Because of their location, mediastinal masses often involve vital structures, and can give rise to life-threatening complications during anesthesia. We present a case in which left main bronchial obstruction, compression of right pulmonary
artery,
and
probable myocardial involvement caused cardiac arrest on induction of general anesthesia.
The patient was a 4-year-old, 14-kg boy complaining with a dry cough and intermittent fever for two months. His chest roentgenogram and computerized tomography showed that a large posterior mediastinal mass compresses the left main bronchus and
right
main pulmonary artery. Preoperative examination revealed a thin boy with intermittent tachypnea and absence of breath sounds in left anterior chest, but his arterial blood gas analysis was normal.
In spite of a well-controlled airway and good ventilation, we were unable to oxygenate the child, and cardiac arrest was followed. All resuscitative measures including external cardiac massage, intravenous and endotracheal epinephrine,
bicarbonate,
and
calcium gluconate were ineffective until his chest was opened to relieve compression of pulmonary artery and heart.
This case demonstrates that unexpected cyanosis and cardiac arrest in presence of mediastinal mass may well due to cardiovascular compression especially with compression of pulmonary artery. (Korean J A Anesthesiol 1995; 29: 433∼437)
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