Mediastinal Masses
Sanjay,
Thanks for looking at the Blog. I hope that you will encourage your friends to post questions and topics that they might be interested in talking about.
Your suggestion that muscle relaxants are not used comes from the experience that decompensation often occurs when patients are paralyzed. The reason is likely multifactorial, but an increase in the mean intrathoracic pressure associated with positive pressure ventilation discourages the return of intravascular volume to the right side of the heart. In the scenario of a large mass that may encapsulate the pericardium, the patient's ability to maintain cardiac output is limited. In addition, the dynamic forces that maintain a patent airway in the spontaneously ventilating patient are eliminated in a patient that is paralyzed, sometimes producing significant intrathoracic airway obstruction.
Given these issues, what do we need to know about these patients before we put them to sleep?
Thanks for looking at the Blog. I hope that you will encourage your friends to post questions and topics that they might be interested in talking about.
Your suggestion that muscle relaxants are not used comes from the experience that decompensation often occurs when patients are paralyzed. The reason is likely multifactorial, but an increase in the mean intrathoracic pressure associated with positive pressure ventilation discourages the return of intravascular volume to the right side of the heart. In the scenario of a large mass that may encapsulate the pericardium, the patient's ability to maintain cardiac output is limited. In addition, the dynamic forces that maintain a patent airway in the spontaneously ventilating patient are eliminated in a patient that is paralyzed, sometimes producing significant intrathoracic airway obstruction.
Given these issues, what do we need to know about these patients before we put them to sleep?
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