Heyba Mohammed, Rashad Areej, Al-Fadhli Abdul-Aziz
Kuwait Board of Anesthesiology, Kuwait City, Kuwait.
Department of Anesthesia and Intensive Care, Farwaniya Hospital, Sabah Al Nasser, Kuwait.
Case Rep Anesthesiol. 2020 Apr 7;2020:9273903. doi: 10.1155/2020/9273903. eCollection 2020.
Intraoperative pneumothorax is a rare but potentially lethal complication during general anesthesia. History of lung disease, barotrauma, and laparoscopic surgery increase the risk of developing intraoperative pneumothorax. The diagnosis during surgery could be difficult because the signs are often nonspecific. We report a case of a middle-aged gentleman who developed right pneumothorax during an elective laparoscopic cholecystectomy. The patient had no risk factors for adverse events during the preoperative assessment (ASA1). The patient underwent general anesthesia and was put on mechanical ventilation. The first signs of abnormality immediately after surgical port insertion were tachycardia and low oxygen saturation in addition to sings of airway obstruction. The diagnosis of pneumothorax was made clinically by chest auscultation and later confirmed by intraoperative chest radiograph. Supportive treatment was started immediately through halting the surgery and manually ventilating the patient using 100% oxygen. Definitive treatment was then done by inserting an intercostal tube. After stabilizing the patient, the surgery was completed; then, the patient was extubated and shifted to the surgical ward. Postoperative computed tomography (CT) scan was done and showed only minimal liver laceration. The patient was discharged after removing the intercostal tube and was stable at the follow-up visit. Therefore, it is important to have a high index of suspicion to early detect and treat such complication. In addition, good communication with the surgeon and use of available diagnostic tools will aid in the proper management of such cases.
术中气胸是全身麻醉期间一种罕见但可能致命的并发症。肺部疾病史、气压伤和腹腔镜手术会增加发生术中气胸的风险。手术期间的诊断可能很困难，因为体征往往不具有特异性。我们报告一例中年男性在择期腹腔镜胆囊切除术期间发生右侧气胸的病例。该患者在术前评估（ASA1级）时没有不良事件的风险因素。患者接受全身麻醉并进行机械通气。手术切口插入后立即出现的异常最初体征除气道梗阻体征外，还有心动过速和低氧饱和度。通过胸部听诊临床诊断为气胸，随后经术中胸部X线片证实。立即通过停止手术并使用100%氧气对患者进行手动通气开始支持治疗。然后通过插入肋间导管进行确定性治疗。患者病情稳定后，完成手术；随后，患者拔管并转入外科病房。术后进行计算机断层扫描（CT），结果显示仅有轻微肝裂伤。患者在拔除肋间导管后出院，随访时情况稳定。因此，保持高度怀疑指数对于早期发现和治疗此类并发症很重要。此外，与外科医生进行良好沟通并使用可用的诊断工具将有助于对此类病例进行妥善管理。
