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19 Cards in this Set
- Front
- Back
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What physiologic effects can mediastinal masses have on the body?
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-compress vital structures
-cause changes in C.O., obstruction to airflow, atelectasis, or central nervous system changes |
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What are the "4 Ts" of Mediastinal Masses?
(common masses) |
-Thymomas
-Thyroid -Teratoma -"Terrible" lymphoma |
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Tumors located where; can cause compression of the trachea or bronchi, increasing resistance to airflow
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anterior mediastinum
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What things (CRNA controlled/external factors) can cause changes to airway dynamics in a pt with a mediastinal mass causing collapse of the airway with total obstruction to flow?
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-supine positioning
-induction of anesthesia -PPV |
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Is it a guarantee that a person can be mechanically ventilated when the have a mediastinal mass?
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NO: if the mass encroaches on the airway distal to the endotracheal tube
(CT or bronch may be used to place tube below mass) |
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What is the primary goal for a pt presenting with mediastinal mass
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maintaining spontaneous ventilation
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What are common symptoms of Mediastinal Mass
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-sweats
-syncope -orthopnea -hoarseness -inability to lie flat -chest pain or fullness -superior vena cava obst -cough (especially when supine)**symptoms may be worse in the supine position* |
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What test can be done to delineate the size and effects of masses
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CT, TEE, MRI
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What PFTs can alert the provider to increased risk of obst. perioperatively
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decreased maximal insp or exp flow rates
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What type of anesthesia should be used during the surgery for the biopsy of masses if there is any sign of respiratory obstruction
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local anesthesia whenever possible
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What type of Rx is suggested before surgery to reduce the risk of airway obstruction
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Radiation to decrease mass bulk in radiosensitive tumors
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What is the first choice for intubation and why?
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awake fiberoptic
b/c it enables the provider to evaluate the lg airways for obstruction and to place the tube beyond the obstruction while maintaining spont ventilation |
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What are emergency strategies that may become necessary in the case of airway compromise
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-repositioning
-awakening the pt -rigid bronchoscopy -sternotomy with manual decompression of the mass off the airway in the case of life threating compromise |
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Mediastinal masses can cause compression of great vessels or cardiac chambers.
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..
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Compression of which artery is rare; however, can lead to sudden hypoxemia, hypotension, or cardiac arrest
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pulmonary artery is rare
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What are the 3 goals in treating someone with cardiac or great vessel involvement
*If GA is required, what should be done prior to surgery? |
-local only (whenever possible)
-remain in sitting position -maintain spont ventilation Placement of femoral ports for emergent ECMO |
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Venous engorgement of the upper body caused by compression of the superior vena cava by a mass
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superior vena cava syndrome
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Superior vena cava syndrome leads to the following S/S
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dilation of collateral veins of the upper part of the thorax and neck
-edema and rubor of the face, neck, and upper torso and airway -edema of the conjunctiva -shortness of breath -headaches -visual distortion -altered mentation |
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Where should you place your IV lines in someone who has superior vena cava syndrome
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lower extremities b/c insertion in sites above the SVC could delay the drug effect as a result of slow distribution
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