Anesth Pain Med.  2017 Jul;12(3):256-260. 10.17085/apm.2017.12.3.256.

Non-intubated video-assisted thoracoscopic biopsy surgery of a large anterior mediastinal mass via epidural anesthesia: A case report

• Kim KY
• Lee GH
• Cho JH
• Choi JW
• Ahn HJ
• Yang MK
• Lee SM

• KMID: 2388843
• DOI: http://doi.org/10.17085/apm.2017.12.3.256

Abstract

Anesthesia for a patient with a large mediastinal mass is a challenge for anesthesiologists, given the risk of airway collapse and hemodynamic compromise. Moreover, there are very few reports on the anesthetic management of non-intubated video-assisted thoracoscopic surgery (VATS). Thus, in the following case report, we provide an account of the successful anesthetic management and excisional biopsy of a large anterior mediastinal mass (measuring 13 × 10 cm) utilizing non-intubated VATS. The patient was kept awake, maintaining consciousness and spontaneous respiration throughout the procedure, in order to prevent devastating airway collapse and pain control and cough prevention were achieved by thoracic epidural analgesia and lidocaine nebulization.

Keyword

Epidural anesthesia; Mediastinal mass; Video-assisted thoracoscopic surgery

MeSH Terms

Analgesia, Epidural
Anesthesia
Anesthesia, Epidural*
Biopsy*
Consciousness
Cough
Hemodynamics
Humans
Lidocaine
Respiration
Thoracic Surgery, Video-Assisted
Lidocaine

Figure

• 

  Fig. 1 (A) Chest computed tomography image in the sagittal view, showing the large anterior mediastinal mass (both white arrows). (B) Chest computed tomography image in the transverse view, showing trachea deviation and narrowing due to the large mediastinal mass.

• 

  Fig. 2 Uni-port utility scope view: mediastinal mass (white arrow) biopsy procedure.

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