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CC BY 4.0 · J Neuroanaesth Crit Care 2023; 10(03): 192-195
DOI: 10.1055/s-0043-1770776
Case Report

A Child with a Large Posterior Mediastinal Mass with Intraspinal Extension—Perioperative Anesthetic Challenges and Importance of Postoperative Analgesia

Sharon K. Chandana
1   Department of Neuroanaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
,
Ramamani Mariappan
1   Department of Neuroanaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
,
Karen R. Lionel
1   Department of Neuroanaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract

A 4-year-old girl child with a large posterior mediastinal mass with intraspinal extension (T2–T5) presented with paraplegia and bowel and bladder dysfunctions. She was planned for T1 to T6 laminoplasty and excision of the intraspinal tumor, followed by thoracotomy and excision of the posterior mediastinal tumor. Neurogenic tumors are common posterior mediastinal masses in children. These children pose many anesthetic challenges because of their size, location, and invasiveness. Challenges include difficult intubation, ventilation due to compression of the tracheobronchial tree, hemodynamic fluctuations because of compression of vital structures, associated autonomic dysfunction, and intraoperative bleeding. Pediatric lung isolation for thoracotomy and excision, obtaining motor evoked potential response in a child with poor functional grade status, and selecting appropriate analgesia techniques in the presence of neurological deficits are some of the added challenges. Anesthetic management and the use of a continuous erector spinae plane block for postoperative analgesia are highlighted in this report.

Keywords

erector spinae plane block - neurogenic tumors - pediatric - posterior mediastinal mass - one-lung ventilation


Publication History

Article published online:
04 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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