Mediastinoscopy
Clinical Procedure
 
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Clarify the nature and size of any mediastinal mass. Cardiovascular and respiratory collapse on induction is possible with larger masses.

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Aug 10, 2011
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If the event of major vessel haemorrhage, urgent mediastinotomy will likely be required. Plan ahead.

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If the patient is at high risk of cardio-repiratory collapse on induction (large mass compressing vessels/airway), perform the procedure in an institution capable of facilitating cardio-pulmonary bypass if required.

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Duration 20-40mins

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Jul 26, 2011
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Large bore intravenous cannula IVC in foot/feet to allow volume resuscitation if brachiocephalic veins injured.

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Brachiocephalic artery can be compressed by mediastinoscope, restricting blood flow to right arm & carotid artery. Placing oximeter on right hand with help reveal compression

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Jul 26, 2011
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In the presence of a large mediastinal mass which places the patient at risk of cardiovascular collapse on induction, place adequate arterial and central venous pressure monitoring pre-induction.

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Head-up position minimises venous engorgement, however, this increases the likelihood of air embolism

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Aug 09, 2011
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Surgical instruments pass posterior to the aortic arch and allows examination and biopsy of the superior mediastinal lymph nodes

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Sep 20, 2011
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Previous mediastinoscopy is a contraindication to repeated mediastinoscopies as the plane of dissection is lost #ref

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Aug 10, 2011
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Relative contraindications to mediastinoscopy include, thoracic aortic aneurysm, SVC syndrome, severe tracheal deviation #ref

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Relaxant anesthetic preferable to reduce risk of patient injury from movement, although it can be performed under local anesthetic.

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Jul 26, 2011
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Risk of damage to right brachiocephalic artery.

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May 18, 2011
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Risk of major vessel injury/haemorrhage increased in patients with superior vena cava SVC obstruction.

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May 18, 2011
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