Novel use of a guidewire to facilitate intubation in an obstructing anterior mediastinal mass

This report describes the management of a life-threatening tracheal obstruction due to a thymoma in the anterior mediastinum and the use of a guidewire to facilitate intubation. Anesthetic management of patients presenting with large anterior mediastinal masses is always challenging. Catastrophic complications can occur after loss of consciousness due to compression of the airway, heart, or great vessels. Intrathoracic airway compression may become complete with a life-threatening inability to ventilate the lungs. We discuss the management of this case presenting to a regional centre prior to transfer to a tertiary care facility and point out current recommendations for pre-induction assessment and airway management in similar cases. Confirmed guidewire placement prior to induction enabled intubation in a setting without cardiothoracic backup capabilities.