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Lee SK, Seo KH, Kim YJ, Youn EJ, Lee JS, Park J, Moon HS. Cardiac arrest caused by contralateral tension pneumothorax during one-lung ventilation: - A case report. Anesth Pain Med (Seoul) 2020; 15:78-82. [PMID: 33329794 PMCID: PMC7713858 DOI: 10.17085/apm.2020.15.1.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 12/12/2022] Open
Abstract
Background Tension pneumothorax on the contralateral lung during one-lung ventilation (OLV) can be life-threatening if not rapidly diagnosed and managed. However, diagnosis is often delayed because the classic signs of tension pneumothorax are similar to clinical manifestations commonly observed during OLV. Case We report a case of contralateral tension pneumothorax in a patient undergoing right upper lobectomy during OLV. The patient suffered from sudden cardiac arrest and was assisted by extra-corporeal membrane oxygenation. Conclusions Contralateral pneumothorax during OLV is rare but can occur at any time. Therefore, anesthesiologists should consider this critical complication.
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Affiliation(s)
- Soo Kyung Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Kwon Hui Seo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - You Jung Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Eun Ji Youn
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jun Suck Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jieun Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Hyun Soo Moon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon, Korea
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Hoechter DJ, Speck E, Siegl D, Laven H, Zwissler B, Kammerer T. Tension Pneumothorax During One-Lung Ventilation – An Underestimated Complication? J Cardiothorac Vasc Anesth 2018; 32:1398-1402. [DOI: 10.1053/j.jvca.2017.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Indexed: 01/28/2023]
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El Jaouhari SD, Mamane Nassirou O, Meziane M, Bensghir M, Haimeur C. [Gas tamponade following intraoperative pneumothorax on a single lung: A case study]. Rev Pneumol Clin 2017; 73:90-95. [PMID: 28259372 DOI: 10.1016/j.pneumo.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/24/2016] [Accepted: 01/21/2017] [Indexed: 06/06/2023]
Abstract
Intraoperative pneumothorax is a rare complication with a high risk of cardiorespiratory arrest by gas tamponade especially on a single lung. We report the case of a female patient aged 53 years who benefited from a left pneumonectomy on pulmonary tuberculosis sequelae. The patient presented early postoperative anemia with a left hemothorax requiring an emergency thoracotomy. In perioperative, the patient had a gas tamponade following a pneumothorax of the remaining lung, and the fate has been avoided by an exsufflation. Intraoperative pneumothorax can occur due to lesions of the tracheobronchial airway, of the brachial plexus, the placement of a central venous catheter or barotrauma. The diagnosis of pneumothorax during unipulmonary ventilation is posed by the sudden onset of hypoxia associated with increased airway pressures and hypercapnia. The immediate life-saving procedure involves fine needle exsufflation before the placement of a chest tube. Prevention involves reducing the risk of barotrauma by infusing patients with low flow volumes and the proper use of positive airway pressure, knowing that despite protective ventilation, barotraumas risk still exists.
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Affiliation(s)
- S D El Jaouhari
- Pôle anesthesie-réanimation, hôpital militaire d'instruction Mohammed V (HMIMV), faculté de médecine et de pharmacie,université Mohammed V Souissi, Rabat, Maroc.
| | - O Mamane Nassirou
- Pôle anesthesie-réanimation, hôpital militaire d'instruction Mohammed V (HMIMV), faculté de médecine et de pharmacie,université Mohammed V Souissi, Rabat, Maroc
| | - M Meziane
- Pôle anesthesie-réanimation, hôpital militaire d'instruction Mohammed V (HMIMV), faculté de médecine et de pharmacie,université Mohammed V Souissi, Rabat, Maroc
| | - M Bensghir
- Pôle anesthesie-réanimation, hôpital militaire d'instruction Mohammed V (HMIMV), faculté de médecine et de pharmacie,université Mohammed V Souissi, Rabat, Maroc
| | - C Haimeur
- Pôle anesthesie-réanimation, hôpital militaire d'instruction Mohammed V (HMIMV), faculté de médecine et de pharmacie,université Mohammed V Souissi, Rabat, Maroc
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Santhosh MCB, Bhat Pai R, Rao RP. Anesthetic management of nephrectomy in a chronic obstructive pulmonary disease patient with recurrent spontaneous pneumothorax. Braz J Anesthesiol 2016; 66:423-5. [PMID: 27343795 DOI: 10.1016/j.bjane.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/05/2014] [Indexed: 11/26/2022] Open
Abstract
Nephrectomies are usually performed under general anesthesia alone or in combination with regional anesthesia and rarely under regional anesthesia alone. We report the management of a patient with chronic obstructive pulmonary disease with a history of recurrent spontaneous pneumothorax undergoing nephrectomy under regional anesthesia alone.
