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Canadian Journal of Anesthesia 49:90-91 (2002)
© Canadian Anesthesiologists' Society, 2002
Cardiothoracic Anesthesia, Respiration and Airway

Images in Anesthesia: Bilateral pneumothorax following tracheal extubation

Rachid Badaoui, MD, Chafik El Kettani, MD, Martiel Ouendo, MD, Mohamed Fikri, MD and Philippe Montravers, MD

Amiens France


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PNEUMOTHORAX may be a medical emergency.1 Iatrogenic pneumothorax is more common than all forms of spontaneous pneumothorax.2–5 A 55-yr-old, 101 kg, male underwent cardiac surgery under general anesthesia. Examination of the heart and lungs showed no abnormality and the patient's past medical history did not indicate any respiratory disease. The preoperative chest radiograph was normal. Arterial blood pressure, heart rate, and arterial oxygen saturation (SpO2) were stable during the operation. Because of hemodynamic instability extubation was possible only six days postoperatively. Soon after extubation, the patient developed cyanosis and SpO2 declined to 90%. Chest radiography revealed bilateral pneumothorax, which was treated successfully by inserting bilateral chest tubes. In the absence of chronic lung disease, especially bronchitis and emphysema, a diagnosis of iatrogenic pneumothorax was made.



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  		Bilateral pneumothorax after cardiac surgery

 

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1 Williamson JA, Webb RK, Van der Walt JH, Runciman WB. The Australian Incident Monitoring Study. Pneumothorax: an analysis of 2000 incident reports. Anaesth Intensive Care 1993; 21: 642–5.[Medline]

2 Kolbitsch C, Pomaroli A, Lorenz I, Gassner M, Luger TJ. Pneumothorax following nasogastric feeding tube insertion in a tracheostomized patient after bilateral lung transplantation. Intensive Care Med 1997; 23: 440–2.[Medline]

3 McLuckie A, Frazer S. Bilateral pneumothorax after removal of a thyroglossal cyst. Anaesthesia 1989; 44: 72–3.[Medline]

4 Ramachandran M, Dulay VC, Lobo ZA, Kuriyan JB. Bilateral pneumothorax with pneumomediastinum under anaesthesia in a healthy female. Can Anaesth Soc J 1982; 29: 391–4.[Medline]

5 Nakamura V, Allaouchiche B, Lansiaux S, Chassard D. Pneumothorax bilatéral secondaire à une dilatation de sténose laryngée. Ann Fr Anesth Réanim 2000; 19: 68–9.[Medline]





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