Regional anaesthesia with extracorporeal membrane oxygenation backup for caesarean section in a parturient with neck and mediastinal masses

Int J Obstet Anesth. 2018 Aug:35:99-103. doi: 10.1016/j.ijoa.2018.02.009. Epub 2018 Mar 2.

Abstract

Mediastinal mass in pregnancy is a rare condition that presents significant anaesthetic challenges. We present a woman with relapsed Hodgkin's lymphoma during pregnancy who declined to have chemotherapy because of concerns for her unborn child. She failed to attend follow-up clinic appointments and presented at 33 weeks' gestation with tracheal deviation and narrowing down to the level of the carina, as a result of large neck and mediastinal masses. She required delivery of the baby to allow her to receive urgent chemotherapy. We describe successful management of a caesarean section under combined spinal-epidural anaesthesia, at which bilateral femoral vein access was gained in case of the need for urgent extracorporeal membrane oxygenation.

Keywords: Anaesthesia, obstetric; Caesarean section; Extracorporeal membrane oxygenation, ECMO; Lymphoma; Mediastinal mass.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anesthesia, Epidural / methods*
  • Anesthesia, Obstetrical / methods*
  • Anesthesia, Spinal / methods*
  • Cesarean Section
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Head and Neck Neoplasms / complications*
  • Hodgkin Disease / complications*
  • Humans
  • Mediastinal Neoplasms / complications*
  • Pregnancy
  • Pregnancy Complications, Neoplastic*