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Affiliation(s)
| | - Rohini Bhat Pai
- Department of Anesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Raghavendra P Rao
- Department of Anesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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Santhosh MCB, Bhat Pai R, Rao RP. [Anesthetic management of nephrectomy in a chronic obstructive pulmonary disease patient with recurrent spontaneous pneumothorax]. Rev Bras Anestesiol 2016; 66:423-5. [PMID: 27343353 DOI: 10.1016/j.bjan.2014.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/05/2014] [Indexed: 10/24/2022] Open
Abstract
Nephrectomies are usually performed under general anesthesia alone or in combination with regional anesthesia and rarely under regional anesthesia alone. We report the management of a patient with chronic obstructive pulmonary disease with a history of recurrent spontaneous pneumothorax undergoing nephrectomy under regional anesthesia alone.
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Affiliation(s)
| | - Rohini Bhat Pai
- Departamento de Anestesiologia, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, Índia
| | - Raghavendra P Rao
- Departamento de Anestesiologia, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, Índia
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Arai H, Tajiri M, Ebuchi K, Ando K, Okudela K, Gamo M, Masuda M. Contralateral tension pneumothorax during video-assisted thorascoscopic surgery for lung cancer: a case report. Clin Respir J 2016; 12:298-301. [DOI: 10.1111/crj.12470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/21/2016] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Hiromasa Arai
- Department of General Thoracic Surgery; Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi; Kanazawa-ku Yokohama 236-8651 Japan
| | - Michihiko Tajiri
- Department of General Thoracic Surgery; Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi; Kanazawa-ku Yokohama 236-8651 Japan
| | - Keigo Ebuchi
- Department of Anesthesiology; Yokohoma City University Graduate School of Medicine, 3-9 Fukuura; Kanazawa-ku Yokohama 236-0004 Japan
| | - Kohei Ando
- Department of General Thoracic Surgery; Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi; Kanazawa-ku Yokohama 236-8651 Japan
| | - Koji Okudela
- Department of Pathology; Yokohoma City University Graduate School of Medicine, 3-9 Fukuura; Kanazawa-ku Yokohama 236-0004 Japan
| | - Masahiro Gamo
- Department of Anesthesiology; Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi; Kanazawa-ku Yokohama 236-8651 Japan
| | - Munetaka Masuda
- Departoment of Surgery; Yokohoma City University Graduate School of Medicine, 3-9 Fukuura; Kanazawa-ku Yokohama 236-0004 Japan
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Kenta O, Shoko A, Takeshi I, Satoshi H, Yuji F, Yasushi S, Masato M, Meinoshin O. Dependent Lung Tension Pneumothorax During 1-Lung Ventilation. ACTA ACUST UNITED AC 2015; 5:61-3. [DOI: 10.1213/xaa.0000000000000180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ender J, Brodowsky M, Falk V, Baunsch J, Koncar-Zeh J, Kaisers UX, Mukherjee C. High-Frequency Jet Ventilation as an Alternative Method Compared to Conventional One-Lung Ventilation Using Double-Lumen Tubes During Minimally Invasive Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 2010; 24:602-7. [PMID: 20056443 DOI: 10.1053/j.jvca.2009.10.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Pneumothorax is a potentially dangerous condition which may arise unexpectedly during anaesthesia. The diagnosis is one of exclusion, as initial changes in vital signs (cardiorespiratory decompensation and difficulty with ventilation) are non-specific, and other causes of such changes are more common, whereas local signs may be difficult to elicit, especially without full access to the chest. OBJECTIVES To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for pneumothorax, in the management of pneumothorax occurring in association with anaesthesia. METHODS Reports of pneumothorax were extracted and studied from the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS). The potential performance of the structured approach, using the combination of algorithims described above for each of the relevant incidents, was compared with the actual management as reported by the anaesthetists involved. RESULTS Pneumothorax was noted as a possible diagnosis in 65 reports; 24 cases had a confirmed pneumothorax, of which 17 were in association with general anaesthesia. It was considered that, correctly applied, the application of the algorithms would have led to earlier recognition of the problem and/or better management in 12% of cases. CONCLUSION Any pneumothorax may become a dangerous tension pneumothorax with the application of positive pressure ventilation. Limited access to the chest during anaesthesia may compromise the diagnosis. Recognition of any preoperative predisposition to a pneumothorax (for example, iatrogenic or traumatic penetrating procedures around the base of the neck) and close communication with the surgeon are important. Aspiration diagnosis in suspected cases and correct insertion of a chest drain are essential for the safe conduct of anaesthesia and surgery.
