Document Detail


Anesthesia for pericardial window in a pregnant patient with cardiac tamponade and mediastinal mass.
MedLine Citation:
PMID:  14525821     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To present a case report of anesthesia for pericardial window surgery for acute cardiac tamponade in a patient with an anterior mediastinal mass in late pregnancy. CLINICAL FEATURES: A 34-yr-old gravida 2, para 1 patient presented at 29 weeks gestation with dyspnea, orthopnea, chest pain, and cough. Investigations showed an anterior mediastinal mass due to Hodgkin's disease. A course of vinblastine at 31 weeks gestation resulted in symptomatic improvement but at 34 weeks gestation she developed an acute cardiac tamponade for which pericardial window drainage was required. Additional help and equipment were assembled in case of cardiopulmonary deterioration. Intra-arterial pressure and continuous fetal monitoring were established and iv access was secured in both arms and the left foot. After awake fibreoptic intubation, spontaneous ventilation was maintained. Anesthesia consisted of local anesthetic infiltration of the anterior chest wall, supplemented with fentanyl, midazolam, and ketamine. The patient remained stable, was extubated fully awake, and then monitored in an intensive care area. CONCLUSION: This patient presented with acute cardiac tamponade and an anterior mediastinal mass in late pregnancy, an unusual combination of challenges that requires a careful approach to anesthetic management.
Authors:
J Anne Webster; D Dean Self
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  50     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-10-03     Completed Date:  2004-02-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  815-8     Citation Subset:  IM    
Affiliation:
Department of Anesthesia, Kelowna General Hospital, Kelowna, British Columbia, Canada. jawebster@shaw.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia*
Cardiac Tamponade / surgery*
Female
Fetal Monitoring
Hodgkin Disease / complications
Humans
Mediastinal Neoplasms / complications*
Monitoring, Intraoperative
Pericardial Window Techniques*
Pregnancy

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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