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Children with mediastinal masses—tumors in their chest outside the lungs—are at special risk for developing breathing problems when they undergo anesthesia. These young patients are of special concern to clinicians who must anesthetize them as part of their medical treatment.
This problem has generated a controversy among clinicians concerning the best way to handle young oncology patients, and whether they should be anesthetized at all. In turn, the controversy has made clinicians especially eager to be able to predict which patients are at highest risk of anesthetic complications.
A team of St. Jude researchers has shown that children who have difficulty breathing while lying down, who have edema (excessive fluid) in their upper body, or who suffer from compression of one bronchus (windpipe) or one of the major blood vessels in their chest, are at increased risk for anesthesia-related complications. This new information should help guide clinicians in their care of children who need management, according to the researchers.
The St. Jude team also found a relationship between the risk of anesthetic complications and the T-cell form of acute lymphoblastic leukemia. Although children with anesthetic complications tended to be younger than those who did not have problems, the difference was not significant, the researchers said. Children who presented anesthesia-related complications had larger masses than those who did not; however, the difference did not reach statistical significance. A report on these findings appears in the advanced, online issue of Pediatric Anesthesia.
The investigators reviewed the medical records—including diagnostic imaging results—of 117 patients who had mediastinal masses at the time they were diagnosed with cancer anytime between October 1985 and May 2000. The team then analyzed the clinical and diagnostic imaging information to identify which factors were associated with anesthesia-related complications.
Among these 117 patients, 77 percent had a mediastinal mass in the anterior mediastinum (front part of the chest between the lungs); and all 11 of the patients with complications from anesthesia occurred in this group, the researchers reported. These complications included respiratory problems that required suctioning of the airway, breathing assistance with a mask, changing position from reclining to sitting up or placement of a breathing tube. The surgical procedures associated with these anesthetic complications included biopsies (removal of tissue for examination) and central venous line placement (insertion of a catheter into a large vein in the chest).
“The overall rate of complications among our patients is comparable to similar studies that have been done previously by other researchers,” said the paper’s first author, Doralina Anghelescu, MD, Anesthesiology. “However, the complications we saw in our patients were less severe than those reported in the other studies.”
The St. Jude researchers attributed the less severe complications in their patients to a variety of factors, such as the use of the least invasive method of obtaining tissue for diagnosis, thorough preoperative assessment and the use of the least amount of anesthesia possible.
“This is the largest study to date in a single institution of anesthesia-related complications in children with cancerous mediastinal masses,” said John Sandlund, MD, Oncology, senior author of the paper. “Most of the complications were minor and none was life-threatening,” he noted.
The other authors of the paper include Laura Burgoyne, Anesthesia; Chin-Shang Li, Biostatistics; Ching-Hon Pui, MD, Oncology chair; Melissa Hudson, MD, and Wayne Furman, MD, Oncology; and former St. Jude employee Tiebin Liu.