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Affiliation(s)
- A K Bacon
- St John of God Hospital, Berwick, Victoria, Australia
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Pompeo E, Tacconi F, Mineo D, Mineo TC. The role of awake video-assisted thoracoscopic surgery in spontaneous pneumothorax. J Thorac Cardiovasc Surg 2007; 133:786-90. [PMID: 17320585 DOI: 10.1016/j.jtcvs.2006.11.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 10/25/2006] [Accepted: 11/01/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We assessed in a randomized study the feasibility and efficacy of awake video-assisted thoracoscopic bullectomy with pleural abrasion to treat spontaneous pneumothorax. METHODS Between January 2001 and June 2005, a total of 43 patients with primary spontaneous pneumothorax were randomly assigned by computer to undergo video-assisted thoracoscopic bullectomy and pleural abrasion under sole thoracic epidural anesthesia or general anesthesia with single-lung ventilation (control group). Primary outcome measures included technical feasibility and patient satisfaction with anesthesia as scored into 4 grades (from 1, unsatisfactory, to 4, excellent). Secondary outcome measures included global operating room time, assessment of thoracic pain by visual analog pain scale, number of nursing care calls, hospital stay, and recurrences within 12 months. RESULTS In the awake group, technical feasibility was scored as excellent, good, and satisfactory in 8, 7, and 6 patients, respectively. Intergroup comparisons (awake versus control) showed that global operating room time (78.0 +/- 20.0 vs 105.0 +/- 15.0 minutes, P < .0001), perioperative visual analog pain scale score (2.0 +/- 3.0 vs 3.5 +/- 2.0, P = .005), nursing care calls (2.0 +/- 1 vs 3.0 +/- 3.0, P = .017), hospital stay (2.0 +/- 1.0 days vs 3.0 +/- 1.0 days, P < .0001), and overall costs (2540 euros +/- 352 euros vs 3550 euros +/- 435 euros, P < .0001) were significantly better in the awake group. In the awake group, 5 patients (23.8%) could be discharged within the first 24 postoperative hours. One patient in the awake group and 2 patients in the control group had recurrences within 12 months (difference not significant). CONCLUSION In our study, awake video-assisted thoracoscopic bullectomy with pleural abrasion proved easily feasible and resulted in shorter hospital stays and reduced procedure-related costs while providing equivalent outcome to procedures performed under general anesthesia.
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Affiliation(s)
- Eugenio Pompeo
- Thoracic Surgery Division, Tor Vergata University School of Medicine, Rome, Italy.
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Abstract
A 76-year-old woman underwent double-lumen endotracheal tube intubation for right upper lobectomy. During one-lung ventilation, she developed tension pneumothorax on her dependent lung and suffered cardiac arrest. The presenting signs of tension pneumothorax--hypoxemia, hypotension, and increased airway pressure--are relatively common during this procedure, leading to a delay in diagnosis and effective treatment. When all three signs occur together during one-lung ventilation, cardiovascular collapse can result and serious consideration must be given to the diagnosis of tension pneumothorax in the dependent lung.
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Affiliation(s)
- Weili Weng
- Department of Anesthesiology, Winthrop University Hospital, Mineola, NY, USA.
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Malik S, Shapiro WA, Jablons D, Katz JA. Contralateral tension pneumothorax during one-lung ventilation for lobectomy: diagnosis aided by fiberoptic bronchoscopy. Anesth Analg 2002; 95:570-2, table of contents. [PMID: 12198039 DOI: 10.1097/00000539-200209000-00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPLICATIONS Tension pneumothorax during one-lung ventilation can be a life threatening emergency. Clinical diagnosis may be confusing in the operative setting. We present a case in which fiberoptic bronchoscopy excluded tube malpositioning and lead us to the diagnosis of a tension pneumothorax.
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Affiliation(s)
- Sundeep Malik
- Department of Anesthesia, University of California-San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143-0648, USA
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Malik S, Shapiro WA, Jablons D, Katz JA. Contralateral Tension Pneumothorax During One-Lung Ventilation for Lobectomy: Diagnosis Aided by Fiberoptic Bronchoscopy. Anesth Analg 2002. [DOI: 10.1213/00000539-200209000-00014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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