Mediastinoscopy 

 

 

Considerations

 

  • Limited access to airway

  • Indication for procedure: lung cancer staging, biopsy of anterior mediastinal mass & associated patient comorbidities

  • Surgical approach: cervical vs anterior (Chamberlain)

  • Potentially life threatening complications: hemorrhage, pneumothorax, airway disruption, stroke

  • Monitoring: perfusion monitoring of right arm, consider lower extremity IV, BP monitoring left arm (avoid fictitious BP)

  • Need for quiet surgical field & airway control

 

 

Goals

 

  • Optimize surgical conditions: deep anesthesia, paralysis

  • Safe care of anterior mediastinal mass

  • Preparation for transfusion: large bore IV, cross match, consider lower extremity IV 

 

 

Conflicts

 

  • Deep anesthesia +/- paralysis vs anterior mediastinal mass

  • Cerebrovascular disease & innominate compression

  • Contraindications:

    • Previous mediastinoscopy or surgery in anterior mediastinum

    • Relative: SVC syndrome, tracheal deviation, thoracic aortic aneurysm, radiation

 

 

Complications

 

  • Hemorrhage (aorta, superior vena cava, pulmonary artery ) → may need urgent/emergent thoracotomy

  • Innominate artery compression  stroke

  • Recurrent laryngeal nerve injury

  • Phrenic nerve injury

  • Tracheal injury

  • Pneumothorax, pneumomediastinum

  • Chylothorax

  • Esophageal injury

  • Venous air embolism

  • Bradycardia, arrhythmias

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