Anesthetic Management and Prognosis of a Large Right Mediastinal Mass: Strategy of Unipulmonary Ventilation

Introduction: The mediastinum is a complex anatomical region that can be the site of a variety of tumour pathologies. These masses, often discovered late due to their silent growth, pose major diagnostic and therapeutic challenges. Our study focuses on the particularities of anesthetic management of these lesions, which present high operative risks with a morbidity of up to 45%. Case report: We report the case of a 59-year-old patient, a former smoker, presenting with a voluminous 20 cm right mediastinal mass. After preparation including pleural drainage and non-invasive ventilation, partial surgical resection was performed by thoracotomy. Anaesthetic management: The team implemented a protective unipulmonary ventilation strategy with rigorous parameters: reduced tidal volume (4-6 ml/kg), individualized PEEP and moderate FiO2. Invasive hemodynamic monitoring managed refractory hypotension requiring the use of noradrenaline. Postoperative analgesia was provided by epidural, favoring early rehabilitation. Discussion: Several lessons can be drawn from this observation. Firstly, late diagnosis remains frequent, underlining the importance of early chest imaging in the face of persistent respiratory symptoms. Secondly, protective ventilation proved crucial in preserving the patient’s lung function, in line with recent data in the literature. Conclusion: This observation illustrates the complexity of managing mediastinal masses. Recent advances in thoracic anesthesia, notably in protective ventilation and multimodal analgesia techniques, have improved postoperative prognosis.