Clinical and diagnostic imaging findings predict anesthetic complications in children presenting with malignant mediastinal masses

Doralina L. Anghelescu, Laura L. Burgoyne, Tiebin Liu, Chin-Shang Li, Ching Hon Pui, Melissa M. Hudson, Wayne L. Furman, John T. Sandlund

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: The presence of a mediastinal mass in a child poses significant anesthesia-related risks including death. To optimize outcome clinicians must be able to predict which patients are at highest risk of anesthetic complications. Methods: We conducted a retrospective review of 118 pediatric patients who presented with mediastinal masses. We investigated their medical records for clinical symptoms and signs at presentation and reviewed their chest radiographs, computed tomography scans, and echocardiograms and electrocardiograms when available. We then conducted analyses to identify clinical and diagnostic imaging features associated with anesthesia-related complications. Results: Eleven of 117 [9.4%, 95% confidence interval (CI) 4.1-14.7%] patients experienced an anesthesia-related complication. Four preoperative features were significantly associated with anesthetic complications: orthopnea (P = 0.033, odds ratio (OR) 5.31, 95% CI, 1.15-24.56), upper body edema (P = 0.035, OR 8.00, 95% CI, 1.16-55.07), great vessel compression (P = 0.037, OR 5.41, 95% CI, 1.11-26.49), and main-stem bronchus compression (P = 0.044, OR 5.11, 95% CI, 1.05-24.92). The presence of pleural effusion (P = 0.060, OR 4.53, 95% CI, 0.94-21.96) or tracheal compression (P = 0.061, OR 5.09, 95% CI, 0.93-27.81) also appeared to be risk factors. Although the rate of anesthesia-related complications detected in our cohort was comparable with that found in earlier studies, the events were less severe. Conclusions: Patients who present with orthopnea, upper body edema, great vessel compression and main stem bronchus compression are at risk of anesthesia-related complications. The low severity of complications in our series may reflect a combination of factors: use of the least invasive method such as interventional radiology to obtain tissue for diagnosis, completion of a thorough preoperative assessment and minimal anesthesia intervention.

Original languageEnglish (US)
Pages (from-to)1090-1098
Number of pages9
JournalPaediatric Anaesthesia
Volume17
Issue number11
DOIs
StatePublished - Nov 2007
Externally publishedYes

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Diagnostic Imaging
Anesthetics
Confidence Intervals
Anesthesia
Odds Ratio
Bronchi
Edema
Interventional Radiology
Pleural Effusion
Signs and Symptoms
Medical Records
Electrocardiography
Thorax
Tomography
Pediatrics

Keywords

  • Anesthetic complications
  • Mediastinal mass
  • Pediatric oncology

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Clinical and diagnostic imaging findings predict anesthetic complications in children presenting with malignant mediastinal masses. / Anghelescu, Doralina L.; Burgoyne, Laura L.; Liu, Tiebin; Li, Chin-Shang; Pui, Ching Hon; Hudson, Melissa M.; Furman, Wayne L.; Sandlund, John T.

In: Paediatric Anaesthesia, Vol. 17, No. 11, 11.2007, p. 1090-1098.

Research output: Contribution to journalArticle

Anghelescu, Doralina L. ; Burgoyne, Laura L. ; Liu, Tiebin ; Li, Chin-Shang ; Pui, Ching Hon ; Hudson, Melissa M. ; Furman, Wayne L. ; Sandlund, John T. / Clinical and diagnostic imaging findings predict anesthetic complications in children presenting with malignant mediastinal masses. In: Paediatric Anaesthesia. 2007 ; Vol. 17, No. 11. pp. 1090-1098.
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abstract = "Background: The presence of a mediastinal mass in a child poses significant anesthesia-related risks including death. To optimize outcome clinicians must be able to predict which patients are at highest risk of anesthetic complications. Methods: We conducted a retrospective review of 118 pediatric patients who presented with mediastinal masses. We investigated their medical records for clinical symptoms and signs at presentation and reviewed their chest radiographs, computed tomography scans, and echocardiograms and electrocardiograms when available. We then conducted analyses to identify clinical and diagnostic imaging features associated with anesthesia-related complications. Results: Eleven of 117 [9.4{\%}, 95{\%} confidence interval (CI) 4.1-14.7{\%}] patients experienced an anesthesia-related complication. Four preoperative features were significantly associated with anesthetic complications: orthopnea (P = 0.033, odds ratio (OR) 5.31, 95{\%} CI, 1.15-24.56), upper body edema (P = 0.035, OR 8.00, 95{\%} CI, 1.16-55.07), great vessel compression (P = 0.037, OR 5.41, 95{\%} CI, 1.11-26.49), and main-stem bronchus compression (P = 0.044, OR 5.11, 95{\%} CI, 1.05-24.92). The presence of pleural effusion (P = 0.060, OR 4.53, 95{\%} CI, 0.94-21.96) or tracheal compression (P = 0.061, OR 5.09, 95{\%} CI, 0.93-27.81) also appeared to be risk factors. Although the rate of anesthesia-related complications detected in our cohort was comparable with that found in earlier studies, the events were less severe. Conclusions: Patients who present with orthopnea, upper body edema, great vessel compression and main stem bronchus compression are at risk of anesthesia-related complications. The low severity of complications in our series may reflect a combination of factors: use of the least invasive method such as interventional radiology to obtain tissue for diagnosis, completion of a thorough preoperative assessment and minimal anesthesia intervention.",
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AU - Anghelescu, Doralina L.

