TRACHEAL COMPRESSION BY A MEDIASTINAL MAS S IN CHILDREN - VALUE OF FIBEROPTIC BRONCHOSCOPY FOR ANESTHETIC MANAGEMENT

Due to the action of the drugs and the position of the patient, genera l anaesthesia in a child with a mediastinal tumor can complete the obs truction of the trachea and/or the main bronchi and possibly result in reversible respiratory failure. The risk is directly linked to the de gree of lumen amputation of the trachea, usually evaluated by CT-scan: there is a risk of accident if the degree of lumen amputation is grea ter than 30%. The case reports underline the value of the flexible fib reoptic bronchoscopy under local anaeshesia. This examination, as well as the CT-scan, allows to evaluate the degree of tracheal compression . Moreover, it carries a lower risk than the CT-scan which requires, i n a small child, either general anaesthesia of heavy premedication whi ch could lead to asphyxia. Total obstruction most often occurs with an terior mediastinal tumors. However, even posterior or lateral tumors c an extend to an anterior position, especially in the young child. If t he obstruction of the lumen is greater than 30% and if general anaesth esia is required, the fibreoptic bronchoscopy allows endotracheal intu bation under local anaeshesia before general anaeshesia. We report 5 c ases which illustrate the risk of tracheal compression during general anaesthesia in patients with a mediastinal tumor and substantiate the advantages of a flexible fibreoptic bronchoscope in the management of these patients before and during general anaesthesia.