Neonatal pneumothorax – an unexpected perioperative complication

Glaisyer, Hilary; Way, Carolyn

doi:10.1111/j.1460-9592.2004.01558.x

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…Pneumothorax is uncommon in the pediatric population without risk factors [ 1 ]. They occur mainly due to external causes or underlying lung disease.…”

Section: Discussionmentioning

confidence: 99%

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Major pneumothorax during pediatric cardiac MRI procedure under general anesthesia: step-by-step analysis and importance of a well-known environment and material

Delhez,

Bairy,

Mitchell

et al. 2024

BMC Anesthesiol

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Background To perform step-by-step analysis of the different factors (material, anesthesia technique, human, and location) that led to major pneumothorax during an infrequent pediatric cardiac MRI and to prevent its occurrence in the future. Anesthesia equipment used in a remote location is often different than those in operating rooms. For magnetic resonance imaging (MRI), ventilation devices and monitors must be compatible with the magnetic fields. During cardiac MRI numerous apneas are required and, visual contact with the patient is limited for clinical evaluation. Anesthesia-related barotrauma and pneumothorax are rare in children and the first symptoms can be masked. Case Presentation A 3-year-old boy with atrial septal defect (ASD) and suspicious partial anomalous pulmonary venous return was anesthetized and intubated to perform a follow up with MRI. Sevoflurane maintenance and ventilation were performed using a circular CO2 absorber device, co-axial circuit, and 500 mL pediatric silicone balloon. Apneas were facilitated by Alfentanyl boluses and hyperventilation. A few moderated desaturations occurred during the imaging sequences without hemodynamic changes. At the end of the MRI, facial subcutaneous emphysema was observed by swollen eyelids and crackling snow neck palpation. A complete left pneumothorax was diagnosed by auscultation, sonography examination, and chest radiograph. Pneumo-mediastinum, -pericardium and -peritoneum were present. A chest drain was placed, and the child was extubated and transferred to the pediatric intensive care unit (PICU). Despite the anesthesiologist’s belief that PEEP was minimal, critical analysis revealed that PEEP was maintained at a high level throughout anesthesia. After the initial barotrauma, repeated exposure to high pressure led to the diffusion of air from the pleura to subcutaneous tissues and mediastinal and peritoneal cavities. Equipment check revealed a functional circular circuit; however, the plastic adjustable pressure-limiting valve (APL) closed within the last 30° rotation. The balloon was found to be more rigid and demonstrated significantly reduced compliance. Conclusions Anesthetists require proficiency is using equipment in non-OR locations and this equipment must be properly maintained and checked for malfunctions. Controlling the human factor risks by implementing checklists, formations, and alarms allows us to reduce errors. The number of pediatric anesthesia performed routinely appeared to be essential for limiting risks and reporting our mistakes will be a benefit for all who care about patients.

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“…Pneumothorax is uncommon in the pediatric population without risk factors [ 1 ]. They occur mainly due to external causes or underlying lung disease.…”

Section: Discussionmentioning

confidence: 99%

“…Anesthesia-related barotrauma and pneumothorax are rare in children [ 1 ] and the first symptoms can go unnoticed due to mechanical ventilation and high fractional inspired oxygen (FiO 2 ). Pneumothorax due to barotraumatism in pediatric is relatively well-documented in the literature.…”

Section: Introduction/backgroundmentioning

confidence: 99%

Major pneumothorax during pediatric cardiac MRI procedure under general anesthesia: step-by-step analysis and importance of a well-known environment and material

Delhez,

Bairy,

Mitchell

et al. 2024

BMC Anesthesiol

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“…Kumar and Walker[ 28 ] reported cases of perforation of the airway caused by the bougie. Glaisyer and Way[ 29 ] reported 3 cases of pneumothorax during surgery in neonates, and no specific cause was determined, but 2 cases were reintubated using the bougie. In two patients with pneumothorax reported by Parekh et al [ 1 ], it was suspected that pneumothorax was caused by trauma to the tracheal wall that occurred during bougie-guided endotracheal intubation.…”

Section: Risk Factorsmentioning

confidence: 99%

Review of risk factors, clinical manifestations, rapid diagnosis, and emergency treatment of neonatal perioperative pneumothorax

Zhang¹,

Zhang²,

Ren³

2022

World J Clin Cases

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Perioperative neonatal pneumothorax (NP) is rare but very fatal. Most of the surgeries and treatments in the neonatal period are time-limited or emergent, and there are often some risk factors for pneumothorax before surgery. Physicians, surgeons and anesthesiologists need to identify possible risk factors for pneumothorax before surgery in preterm babies, patients receiving mechanical ventilation and those with underlying lung disease. The clinical presentation of NP is nonspecific, and patients may rapidly develop life-threatening complications if not promptly diagnosed and managed. This review highlights recent progress in the identification of risk factors, clinical manifestations, diagnosis and management of NP during the perioperative period.

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“…[ 4 ] The use of bougie for reintubation or in the management of difficult airways in neonatal emergencies had been correlated with the occurrence of pneumothorax. [ 5 ]…”

mentioning

confidence: 99%

Pneumothorax in a preterm during tracheoesophageal fistula repair: Challenges in diagnosis and management

2018

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Neonatal pneumothorax – an unexpected perioperative complication

Cited by 6 publications

References 10 publications

Major pneumothorax during pediatric cardiac MRI procedure under general anesthesia: step-by-step analysis and importance of a well-known environment and material

Major pneumothorax during pediatric cardiac MRI procedure under general anesthesia: step-by-step analysis and importance of a well-known environment and material

Review of risk factors, clinical manifestations, rapid diagnosis, and emergency treatment of neonatal perioperative pneumothorax

Pneumothorax in a preterm during tracheoesophageal fistula repair: Challenges in diagnosis and management

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