PDF(Pubmed)
Abstract：
Background and Objectives: Tension pneumothorax is a life-threatening emergency condition that requires immediate diagnosis and intervention. However, due to the non-specific symptoms and the rarity of its occurrence during surgery, anesthesiologists encounter difficulties in promptly diagnosing tension pneumothorax when it arises intraoperatively. Diagnosing tension pneumothorax can become even more challenging in unexpected situations in patients with normal preoperative evaluation for general anesthesia. Materials and Methods, Results: We report the case of a 66-year-old woman who underwent general anesthesia for oblique lateral interbody fusion surgery of her lumbar spine. Though she did not have any respiratory symptoms prior to the induction of anesthesia, auscultation following endotracheal intubation indicated decreased breathing sound in the left hemithorax of the chest. Subsequently, her vital signs showed tachycardia, hypotension, and hypoxemia, and the ventilator indicated a gradual increase in the airway pressure. We verified the proper depth of the endotracheal tube to exclude one-lung ventilation, and, in the meantime, learned that there had been unsuccessful attempts at left subclavian venous catheterization by the surgical department on the previous day. Tension pneumothorax was diagnosed through portable chest radiography in the operating room, and needle thoracostomy and chest tube insertion were performed immediately, which in turn stabilized her vital signs and airway pressure. The surgery was uneventful, and the chest tube was removed one week later after evaluation by the cardiothoracic department. The patient was discharged from hospital on postoperative day 14 without known complications. Conclusions: Anesthesiologists should be aware of the conditions and risk factors that may cause tension pneumothorax and remain vigilant for signs of its development throughout surgery, even for patients who show normal preoperative assessments. An undetected small pneumothorax without any symptoms can progress to tension pneumothorax through positive pressure ventilation during general anesthesia, posing a life-threatening situation. If a tension pneumothorax is highly suspected through clinical assessments, its prompt differentiation and timely diagnosis are crucial, allowing for rapid intervention to stabilize vital signs.
摘要：
背景和目的：张力性气胸是一种危及生命的紧急情况，需要立即诊断和干预。然而,由于非特异性症状和在手术过程中很少发生，术中出现张力性气胸时，麻醉医师在及时诊断方面遇到困难。在全身麻醉术前评估正常的患者中，在意外情况下诊断张力性气胸可能变得更具挑战性。材料与方法,结果：我们报告了一名66岁的女性，她接受了腰椎斜外侧椎间融合手术的全身麻醉。尽管她在麻醉诱导前没有任何呼吸道症状，气管插管后听诊显示左胸呼吸音减少。随后，她的生命体征显示心动过速,低血压,和低氧血症,呼吸机显示气道压力逐渐升高。我们验证了气管导管的适当深度，以排除单肺通气，and,同时,得知外科前一天进行左锁骨下静脉置管的尝试未成功。在手术室通过便携式胸片诊断为张力性气胸,并立即进行针式胸廓造口术和胸管插入，这反过来又稳定了她的生命体征和气道压力。手术很顺利,心胸科评估后一周拔除胸管。患者在术后第14天出院，无已知并发症。结论：麻醉医师应了解可能导致张力性气胸的情况和危险因素，并在整个手术期间对其发展的迹象保持警惕。即使是术前评估正常的患者。在全身麻醉期间，没有任何症状的未发现的小气胸可以通过正压通气发展为张力性气胸，威胁生命的情况.如果通过临床评估高度怀疑张力性气胸，它的及时鉴别和及时诊断至关重要，允许快速干预以稳定生命体征。
