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Anesthesia for pericardial window in a pregnant patient with cardiac tamponade and mediastinal mass

Anesthésie pour une fenêtre péricardique chez une femme enceinte qui présente une tamponnade cardiaque et une masse médiastinale

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Abstract

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. Intraarterial 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.

Résumé

Objectif

Décrire l’anesthésie pour une fenêtre péricardique pour tamponnade cardiaque aiguë chez une patiente en fin de grossesse qui présente une masse médiastinale antérieure.

Éléments cliniques

Une patiente de 34 ans, gravida 2, para 1, a consulté à 29 sem de grossesse pour dyspnée, orthopnée, douleur thoracique et toux. Les examens ont montré une masse médiastinale antérieure liée à la maladie de Hodgkin. Le traitement par vinblastine, à 31 sem, a diminué les symptômes, mais à 34 sem, une tamponnade cardiaque aiguë s’est développée, exigeant un drainage par fenêtre péricardique. Du personnel et du matériel supplémentaires ont été réunis en cas de détérioration cardio-pulmonaire. Le monitorage de la tension intra-artérielle et la surveillance fœtale continue ont été installés, ainsi qu’un accès iv aux deux bras et au pied gauche. Après l’intubation fibroscopique vigile, la ventilation spontanée a été maintenue. L’anesthésie comprenait l’infiltration d’un anesthésique local dans la paroi thoracique antérieure, complété par du fentanyl, du midazolam et de la kétamine. Les signes vitaux de la patiente sont demeurés stables; elle a été extubée complètement éveillée et gardée en observation à l’unité de soins intensifs.

Conclusion

Cette patiente présentait une tamponnade cardiaque aiguë et une masse médiastinale antérieure en fin de grossesse, une combinaison inhabituelle de défis qui exigent un traitement anesthésique prudent.

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Author information

Correspondence to J. Anne Webster.

Additional information

No financial support has been received for this work.

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Webster, J.A., Self, D.D. Anesthesia for pericardial window in a pregnant patient with cardiac tamponade and mediastinal mass. Can J Anesth 50, 815 (2003). https://doi.org/10.1007/BF03019378

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Keywords

  • Sevoflurane
  • Cardiac Tamponade
  • Mediastinal Mass
  • Spontaneous Ventilation
  • Anterior Mediastinal Mass