# Comprehensive Anesthetic Management for Posterior Mediastinal Tumor Resection in the Prone Position: A Case Report

## TL;DR

This case report describes the successful anesthetic management of a high-risk posterior mediastinal tumor surgery in the prone position, highlighting the importance of a multidisciplinary approach.

## Contribution

The paper presents a detailed, proactive anesthetic strategy for a complex posterior mediastinal tumor resection in the prone position with bilateral artificial pneumothorax.

## Key findings

- A comprehensive anesthetic plan ensured safe surgery despite airway compression and ventilatory challenges.
- Real-time cerebral and hemodynamic monitoring helped maintain stability during the procedure.
- Pre-emptive veno-arterial extracorporeal membrane oxygenation sheath insertion provided emergency readiness.

## Abstract

Posterior mediastinal tumors account for a small proportion of mediastinal tumors and are generally less likely to cause perioperative complications than anterior mediastinal tumors. However, large posterior mediastinal tumors or those adjacent to critical thoracic structures can complicate anesthesia management, especially when prone positioning and artificial pneumothorax (AP) are required during video-assisted thoracoscopic surgery. This case report details the successful perioperative management of a 64-year-old woman with a large posterior mediastinal tumor compressing the trachea and left main bronchus, undergoing tumor resection in the prone position. A multidisciplinary team devised a comprehensive plan addressing airway management, cardiovascular stability, and emergency preparedness. Advanced monitoring techniques, including regional oxygen saturation and transesophageal echocardiography, were employed to assess cerebral and cardiovascular stability. Challenges such as airway compression, ventilatory difficulties during AP, and double-lumen tube malposition were effectively managed, ensuring safe surgery and recovery. This case underscores the need for a proactive and multidisciplinary anesthetic strategy employed for a high-risk posterior mediastinal tumor resection in the prone position with bilateral AP. Pre-emptive insertion of sheaths for veno-arterial extracorporeal membrane oxygenation, real-time cerebral and hemodynamic monitoring, and rapid intraoperative response to airway compromise represents a level of detailed planning and adaptability that may offer practical insights for similar cases.