AU - Burgoyne, Laura L.

AU - Liu, Tiebin

AU - Li, Chin-Shang

AU - Pui, Ching Hon

AU - Hudson, Melissa M.

AU - Furman, Wayne L.

AU - Sandlund, John T.

PY - 2007/11

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N2 - Background: The presence of a mediastinal mass in a child poses significant anesthesia-related risks including death. To optimize outcome clinicians must be able to predict which patients are at highest risk of anesthetic complications. Methods: We conducted a retrospective review of 118 pediatric patients who presented with mediastinal masses. We investigated their medical records for clinical symptoms and signs at presentation and reviewed their chest radiographs, computed tomography scans, and echocardiograms and electrocardiograms when available. We then conducted analyses to identify clinical and diagnostic imaging features associated with anesthesia-related complications. Results: Eleven of 117 [9.4%, 95% confidence interval (CI) 4.1-14.7%] patients experienced an anesthesia-related complication. Four preoperative features were significantly associated with anesthetic complications: orthopnea (P = 0.033, odds ratio (OR) 5.31, 95% CI, 1.15-24.56), upper body edema (P = 0.035, OR 8.00, 95% CI, 1.16-55.07), great vessel compression (P = 0.037, OR 5.41, 95% CI, 1.11-26.49), and main-stem bronchus compression (P = 0.044, OR 5.11, 95% CI, 1.05-24.92). The presence of pleural effusion (P = 0.060, OR 4.53, 95% CI, 0.94-21.96) or tracheal compression (P = 0.061, OR 5.09, 95% CI, 0.93-27.81) also appeared to be risk factors. Although the rate of anesthesia-related complications detected in our cohort was comparable with that found in earlier studies, the events were less severe. Conclusions: Patients who present with orthopnea, upper body edema, great vessel compression and main stem bronchus compression are at risk of anesthesia-related complications. The low severity of complications in our series may reflect a combination of factors: use of the least invasive method such as interventional radiology to obtain tissue for diagnosis, completion of a thorough preoperative assessment and minimal anesthesia intervention.

AB - Background: The presence of a mediastinal mass in a child poses significant anesthesia-related risks including death. To optimize outcome clinicians must be able to predict which patients are at highest risk of anesthetic complications. Methods: We conducted a retrospective review of 118 pediatric patients who presented with mediastinal masses. We investigated their medical records for clinical symptoms and signs at presentation and reviewed their chest radiographs, computed tomography scans, and echocardiograms and electrocardiograms when available. We then conducted analyses to identify clinical and diagnostic imaging features associated with anesthesia-related complications. Results: Eleven of 117 [9.4%, 95% confidence interval (CI) 4.1-14.7%] patients experienced an anesthesia-related complication. Four preoperative features were significantly associated with anesthetic complications: orthopnea (P = 0.033, odds ratio (OR) 5.31, 95% CI, 1.15-24.56), upper body edema (P = 0.035, OR 8.00, 95% CI, 1.16-55.07), great vessel compression (P = 0.037, OR 5.41, 95% CI, 1.11-26.49), and main-stem bronchus compression (P = 0.044, OR 5.11, 95% CI, 1.05-24.92). The presence of pleural effusion (P = 0.060, OR 4.53, 95% CI, 0.94-21.96) or tracheal compression (P = 0.061, OR 5.09, 95% CI, 0.93-27.81) also appeared to be risk factors. Although the rate of anesthesia-related complications detected in our cohort was comparable with that found in earlier studies, the events were less severe. Conclusions: Patients who present with orthopnea, upper body edema, great vessel compression and main stem bronchus compression are at risk of anesthesia-related complications. The low severity of complications in our series may reflect a combination of factors: use of the least invasive method such as interventional radiology to obtain tissue for diagnosis, completion of a thorough preoperative assessment and minimal anesthesia intervention.

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