Mediastinoscopy. Nadeen mohamed mamdouh Habib. Objectives. Indications . The nature of the procedure. Important anesthetic management principles . Anesthetic technique. Complications. Indications.
Nadeen mohamed mamdouh Habib
Mediastinoscopy is commonly performed before thoracotomy to establish the diagnosis or to determine the resectability of lung carcinoma.
A tunnel is created by blunt dissection along the anterior and lateral walls of the trachea into the mediastinum down to the subcarinal area, for direct inspection and biopsy of superior mediastinal lymph nodes.
Relative contraindication to mediastinoscopy include:Superior vena cava syndrome Severe tracheal deviation Cerebrovascular disease Thoracic aortic aneurysm
Anesthetic technique:General anesthesia with muscle relaxation and positive pressure ventilation (facilitates dissection and management of complications, minimizes air embolism)
(This phenomenon of special significance in payients with preexisting compromised cerebral circulation)
Sudden changes in the pulse or the blood pressure during mediastinoscopy, may empirically be treated by repositioning of the mediastinoscope.
Atropine is given for persistent bradycardia.
However patients should be monitored for signs of intraoperative pneumothorax:
That requires immediate decompression