Anesthetic Management of a Pediatric Patient with a Giant Anterior Mediastinal Mass and Dextrocardia: A Case Report

Introduction: Anterior mediastinal masses in pediatric patients pose an anesthetic challenge due to the risk of airway compression and cardiovascular collapse, further complicated by anomalies such as dextrocardia and thoracic deformities. Case presentation: A 6-year-old male patient with dextrocardia, pectus excavatum, and chronic biomass exposure presented with progressive respiratory distress. CT imaging revealed a 13 × 9 × 13 cm cystic-solid lesion occupying the left hemithorax and anterior mediastinum. The anesthetic risk was classified as ASA III due to tumor size and associated comorbidities. Thoracotomy, complete tumor resection, and left pneumonectomy were performed. Anesthetic approach: An individualized general anesthesia strategy was implemented, emphasizing invasive monitoring, hemodynamic support, and airway management under indirect visualization. Balanced anesthesia included sevoflurane, dexmedetomidine, magnesium sulfate, opioids, and vasopressors. The surgery lasted 10 hours, with significant blood loss requiring transfusion support. Outcomes: The patient was admitted to the pediatric intensive care unit under mechanical ventilation and vasopressor support, both successfully withdrawn within 24 hours. Histopathological analysis confirmed a mature cystic teratoma. The patient was discharged without complications. Conclusion: This case highlights the importance of individualized anesthetic planning and multidisciplinary coordination in high-risk pediatric patients with mediastinal masses. Early identification of clinical and radiologic warning signs, proactive hemodynamic management, and appropriate airway control are essential to prevent potentially fatal complications..