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Unexpected Tension Pneumothorax Developed during Anesthetic Induction Aggravated by Positive Pressure Ventilation: A Case Report – Lumbar Fusion

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The article discusses a case study of a 66-year-old woman who underwent general anesthesia for spinal surgery and developed tension pneumothorax, a life-threatening condition. The patient did not have any respiratory symptoms before the anesthesia, but decreased breathing sounds were noticed in the left chest during auscultation. Subsequently, vital signs abnormalities and increased airway pressure were observed. Further investigation revealed unsuccessful attempts at left subclavian venous catheterization the previous day. Portable chest radiography confirmed the diagnosis of tension pneumothorax, and immediate intervention was performed to stabilize the patient’s condition. The study emphasizes the importance of recognizing the risk factors and symptoms of tension pneumothorax in intraoperative settings, even for patients with normal preoperative evaluations. Timely diagnosis and intervention are crucial to prevent life-threatening situations

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

Background and Objectives: Tension pneumothorax is a life-threatening emergency condition that requires immediate diagnosis and intervention. However, due to the non-specific symptoms and the rarity of its occurrence during surgery, anesthesiologists encounter difficulties in promptly diagnosing tension pneumothorax when it arises intraoperatively. Diagnosing tension pneumothorax can become even more challenging in unexpected situations in patients with normal preoperative evaluation for general…

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Medicina (Kaunas). 2023 Sep 8;59(9):1631. doi: 10.3390/medicina59091631.ABSTRACTBackground and Objectives: Tension pneumothorax is a life-threatening emergency condition that requires immediate diagnosis and intervention. However, due to the non-specific symptoms and the rarity of its occurrence during surgery, anesthesiologists encounter difficulties in promptly diagnosing tension pneumothorax when it arises intraoperatively. Diagnosing tension pneumothorax can become even more,

Medicina (Kaunas). 2023 Sep 8;59(9):1631. doi: 10.3390/medicina59091631.

ABSTRACT

Background and Objectives: Tension pneumothorax is a life-threatening emergency condition that requires immediate diagnosis and intervention. However, due to the non-specific symptoms and the rarity of its occurrence during surgery, anesthesiologists encounter difficulties in promptly diagnosing tension pneumothorax when it arises intraoperatively. Diagnosing tension pneumothorax can become even more challenging in unexpected situations in patients with normal preoperative evaluation for general anesthesia. Materials and Methods, Results: We report the case of a 66-year-old woman who underwent general anesthesia for oblique lateral interbody fusion surgery of her lumbar spine. Though she did not have any respiratory symptoms prior to the induction of anesthesia, auscultation following endotracheal intubation indicated decreased breathing sound in the left hemithorax of the chest. Subsequently, her vital signs showed tachycardia, hypotension, and hypoxemia, and the ventilator indicated a gradual increase in the airway pressure. We verified the proper depth of the endotracheal tube to exclude one-lung ventilation, and, in the meantime, learned that there had been unsuccessful attempts at left subclavian venous catheterization by the surgical department on the previous day. Tension pneumothorax was diagnosed through portable chest radiography in the operating room, and needle thoracostomy and chest tube insertion were performed immediately, which in turn stabilized her vital signs and airway pressure. The surgery was uneventful, and the chest tube was removed one week later after evaluation by the cardiothoracic department. The patient was discharged from hospital on postoperative day 14 without known complications. s: Anesthesiologists should be aware of the conditions and risk factors that may cause tension pneumothorax and remain vigilant for signs of its development throughout surgery, even for patients who show normal preoperative assessments. An undetected small pneumothorax without any symptoms can progress to tension pneumothorax through positive pressure ventilation during general anesthesia, posing a life-threatening situation. If a tension pneumothorax is highly suspected through clinical assessments, its prompt differentiation and timely diagnosis are crucial, allowing for rapid intervention to stabilize vital signs.

PMID:37763751 | PMC:PMC10535224 | DOI:10.3390/medicina59091631

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Unexpected Tension Pneumothorax Developed during Anesthetic Induction Aggravated by Positive Pressure Ventilation: A Case Report

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Medicina (Kaunas). 2023 Sep 8;59(9):1631. doi: 10.3390/medicina59091631.ABSTRACTBackground and Objectives: Tension pneumothorax is a life-threatening emergency condition that requires immediate diagnosis and intervention. However, due to the non-specific symptoms and the rarity of its occurrence during surgery, anesthesiologists encounter difficulties in promptly diagnosing tension pneumothorax when it arises intraoperatively. Diagnosing tension pneumothorax can become even more

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