Safe Anesthesia Induction in Patients with Anterior Mediastinal Mass Using Muscle Paralysis

Available reports suggest that an anterior mediastinal mass causing more than 50% narrowing of the trachea and compressing the great vessels can cause further narrowing of the airway and cardiovascular collapse after the administration of muscle relaxants. Accordingly, inhalation induction of general anesthesia or awake intubation is used to avoid the use of muscle relaxation. The following two case reports describe the stepwise safe anesthetic induction of two patients with anterior mediastinal masses using total intravenous anesthesia followed by tailored positive pressure ventilation and administration of muscle relaxant.