• Thomas Hachenberg, Thomas Schilling, and Moritz Kretzschmar.
• Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Otto-von-Guericke University.
• Curr Opin Anaesthesiol. 2024 Dec 9.

Purpose Of The ReviewThe mediastinal mass syndrome (MMS) can occur after induction of anesthesia, intraoperatively or even days after the surgical procedure. The focus of this review is on the management of pediatric and adult patients with a significant mediastinal mass.Recent FindingsThe age distribution of patients with mediastinal lesions suggests a bimodal shape, with an increased incidence among children under 10 years old and adults aged 60-70 years old. The traditional approach to avoid general anesthesia and mechanical ventilation has been challenged recently. Induction of general anesthesia may be achieved by a titrated intravenous infusion of propofol, with the patient positioned in a semi-sitting position. Mechanical ventilation with a prolonged I:E ratio, low respiratory rate and rigid or flexible bronchoscopy to stent the obstructed airway can facilitate expiration of tidal volume. Continuous video bronchoscopy recordings of the compromised portion of the airway have shown that positive pressure ventilation and neuromuscular blockade can induce an increase in the mean airway patency score.SummaryMeticulous planning, implementation of anesthetic management protocols and protocols for emergency situations are essential to guarantee patient safety with a mediastinal mass.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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