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Anesthetic Management of a Parturient with Hodgkin’s Lymphoma resulting in a Large Anterior Mediastinal Mass: A Case Report
Abstract Number: RF1AA-45
Abstract Type: Case Report Case Series
Anterior mediastinal masses present many challenges to anesthesiologists. Respiratory and hemodynamic collapse upon induction represents two of the most critical situations we encounter during the care of these patients. We present a woman, at 36 weeks gestation, with new onset cough, shortness of breath, stridor, and palpitations. Upon workup a large anterior mediastinal mass (12 x 15cm), which compressed her bilateral bronchi, superior vena cava (SVC), and aortic arch was found. She was diagnosed by biopsy with Hodgkin's Lymphoma.
A multi-disciplinary discussion occurred and ultimately, the decision was made to proceed with cesarean delivery in order to expedite chemotherapy and radiation. Because of concern for total cardiovascular collapse if general anesthesia became necessary for cesarean section, prophylactic venous-arterial extracorporeal membrane oxygenation (VA-ECMO) catheters were placed by the Cardio-thoracic team.
A slowly dosed dural- puncture epidural was the anesthetic of choice for her cesarean section in order to allow for gradual loss of sensation with maintained hemodynamic stability. The intra-operative course was mostly uneventful aside from profound hypotension (60/40) which occurred with fundal pressure while trying to extract the fetus. The post-operative course was uncomplicated and on post-operative day one the ECMO catheters were removed. The patient received chemotherapy on post-operative day four and was discharged from the hospital on post-operative day 5.
This case highlights the challenges associated with anterior mediastinal masses in parturients and the importance of multi-disciplinary management of complex patients.
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