Smajor Hemorrahage During Mediastinoscopy: Do You Panic or Do you Have a Protocol?

INTRODUCTION: Although uncommon, major vessel hemorrhage is the most feared complication of mediastinoscopy. Our goal was to determine the optimal management strategy and to develop a simple and accessible protocol for optimizing care in these situations.

METHODS: Data collection after reviewing the relevant literature. A literature review was conducted using the following databases: PubMed, Medline, Embase and ScienceDirect.

RESULTS: The protocol consists of three distinct parts - initial checklist, considerations in minor bleeding and performance in major bleeding. In this last section we propose an initial approach based mainly on fluid resuscitation and immediate surgical correction if the former has not been successful.

CONCLUSION: Mediastinoscopy continues to be an important and effective diagnostic tool. However, it can cause important iatrogenic lesions which the anesthesiologist and surgical team must be prepared to diagnose early and treat properly.