Anaesthetic management of two different cases of mediastinal mass
An 8-year-old boy weighing 16 kg scheduled for median sternotomy for excision of anterior mediastinal mass had intermittent fever for 3 months and dry cough for 2 weeks associated with breathlessness on exertion. Chest X-ray, computer tomography (CT) scan, magnetic resonance imaging (MRI) and echocardiogram were performed to assess the mass and its compression on vital structures. Biochemical investigations were normal.\nIntravenous (I.V.) access was established in the right and left hands with a 22G I.V. cannula in addition to a femoral vein catheter for central venous access. The child was pre-medicated and induced with 5 mg/kg of thiopentone I.V. After confirming mask ventilation, suxamethonium 1.5 mg/kg was used for intubation. Intubation was performed with a 5.5-mm I.D. cuffed reinforced oral endotracheal tube connected to Bain's system. Anaesthesia was maintained with N2O:O2 (50:50) and sevoflurane 0.8-2.0%. Relaxation was achieved with vecuronium bromide 0.1 mg/kg. Analgesia was achieved with I.V. morphine 0.1 mg/kg. Normocapnia was maintained with suitable ventilatory frequency and tidal volume. Five hundred millilitres of Ringer's lactate was administered over 2 h.\nHeart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, oxygen saturation, end-tidal carbon-di-oxide (EtCO2) and electrocardiography (ECG) with ST segment analysis were recorded. Anterior mediastinal mass was removed. Minimal compression was noted on innominate vein and addressed intra-operatively. Sternum was closed in midline. The patient was electively ventilated in a paediatric Intensive Care Unit (ICU) for 3 h, reversed and extubated. He was haemodynamically stable. Later, he had an uneventful course in the hospital before discharge.