Surgical and anesthetic managements of an adult patient with a giant mediastinal mass

Abstract

A 22-year-old male with a giant anterior mediastinal mass underwent general anesthesia and tumor removal through Clamshell incision. The mass (approximately 4 kg) that occupied the plural cavity with retarded venous drainage of the chest caused the symptoms and signs of SVC obstruction. Due to no sign of upper thoracic airway obstruction, the operation plan was not included CPB standby. Anesthesia in this case was difficult from the beginning. However, it was smoothed out with subsequent intravenous thiopental induction, followed by atracurium and sevoflurane in maintenance of the anesthesia. During the operation, accidental tear of the right atrium occurred; controls of the cardiovascular stability were subsequently critical. In spite of this, the patient was finally saved and had rapid recovery after surgery. Postoperative pathological examination including microscopic examination revealed only benign component of germ cells viable in the specimen. All margins were free from the tumor. The patient was discharged 5 days after the operation.