Airway obstruction by a metastatic mediastinal tumor during anesthesia.

A case of low back pain syndrome was diagnosed due to spinal metastasis with unknown primary origin. During anesthesia for surgical stabilization, unexpected airway obstruction occurred after endotracheal intubation. Fiber-optic bronchoscopic examination showed narrowing of the trachea and main bronchi caused by extrinsic compression. After administration of neostigmine to reverse neuromuscular blockade, the patient resumed spontaneous breath. Airway obstruction was relieved thereafter. The extrinsic lesion was diagnosed as mediastinal lung cancer. The mechanism and management of this airway compromise caused by mediastinal tumor is discussed.