Mediastinoscopy

Question 1

What is a mediastinoscopy, and why is it performed?

Answer 1

A mediastinoscopy is a surgical procedure in which an
instrument called a mediastinoscope is inserted into the
mediastinal space in order to view and biopsy lymph nodes.
The most common reason for performing the procedure is
bronchogenic carcinoma, although it is also performed for other
lymphadenopathic processes such as lymphoma, infectious
granulomatous diseases, and sarcoidosis.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 309.

Question 2

Mediastinoscopy can result in decrease blood flow

through which vessel?

Answer 2

The mediastinoscope can compress the innominate artery
which gives rise to the right subclavian, right common carotid,
and right vertebral arteries.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 681.

Question 3

What factors can increase the risk of complications

due to air embolism during mediastinoscopy?

Answer 3

In the event of damage to a blood vessel during a
mediastinoscopy, having the head elevated increases the risk of
air entrainment as does the negative intrathoracic pressure
associated with spontaneous respiration. If an air embolus
were to occur, the use of nitrous oxide could cause it to expand
rapidly and increase the severity of the embolus. The head
down position would decrease the risk of air entrainment
through a damaged blood vessel although it may increase the
risk of compression of the superior vena cava or airway edema.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 314.

Question 4

What are the potential complications of a

mediastinoscopy?

Answer 4

Mediastinoscopy can result in a wide range of complications
such as tearing of great vessels, pneumothorax,recurrent
laryngeal nerve palsy, chylothorax, bronchospasm from airway
manipulation, air embolism, arrhythmias, and esophageal
laceration.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 681.

Question 5

How should monitors be placed on a patient

undergoing mediastinoscopy and why?

Answer 5

The conventional monitor placement for a patient undergoing
mediastinscopy is: radial arterial line (if used) and O2 saturation
monitor on the right arm and the blood pressure cuff on the left
arm. During mediastinoscopy, there is a significant risk of
compression of the innominate artery by a mediastinal mass or
by the mediastinoscope itself resulting in a drop in right arm
blood pressure. If only the right arm blood pressure is
monitored, the patient may be treated inappropriately for
hypotension. If only the left arm is monitored, the obstruction
may go unnoticed. If the pressure in the right arm is less than
that of the left arm, you should suspect innominate vessel
compression.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 314.