Perioperative anesthetic management of patients undergoing resection of huge mediastinal mass and recommendations for enhanced recovery after surgery protocol pathway
10.3760/cma.j.issn.0254-1416.2017.09.003
- VernacularTitle:巨大纵隔肿瘤切除术患者围术期麻醉管理与ERAS建议流程
- Author:
Mingzhu ZHANG
1
,
2
;
中国医学科学院肿瘤医院麻醉科
;
Zhichao LOU
;
Le SHEN
;
Hong LI
;
Xiuhua ZHANG
;
Yuguang HUANG
Author Information
1. 100730 中国医学科学院 北京协和医学院 北京协和医院麻醉科
2. 中国医学科学院肿瘤医院麻醉科
- Keywords:
Mediastinal masses;
Perioperative managements;
ERAS
- From:
Chinese Journal of Anesthesiology
2017;37(9):1037-1042
- CountryChina
- Language:Chinese
-
Abstract:
Objective The mediastinal mass usually posed higher risk of anesthesia and surgery due to its especial anatomical position,and this study aimed to analyze the perioperative anesthetic management of 3 patients undergoing resection of huge mediastinal mass,to identify the potential risks for this type of surgery and to summarize the corresponding perioperative anesthetic management protocol.Methods Three cases recently underwent resection of huge mediastinal mass in our hospital were reviewed.Their preoperative assessment and preparation,intraoperative anesthetic management,postoperative pain management and special interventions needed in the perioperative period were summarized and analyzed retrospectively.The enhanced recovery after surgery (ERAS) protocol was established for this type of surgery based on the analysis mentioned above,evidence reported at home and abroad and currently available ERAS protocols for other surgeries.Results Pleural malignant solitary fibrous tumor,thymus squamous cell carcinoma and malignant mixed germ cell tumor were the three mediastinal masses.The preoperative assessment focused on the impact of tumor on other vital organs within the mediastinum;anesthesiologists focused on massive hemorrhage and severe complications such as cardiac insufficiency and respiratory insufficiency;all the three patients were sent to the intensive care unit after surgery for further treatment,successfully recovered and were discharged;improving postoperative analgesia was helpful for recovery after resection of huge mediastinal mass.Conclusion Perioperative anesthetic management of patients undergoing resection of huge mediastinal mass is related to high risk,and establishing specific ERAS protocol is helpful in reducing complications and in promoting recovery after surgery based on the currently available evidence and characteristics of this type of surgery.
