Zhang Xu, Song Hai-Cheng, Wang Kui-Liang, Ren Yue-Yi
Department of Heart Center, Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China.
World J Clin Cases. 2022 Jul 26;10(21):7592-7598. doi: 10.12998/wjcc.v10.i21.7592.
Tension pneumothorax of the contralateral lung during single-lung ventilation (SLV) combined with artificial pneumothorax can cause cardiac arrest due to bilateral pneumothorax. If not rapidly diagnosed and managed, this condition can lead to sudden death. We describe the emergency handling procedures and rapid diagnostic methods for this critical emergency situation.
We report a case of bilateral pneumothorax in a neonatal patient who underwent thoracoscopic esophageal atresia and tracheoesophageal fistula repair under the combined application of SLV and artificial pneumothorax. The patient suffered sudden cardiac arrest and received emergency treatment to revive her. The recognition of dangerous vital sign parameters, rapid evacuation of the artificial pneumothorax, and initiation of lateral position cardiopulmonary resuscitation while simultaneously removing the endotracheal tube to the main airway are critically important. Moreover, even though the sinus rhythm was restored, the patient's continued tachycardia, reduced pulse pressure, and depressed pulse oximeter waveform were worrisome. We should highly suspect the possibility of pneumothorax and use rapid diagnostic methods to make judgment calls. Sometimes thoracoscopy can be used for rapid examination; if the mediastinum is observed to be shifted to the right, it may indicate tension pneumothorax. This condition can be immediately relieved by needle thoracentesis, ultimately allowing the safe completion of the surgical procedure.
Bilateral pneumothorax during SLV combined with artificial pneumothorax is rare but can occur at any time in neonatal thoracoscopic surgery. Therefore, anesthesiologists should consider this possibility, be alert, and address this rare but critical complication in a timely manner.
单肺通气（SLV）联合人工气胸时对侧肺发生张力性气胸可因双侧气胸导致心脏骤停。若不能迅速诊断和处理，这种情况可导致猝死。我们描述了这种危急紧急情况的应急处理程序和快速诊断方法。
我们报告一例新生儿患者在SLV联合人工气胸下行胸腔镜食管闭锁和气管食管瘘修复术时发生双侧气胸的病例。该患者突然心脏骤停并接受了复苏急救。识别危险的生命体征参数、迅速排出人工气胸、在将气管内导管移至主气道的同时开始侧卧位心肺复苏至关重要。此外，即使恢复了窦性心律，患者持续的心动过速、脉压降低和脉搏血氧饱和度波形压低仍令人担忧。我们应高度怀疑气胸的可能性并使用快速诊断方法进行判断。有时可使用胸腔镜进行快速检查；若观察到纵隔向右移位，则可能提示张力性气胸。通过胸腔穿刺可立即缓解这种情况，最终使手术得以安全完成。
SLV联合人工气胸时发生双侧气胸虽罕见，但在新生儿胸腔镜手术中可随时发生。因此，麻醉医生应考虑到这种可能性，保持警惕，并及时处理这种罕见但危急的并发症。
