Anesthetic Implications of SVC Syndrome

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Which type of tumors are most likely to produce SVC compression according to the text?

Mesothelioma

Oat-cell carcinoma (correct)

Adenocarcinoma

Squamous cell carcinoma

What symptoms may patients with SVC obstruction present with?

Fullness in the abdomen

Tongue swelling and upper airway edema (correct)

Dilated veins across the lower chest

Blue discoloration of the legs

How can symptoms of SVC obstruction be relieved?

By lying in a prone position

By bending the knees

By head elevation (correct)

By chest compression

What is considered to be a contraindication to mediastinoscopy according to the text?

SVC obstruction Signup and view all the answers

How is SVC congestion typically controlled in patients according to the text?

Steroids or diuretics Signup and view all the answers

What treatment might be scheduled before mediastinoscopy for patients with SVC syndrome?

Radiation or chemotherapy Signup and view all the answers

Why is assiduous neuromuscular blockade monitoring particularly important for patients undergoing mediastinoscopy?

To avoid complications related to anesthesia Signup and view all the answers

Why should blood be typed and cross-matched for patients undergoing mediastinoscopy?

To anticipate potential massive hemorrhage complications Signup and view all the answers

What is the reason for preparing emergency thoracotomy equipment and a plan before mediastinoscopy?

To manage significant intraoperative blood loss Signup and view all the answers

Why should fluids be administered through lower extremity intravenous sites for patients with SVC syndrome during mediastinoscopy?

To reduce the risk of fluid extravasation Signup and view all the answers

Why is it recommended to place at least one large-bore intravenous catheter before inducing anesthesia for a mediastinoscopy?

To prepare for potential massive blood loss scenarios Signup and view all the answers

What complication is specifically mentioned as the most serious associated with mediastinoscopy?

Massive hemorrhage Signup and view all the answers

What should be ensured before extubation to reduce the risk of air embolism in patients undergoing spontaneous ventilation?

Full return of reflexes Signup and view all the answers

Why is the head of the bed elevated postoperatively for a patient recovering from mediastinoscopy?

To improve respiratory function Signup and view all the answers

What can cause respiratory distress in the recovery room post-mediastinoscopy?

Paratracheal hematoma Signup and view all the answers

In what circumstance would a patient who underwent mediastinoscopy require immediate reintubation?

Unilateral recurrent laryngeal nerve damage Signup and view all the answers

What complication may arise during the recovery period in patients with tracheomalacia post-mediastinoscopy?

Unexpected airway obstruction Signup and view all the answers

What is a necessary post-operative monitoring action for a patient recovering from mediastinoscopy in the post anesthesia care unit?

A chest x-ray to rule out pneumothorax Signup and view all the answers

What is the primary concern regarding decreasing innominate blood flow during mediastinoscopy?

Increased risk of cerebral ischemia Signup and view all the answers

What monitoring technique is recommended to assess blood flow to the right arm during mediastinoscopy?

Both B and C Signup and view all the answers

Which positioning consideration is recommended to reduce venous congestion during mediastinoscopy?

Slight head-up position Signup and view all the answers

Which statement regarding anesthetic management during mediastinoscopy is false?

High intrathoracic pressures increase venous return Signup and view all the answers

What is a key consideration during the induction of anesthesia for a patient with SVC syndrome undergoing mediastinoscopy?

A slow, controlled induction in the sitting position is often prudent Signup and view all the answers

Which statement regarding ventilation during mediastinoscopy is correct?

Controlled ventilation should be adjusted to provide the lowest ventilating pressure compatible with oxygenation and normal end-tidal CO2 Signup and view all the answers

What equipment should be immediately available during mediastinoscopy to manage potential airway emergencies?

Both A and B Signup and view all the answers

Which type of endotracheal tube is recommended for mediastinoscopy to minimize the risk of kinking?

Single-lumen reinforced endotracheal tube Signup and view all the answers

Which statement regarding intraoperative hemodynamic changes during mediastinoscopy is correct?

Cardiovascular changes can occur suddenly Signup and view all the answers

In the event of acute cardiovascular collapse during mediastinoscopy, which maneuver may help relieve symptoms?

Changing the patient's position Signup and view all the answers