Perioperative management of thymectomy

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Elisabetta Congedo, Paola Aceto, Alexander Cardone, Rosanna Petrucci, Alessandra Dottarelli, Germano De Cosmo

Ann. Ital. Chir., 2007; 78: 367-370

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Thymoma is the most frequent type of tumor in the anterior-superior mediastinum. The presentation of thymomas is
variable; most are asymptomatic and others present themself with local compression syndrome or parathymic syndrome;
rarely thymomas appear as an acute emergency. Surgery is the treatment of choice for thymic tumors and complete resection
is the most important prognostic factor. Surgery with adjuvant radiation is recommended for invasive thymoma.
The anaesthetic management of patients with mediastinal thymoma undergoing thymectomy is associated with several
risks related to potential airway obstruction, hypoxia and cardiovascular collapse. Patients at high risk of perioperative
complications can be identified by the presence of cardiopulmonary signs and symptoms. However, asymptomatic thymomas
have been occurred with acute cardiorespiratory complications under general anaesthesia. A careful preoperative evaluation
of signs, symptoms, chest X-ray, CT scan, MRI, cardiac echogram and venous angiogram should be helpful to
investigate neoplasm presence and the area of invasion; moreover, an adequate airway and cardiovascular management,
such as performing an awake intubation in the sitting position, allowing spontaneous and non-controlled ventilation, a
rigid bronchoscope available and a standby cardiopulmonary bypass, is suggested to prevent the main life-threatening cardiorespiratory
complications.

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