheezing and 3 pillow orthopnea. The patient had history of recently diagnosed anterior mediastinal mass with significant compression of distal trachea. CT scan showed anterior mediastinal mass (13 cm x 17 cm x 19 cm) with extension into the chest wall, SVC compression, tracheal deviation, tracheal compression to a diameter of 5mm at carina, and severe narrowing of RUL bronchus. The patient was started on heliox 70/30, and BIPAP. An interdisciplinary team discussion between OB-GYN, Anesthesia, pulmonary medicine, and cardiothoracic surgery took place, and the decision was made to immediately proceed with elective cesarean delivery to allow for continued care and treatment of the mother. The procedure was performed in the cardiac surgery operating room. Lumbar epidural catheter was placed in the sitting position and tested for functionality using a low dose bolus. Arterial and venous femoral lines were placed by the cardiac surgeon after placement of the epidural catheter. Perfusion team, ECMO circuit and the cardiac surgeon were on standby for immediate intervention in the event of cardiovascular or respiratory collapse. Epidural anesthesia was slowly administered via lumbar catheter with incremental doses of local anesthetic while maintaining spontaneous ventilation with BIPAP and heliox. After achieving adequate anesthetic level, the procedure commenced as planned. As the patient could not lie flat, she was maintained in 30 degrees head up position throughout the procedure. Femoral lines were removed in the operating room after the procedure. The patient had an uneventful cesarean delivery and started the work up and treatment of the mediastinal mass shortly after delivery.

SOAP 2015