Postoperative Chylothorax Successfully Treated Using Conservative Strategies (original) (raw)

Intraoperative life threatening airway obstruction in a patient with mediastinal mass

Patients with a mediastinal mass are at risk of life threatening complications in peri-operative period. Compression of the heart and great vessels and collapse or occlusion of the trachea and main bronchi are well known cardiorespiratory complications in these patients. The anaesthetic management of a patient with a massive mediastinal mass that resulted in intrathoracic airway obstruction during induction of general anaesthesia is discussed. The role of pre-anaesthetic evaluation and computed tomography imaging criteria as predictors of airway collapse is described.

Anesthetic Management of a Patient with Central Airway Compression Due to Posterior Mediastinal Mass

Acta clinica Croatica, 2016

Patients with mediastinal masses present unique challenge to anesthesiologists. Patients with anterior mediastinal masses have well documented cases of respiratory or cardiovascular collapse during anesthesia and in postoperative period. Masses in the posterior mediastinum have been traditionally regarded to carry a significantly lower risk of anesthesia related complications but cases of near fatal cardiorespiratory complications have been reported. We describe anesthetic management of a patient with posterior mediastinal mass compressing the trachea and the left main bronchus presented for left thoracotomy and tumor excision. The patient experienced pain and cough, and exhibited positional dyspnea. Airway was successfully secured with awake nasotracheal intubation and placement of single lumen endobronchial tube.

Anesthesia for Patients with a Mediastinal Mass

Anesthesiology Clinics of North America, 2001

Anesthesia for biopsy or excision of mediastinal masses is associated with a high risk for severe airway obstruction, hemodynamic compromise, and death. Extrinsic compression of the trachea or mainstem bronchi, occurring usually with anterior mediastinal masses, causes significant airway obstruction and is a cause of death or morbidity with induction of or emergence from anesthesia. Although anesthesiologists are aware of the risks for airway compression, little emphasis is placed on the frequency and morbidity of cardiovascular impairment caused by anterior and visceral mediastinal masses. HISTORY Milton performed the earliest reported successful operation on the mediastinum in 1897 while he was the principal medical officer at Kasr El Aini Hospital, Egypt.41, 6o After initial successful median sternotomies on cadavers, then on a goat, he performed the first operative human median sternotomy. Under chloroform anesthesia, he removed infiltrating tuberculosis of the sternum and substernal nodes from a local farmer. The patient breathed spontaneously throughout, and Milton wrote "Should any difficulty be anticipated, it is a simple matter to carry out artificial respiration with the bellows through a tracheotomy tube. . .

A rare post-operative thoracic surgery complication: chylothorax

Current Thoracic Surgery

Background: Chylothorax is defined as the accumulation of chyle in the pleural space. In this report, we discuss the demographic features of patients with post-operative chylothorax, and the treatment approaches used to emphasize the importance of this complication for thoracic surgery. Materials and Methods: Medical records of 13 patients operated between January 2001 and July 2017, and who were diagnosed with chylothorax in the post-operative period, were retrospectively evaluated. Patients' demographic features, type of surgeries, results of histopathological examination, day of chylothorax diagnosis, and treatment results were recorded. Results: Eight male patients (61.5%) and 5 female patients (38.5%) were included in the study. Chylothorax developed after lobectomy in 9 patients (62.23%), total pleurectomy in 2 patients (15.38%), bilobectomy in 1 patient (7.69%), and pneumonectomy in 1 patient (7.69%). Oral nutrition was discontinued immediately after chylothorax diagnosis, and patients were followed-up with parenteral nutrition. A conservative approach was used in 11 patients (84.61%). Two patients (15.39%) did not respond to medical treatment, and underwent surgery. All patients were successfully treated chylothorax. Conclusions: Chylothorax is a rare but serious post-operative complication after thoracic surgeries. While appropriate conservative treatment leads to recovery in majority of the cases, surgery remains an important option for patients with prolonged drainage and persistent disease.

Emergency airway management of a patient with mediastinal mass

JPMA. The Journal of the Pakistan Medical Association, 2007

Appropriate airway management is an essential part of anaesthesiologist's role. Extrinsic airway compression by rapidly growing mediastinal masses represents a therapeutic challenge to anaesthesiologists. We report a case of successful airway management in a patient with obstructed airway. The patient was a middle aged female who presented with severe respiratory distress secondary to a huge mediastinal mass. CT scan showed widened superior mediastinum with circumferential narrowing of trachea and left main bronchus. Her condition continued to deteriorate during her hospital admission, so emergency intubation and tracheostomy was planned. She was intubated with the help of a bougie using size 6 microlaryngoscopic tube after inhalational induction and mediastinal tracheostomy was done. Intraoperatively, there were few episodes of hypotension and desaturation, otherwise rest of intraoperative course remained uneventful.

Peri-operative anaesthesia challenges in large anterior mediastinal mass - A case report

Indian Journal of Clinical Anaesthesia

Thymic mass is a rare tumor in the anterior mediastinum. They are usually of unknown etiology. About 50% of patients are diagnosed incidentally on chest radiographs. A 45 years, BMI-28, male patient presented to cardiac outpatient department with breathlessness and persistent cough for past three months. He also complained of generalized fatigue and nonspecific chest pain. On chest x-ray (PA view), there were diffuse opacities in middle and lower zone and no tracheal compression or deviation. Lateral neck X-ray also ruled out any airway compression. Computed tomography thorax revealed a huge mass occupying the prevascular compartment of mediastinum and insinuating the visceral compartment bilaterally with extension upto bilateral cardiophrenic and anterior costophrenic angles. CT-guided biopsy was consistent with thymolipoma which was surgically resected.Thymolipomas usually present with nonspecific symptoms. They pose a huge anaesthetic challenge during the peri-operative period in...