Anterior Mediastinal Mass for Mediastinoscopy and Proceed

A patient with mediastinal mass is a challenging case for an anesthesiologist due to the risk of major airway and cardiovascular compression under general anesthesia. The key to successful management is a detailed preoperative assessment with special attention to the relation of the mediastinal mass with the airway and cardiovascular structures, meticulous planning for the conduct of anesthesia after discussion with the surgeon, and preparation for possible perioperative complications. A plan that is reversible including the use of awake fiberoptic intubation and maintenance of spontaneous ventilation can be helpful to avoid any untoward complication in a patient at high risk of airway compression. Patients with symptoms or with significant changes in the CT scan predicting airway compression are at high risk. Immediate availability of emergency equipment like rigid bronchoscope and cardiopulmonary bypass may be required in the most difficult cases.