Flynn David N, Eskildsen Jenny, Levene Jacob L, Allan Jennifer D, Bullard Ty L, Cobb Kathryn W
Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, USA.
Cureus. 2022 May 11;14(5):e24924. doi: 10.7759/cureus.24924. eCollection 2022 May.
Pneumothorax is a known complication following breast surgery but is likely underappreciated by anesthesiologists. Iatrogenic pneumothorax can be caused by needle injury during local anesthetic injection, surgical damage to the intercostal fascia or pleura, or pulmonary injury from mechanical ventilation. We present two cases of pneumothorax following bilateral mastectomy with bilateral pectoral blocks and immediate breast reconstruction. Both cases occurred at a freestanding ambulatory surgery center in patients with no history of lung disease. One patient was found to have bilateral pneumothoraxes after complaining of shortness of breath and chest pain in the post-operative care unit. The second patient was asymptomatic but found to have a right-sided pneumothorax on a chest X-ray (CXR) that was ordered to rule-out left-sided pneumothorax due to concern of intraoperative breach of the left chest wall. Both patients were treated with chest tubes, transferred to a nearby hospital, and discharged several days later. Anesthesiologists must be aware of this potentially life-threatening complication and consider pneumothorax in the differential diagnosis of perioperative hypoxemia, shortness of breath, chest pain, and hemodynamic collapse in patients undergoing breast surgery. Though traditionally diagnosed via radiograph, pneumothorax can be rapidly diagnosed with ultrasound. Tension pneumothorax should be decompressed immediately with a needle. A clinically significant, non-tension pneumothorax is treated with chest tube placement. Equipment necessary to treat pneumothorax should be available for emergency treatment in facilities wherever breast surgery is performed.
气胸是乳房手术后已知的并发症，但麻醉医生可能对此认识不足。医源性气胸可由局部麻醉注射时的针刺伤、肋间筋膜或胸膜的手术损伤，或机械通气导致的肺损伤引起。我们报告两例双侧乳房切除并双侧胸肌阻滞及即刻乳房重建术后发生气胸的病例。两例均发生在一家独立的门诊手术中心，患者均无肺部疾病史。一名患者在术后护理单元主诉呼吸急促和胸痛后被发现双侧气胸。第二名患者无症状，但因担心术中左胸壁破损而进行胸部X线检查（CXR）时发现右侧气胸。两名患者均接受了胸腔闭式引流管治疗，转至附近医院，数日后出院。麻醉医生必须意识到这种潜在的危及生命的并发症，并在对接受乳房手术患者围手术期低氧血症、呼吸急促、胸痛和血流动力学崩溃进行鉴别诊断时考虑气胸。虽然传统上通过X线片诊断气胸，但超声可快速诊断气胸。张力性气胸应立即用针进行减压。有临床意义的非张力性气胸通过放置胸腔闭式引流管治疗。无论在何处进行乳房手术，治疗气胸所需的设备都应在设施中备齐以供紧急治疗。
