Perioperative respiratory complications in pediatric patients with mediastinal masses: a report of 2 cases

General anesthesia in patients with mediastinal masses can lead to life-threatening cardiorespiratory complications. We report the cases of 2 pediatric patients with mediastinal masses who developed serious complications during general anesthesia. The first was a 13-year-old boy with a suspected diagnosis of high-grade T-cell non-Hodgkin lymphoma, lymph node disease, and an anterior mediastinal mass. He developed negative pressure pulmonary edema secondary to severe upper airway obstruction in spontaneous ventilation. The second was a 14-year-old boy with Rosai-Dorfman disease and paratracheal lymph node involvement. He developed severe airway obstruction in the early postoperative period. The anesthetic difficulties that arise in these cases include acute airway occlusion, superior vena cava syndrome, pulmonary artery or cardiac compression, acute pulmonary edema, and cardiopulmonary collapse. The technique of choice is induction with inhaled anesthetics and maintenance of spontaneous ventilation. Neuromuscular relaxants are avoided.