Bacon A K, Paix A D, Williamson J A, Webb R K, Chapman M J
St John of God Hospital, Berwick, Victoria, Australia.
Qual Saf Health Care. 2005 Jun;14(3):e18. doi: 10.1136/qshc.2002.004424.
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.
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.
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.
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.
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.
气胸是一种潜在的危险状况，可能在麻醉期间意外发生。诊断属于排除性诊断，因为生命体征的初始变化（心肺功能失代偿和通气困难）不具有特异性，且此类变化的其他原因更为常见，而局部体征可能难以引出，尤其是在无法完全触及胸部的情况下。
研究先前描述的核心算法“COVER ABCD - A SWIFT CHECK”，辅以气胸特定子算法，在与麻醉相关的气胸管理中的作用。
从向澳大利亚事件监测研究（AIMS）报告的前4000起事件中提取并研究气胸报告。将使用上述算法组合对每个相关事件采用结构化方法的潜在表现与参与麻醉的麻醉医生报告的实际管理情况进行比较。
在65份报告中，气胸被列为可能的诊断；24例确诊为气胸，其中17例与全身麻醉相关。据认为，正确应用这些算法，在12%的病例中可使问题得到更早识别和/或更好管理。
在应用正压通气时，任何气胸都可能发展为危险的张力性气胸。麻醉期间对胸部的触及受限可能会影响诊断。识别任何术前气胸易患因素（例如，颈部基部周围的医源性或创伤性穿透操作）并与外科医生密切沟通很重要。对疑似病例进行穿刺诊断并正确插入胸腔引流管对于安全进行麻醉和手术至关重要。
