ngaybinhyen
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Lymphosarcoma
Children with anterior mediastinal masses, such as lymphomas and primary mediastinal tumors, are at serious risk for airway compromise, cardiac tamponade, and vascular obstruction. Induction of general anesthesia and even mild sedation can rapidly lead to total loss of the airway, with inability to ventilate the child and cardiovascular collapse. These patients often present in a semi-emergent fashion, with the need for both a tissue diagnosis before treatment is initiated and a surgically placed central line.
Significant compression of vital structures can occur with seemingly mild symptoms. Tachypnea, orthopnea, wheezing, and sleep disturbances or avoidance of prone or supine positions are significant indications of serious risk. Pericardial tamponade or superior vena cava syndromes are more concerning findings. A CT scan showing >50% compression of the airway at the carina is an indication to prohibit general anesthesia and provide only mild sedation. Echocardiographic or CT evidence of pericardial tamponade, right ventricular compression, or compression of the pulmonary artery suggests severe risk. Biopsy under local anesthesia may be indicated. If anesthesia is required, cardiopulmonary bypass should be considered in the event that it becomes impossible to ventilate the child. In high-risk children, consideration should be given to initiating treatment with steroids, radiation therapy, and chemotherapy before obtaining a tissue diagnosis
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| nightflight1945
banned
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| DrAlex_76
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where ur source ,Tam ?
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| ngaybinhyen
Forum Guru
Topics: 23
Posts: 657
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Nelson's
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