The Risk Factors Associated With Difficult Ventilation In Children With Mediastinal Masses

Objective:To analyze the risk factors with adverse events during general anesthesia in children with mediastinal masses and anterior mediastinal masses and to provide reference for anesthesia management of mediastinal masses.Methods:Clinical data and anaesthetic records of 101 children with mediastinal masses (including 49 anterior mediastinal masses) were collected retrospectively. The patients were divided into difficult ventilation group and non-difficult ventilation group according to whether they had difficult ventilation during general anesthesia or not. Univariate analysis and multivariate logistic regression analysis were used to investigate the risk factors of difficult ventilation during general anesthesia in 101 mediastinal masses.49 anterior mediastinal masses entered into the follow study. Using univariate analyses and calculate the specificity and sensitivity, positive and negative predictive values.Results:101 mediastinal masses include 49 anterior mediastinal masses, and anterior mediastinal masses mostly arise from the thymus (29/49,59.2%).17 children (16.8%) suffered difficult ventilation in 101 mediastinal masses. For the univariate analysis, lung and chest infection, using tumorectomy, vascular compression, large tumors, adaptive position, and tracheal compression(P<0.05). Multivariate logistic regression analysis indicated that the risk factors of difficult ventilation during anesthesia were adaptive position (OR=6.7) and tracheal compression(OR=7.4).49 anterior mediastinal masses entered into the follow study, and 8 children (16.3%) occurred difficult ventilation in 49 anterior mediastinal masses. For the univariate analysis, five preoperative features were associated with difficult ventilation:vascular compression(P=0.044), rymphoma(P=0.006), large tumors(P=0.019), adaptive position(P=0.000) and tracheal compression(P=0.000), of which adaptive position (sensitivity=100%, positive predictive values=0.67,95%CI=0.37-0.95) and tracheal compression(sensitivity=100%, positive predictive values=0.89, 95%CI=0.54-1.00) are the strongest predictive factors in children with mediastinal tumor at risk of difficult ventilation of receiving general anaesthesia.Conclusion:Adaptive position and tracheal compression not only are the independent risk factors but also are the strongest predictive factors in children with mediastinal tumor at risk of difficult ventilation of receiving general anaesthesia.