Mediastinoscopy
Considerations
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Limited access to airway
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Indication for procedure: lung cancer staging, biopsy of anterior mediastinal mass & associated patient comorbidities
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Surgical approach: cervical vs anterior (Chamberlain)
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Potentially life threatening complications: hemorrhage, pneumothorax, airway disruption, stroke
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Monitoring: perfusion monitoring of right arm, consider lower extremity IV, BP monitoring left arm (avoid fictitious BP)
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Need for quiet surgical field & airway control
Goals
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Optimize surgical conditions: deep anesthesia, paralysis
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Safe care of anterior mediastinal mass
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Preparation for transfusion: large bore IV, cross match, consider lower extremity IV
Conflicts
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Deep anesthesia +/- paralysis vs anterior mediastinal mass
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Cerebrovascular disease & innominate compression
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Contraindications:
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Previous mediastinoscopy or surgery in anterior mediastinum
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Relative: SVC syndrome, tracheal deviation, thoracic aortic aneurysm, radiation
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Complications
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Hemorrhage (aorta, superior vena cava, pulmonary artery ) → may need urgent/emergent thoracotomy
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Innominate artery compression → stroke
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Recurrent laryngeal nerve injury
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Phrenic nerve injury
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Tracheal injury
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Pneumothorax, pneumomediastinum
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Chylothorax
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Esophageal injury
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Venous air embolism
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Bradycardia, arrhythmias