Anaesthetic management of superior vena cava syndrome in a 14- year-old undergoing mediastinal mass excision: a case report
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Abstract
Background: Superior vena cava syndrome occurs when there is obstruction of blood flow through the superior vena cava to the right atrium and is mostly seen in patients with mediastinal masses. It can be a medical emergency associated with respiratory and cardiovascular collapse and requires immediate evaluation and treatment.
Aim: This is a case report of the approach to anaesthetic and intensive care of a 14-year-old scheduled for elective sternotomy for an obstructive mediastinal mass with typical presentations of superior vena cava syndrome.
Case Report: A 14-year-old male patient was diagnosed with features suggestive of superior vena cava syndrome following presentation at the children emergency ward of the University of Port Harcourt Teaching Hospital, Nigeria, and after initial management of acute asthma on account of frequent respiratory distress. Following detailed preoperative assessment and preparation, meticulous anaesthetic care and monitoring contributed to a safe outcome despite challenging perioperative cardiorespiratory events typical of patients with such syndrome. The respiratory and cardiovascular variables later returned to normal values following sternotomy and debulking of the mediastinal mass and recovery was uneventful in the Intensive care unit from where he was finally discharged to the ward after 48 hours.
Conclusion: Diagnosis of superior vena cava syndrome can be masked by other common causes of airway obstruction. These patients pose a high anaesthetic risk perioperatively. Management includes surgical approach while specialised anaesthetic care is crucial to a safe outcome.
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