Anesthetic Management for Sternotomy in Anterior Mediastinal Mass

Preoperative Evaluation and Planning

The American Heart Association recommends obtaining comprehensive chest CT angiography to document the exact anatomical relationship between the mass, great vessels, heart chambers, and the sternum, as repeat sternotomy may be associated with cardiac injury when these structures are closely adherent to the sternum 1, 2
Review of prior operative notes is crucial when repeat sternotomy is planned, as this provides critical insight into previous adhesions and vascular anatomy, according to the American College of Cardiology 1, 2

The American College of Cardiology suggests using volatile anesthetic agents (desflurane or sevoflurane) for maintenance of general anesthesia in hemodynamically stable patients at risk for myocardial ischemia 3

The American College of Cardiology recommends using transesophageal echocardiography intraoperatively to determine the cause of acute, persistent, and life-threatening hemodynamic abnormalities 3
Maintaining body temperature in a normothermic range throughout the procedure is essential, as recommended by the American College of Cardiology 3

Positioning the patient to optimize surgical access while minimizing compression of cardiovascular structures is crucial, recognizing that right-sided heart structures may be enlarged or hypertensive, increasing the potential for injury during sternotomy, according to the American Heart Association 1, 2
Ensuring peripheral vascular access is established prior to sternotomy is necessary, as femoral cannulation may be required emergently, as recommended by the American Heart Association 1, 2
Having defibrillator pads applied outside the operative field but positioned to allow emergency sternotomy if needed is recommended, as suggested by the Society of Thoracic Surgeons 4