What is included in preoperative care prior to resection of tumors of the mediastinum?

Updated: Feb 16, 2021
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

Standard preoperative management applicable to all chest surgical cases applies to the preoperative management of individuals undergoing resection of mediastinal tumors.

Airway management is of paramount importance when dealing with tumors that can produce a mass effect on these structures. For safe management of the airway distorted or narrowed by a mediastinal mass, consider detailed preoperative assessment of the airway and ensure adequate visualization and readily available supplementary equipment (eg, flexible bronchoscope). Placement of a double-lumen endotracheal tube to provide single-lung ventilation is usually preferred for any procedure in which a thoracotomy approach is used.

Some mediastinal tumors may require extensive resection of adjacent tissues, and blood loss may be substantial in these cases. Provide for adequate intravenous access, appropriate monitoring capability, and easy availability of necessary blood products (all of paramount importance) before surgery is begun.

Involvement of associated intrathoracic structures by tumor may mandate their resection. Pulmonary resection; excision of nervous structures such as the phrenic, vagus, or sympathetic chain; or even resection of major vascular structures (eg, superior vena cava [SVC]) may be required. Importantly, the surgeon must be prepared for this and the patient must be informed preoperatively that such resection may be required because this may have additional impact on recovery and perioperative risk.

Several mediastinal tumors can produce important effects that should be taken into account before any type of operative procedure, even simple biopsy, is entertained.


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