Cardiovascular and airway consideration in pediatric thoracic anterior mediastinal mass

Mediastinal tumors are common neoplasms among the pediatric population. The symptoms may be due to the direct compression effects on the surrounding structures or “B” like symptoms of specific lymphomas or due to paraneoplastic syndrome. The cardiovascular and respiratory consequences of the compression effects along with the unique physiological nature of the pediatric airway place the anesthesiologist in a difficult situation and face a new situation called “can intubate-cannot ventilate.” This clinical scenario is not rare, with physicians commonly being confronted with similar situations in patients with severe bronchospasm. This entity has not been incorporated in any of the difficult airway algorithms. But the mediastinal tumors differ from bronchospasm because they cause physical external compression of the airway. This review will bring the readers the common anterior mediastinal tumors in pediatrics, the physiological differences in the pediatric airway in relation to the compression effects of the mediastinal tumors, and the management aspects of the different surgical aspects of the tumor.