Anesthetic Management of a Paraparetic Patient With Multiple Lung Bullae

Bansal, Sonia; Surve, Rohini M.; Venkatapura, Ramesh J.

doi:10.1097/ana.0b013e3182973366

Cited by 7 publications

(11 citation statements)

References 2 publications

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“…e presence of emphysematous bullae or smaller blebs is a well-known situation in which pneumothorax develops with positive pressure ventilation due to bullae or blebs rupture [14]. e current recommendation is to avoid positive pressure during the ventilation of patients with known emphysematous lung disease, including bullae and pleural blebs [15]. Previous cases reported the development of pneumothorax in mechanically ventilated patients under general anesthesia, in which the presence of bullae was the main reason for the development of pneumothorax [15].…”

Section: Discussionmentioning

confidence: 99%

“…e current recommendation is to avoid positive pressure during the ventilation of patients with known emphysematous lung disease, including bullae and pleural blebs [15]. Previous cases reported the development of pneumothorax in mechanically ventilated patients under general anesthesia, in which the presence of bullae was the main reason for the development of pneumothorax [15]. Single lung ventilation, either intentional or accidental, might lead to the development of pneumothorax with positive pressure ventilation, especially in the presence of small blebs [16].…”

Section: Discussionmentioning

confidence: 99%

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Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Heyba

Rashad

Al-Fadhli

2020

Case Reports in Anesthesiology

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Heyba

Rashad

Al-Fadhli

2020

Case Reports in Anesthesiology

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“…A recent study showed that, during VAT surgery, the bullae were expanded enough to be identified as “bullae” due to the sufficient pressure inside the bullae even when the normal lung parenchyma was maintained at approximately 30-50% of the expansion level under low pressure ventilation by means of HFJV + PEEP [8]. Current practice recommends the avoidance of positive pressure ventilation in the presence of bullae [9]. In this case, mechanical ventilation is considered the main predisposing factor for rupture of bullae and hemopneumothorax formation, which in the presence of mechanical ventilation caused the development of tension pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

Unexpected Tension Pneumothorax-Hemothorax during Induction of General Anaesthesia

Amaniti

Provitsaki

Papakonstantinou

et al. 2019

Case Reports in Anesthesiology

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Tension pneumothorax during general anaesthesia is a rare but possibly deleterious event, especially where predisposing factors are absent or unknown, making diagnosis even challenging. We describe a case of a healthy middle-aged woman, who was planned to receive general anaesthesia for total thyroidectomy. After intubation, the patient experienced marked hypoxemia (SpO2=75%), hypotension, and tachycardia. Manual positive pressure ventilation seemed to worsen hypoxemia and tachycardia, while apnoeic oxygenation through circle system with valve open slightly improved cardiorespiratory collapse. The effect of positive ventilation, along with the absence of breath sounds in the right hemithorax and cardiorespiratory collapse, established the diagnosis of tension pneumothorax, managed immediately with emergency thoracentesis and placement of a thoracostomy tube. The patient was improved and pneumothorax was confirmed with chest X-ray and CT. The latter also confirmed the presence of bilateral multiple bullae. The operation was postponed and the patient was extubated a few hours later, in good condition. After thorough evaluation for any systemic disease, which was negative, the patient underwent two-stage thoracotomy for bullectomy.

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“…Extrathoracic surgery in patients with bullae can be conducted using various anesthetic techniques such as general anesthesia with double-lumen tube, inhalational anesthesia with spontaneous ventilation, or sedation using i/v dexmedetomidine infusion. [5] Spontaneous ventilation, whenever possible, is considered the safest approach for anesthetizing these patients. [15] As the bullae are more compliant than the normal lung, they tend to fill preferentially during spontaneous ventilation.…”

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confidence: 99%