Naslov
Why anesthesiologists are afraid of tumors of anterior mediastinum

Autori
Špiček Macan, Jasna ; Hodoba, Nevenka ; Kolarić, Nevenka

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Toraks 2015. - 5. kongres Hrvatskoga torakalnog društva / - , 2015

Skup
Toraks 2015. - 5. kongres Hrvatskoga torakalnog društva

Mjesto i datum
Zagreb, Hrvatska, 24.04.2015. - 25.04.2015

Vrsta sudjelovanja
Plenarno

Vrsta recenzije
Domaća recenzija

Ključne riječi
mediastinum; tumor; anesteziološki postupak; paravertebralni blok
(mediastinum; tumor; paravertebral nerve block; ragional anesthesia; thoracic surgery)

Sažetak
Background and aims: Mediastinal tumors can cause life-threatening complications during general anesthesia (GA). Tumors in this region can compress and obstruct vital mediastinal structures: the tracheobronchial tree in the region of the tracheal carina, the heart, the main pulmonary artery and the superior vena cava. Most adult mediastinal tumors are asymptomatic or are associated with vague complaints such as chest pain or fullness, dyspnea, cough, sweats, superior vena cava obstruction hoarseness, syncope or dysphagia. Several studies have demonstrated that thoracic paravertebral nerve block (TPVB) is adequate for use as the sole anesthetic for various surgical procedures. The aim of this study was to determine the use of TPVB as the sole anesthetic for parasternal anterior mediastinostomy in 9 patients. Methods: After written informed consent, 9 patients ASA class IV with a large superior and middle anterior mediastinal tumor scheduled for anterior mediastinotomy and the biopsy. All patients were administered preoperatively 5 mg of oral diazepam. It was elected to use TPVB repeated at each dermatome level. All patients were in a sitting position, 8 ml of 2% lidocaine was administered subcutaneously. Using a 10-cm long 22-gauge Tuohy spinal needle and a loss of resistance technique, single punctures of the 4 paravertebral spaces from T2-T5 were performed. After aspiration, 5 ml of 0, 5% bupivacaine per segment was administered. Before starting the incision, 0, 05 mg of alfentanil and 1 mg of midazolam were administered intravenously. Results: In all patients onset of sensory loss occurred approximately 25 minutes after the injections. During the operations, the patients were awake, did not experience pain, and were hemodynamically stable and spontaneously breathing. Excellent analgesic effect was achieved. Conclusions: The use of a TPVB as the sole anesthetic for anterior mediastinotomy and the biopsy of anterior mediastinal mass resulted in adequate unilateral anesthesia. It was safe to use in high-risk patients in whom GA should have been avoided.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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