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Pneumothorax following shoulder arthroscopy under combined regional and general anaesthesia—A case report
INTRODUCTION: Pneumothorax is a most rare intraoperative event but jeopardise safety. Risk factors for its occurrence should be acknowledged and it should be considered in cases of unexpected deterioration of oxygenation that not respond to standard management to improve oxygenation. PRESENTATION OF...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885014/ https://www.ncbi.nlm.nih.gov/pubmed/27218200 http://dx.doi.org/10.1016/j.ijscr.2016.05.012 |
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author | Leander-Olsson, Oskar Borglund-Hemph, Anna Jakobsson, Jan G. |
author_facet | Leander-Olsson, Oskar Borglund-Hemph, Anna Jakobsson, Jan G. |
author_sort | Leander-Olsson, Oskar |
collection | PubMed |
description | INTRODUCTION: Pneumothorax is a most rare intraoperative event but jeopardise safety. Risk factors for its occurrence should be acknowledged and it should be considered in cases of unexpected deterioration of oxygenation that not respond to standard management to improve oxygenation. PRESENTATION OF CASE: We describe a patient with mild obesity and recent shoulder trauma scheduled for elective arthroscopy under combined interscalene block and general anaesthesia in the beach chair position. The block was performed with ultrasound guidance in accordance with the departmental routines and before the induction of general anaesthesia. The patient experienced low saturation shortly after administration of general anaesthesia. A thoracic ultrasound was performed in order to rule out pneumothorax and recruitment manoeuvres was done based on the suspicion of atelectasis. Surgery was commenced under pressure controlled ventilation and saturation was kept around 90 at FiO2 1.0 after recruitment manoeuvres. An initial postoperative lung X-ray on the operating table showed subcutaneous emphysema but no pneumothorax. A postoperative CT-thorax, patient still intubated, showed an extensive pneumothorax that was treated with pulmonary drainage. Patient had subsequently an uncomplicated postoperative course. DISCUSSION: We can not state “whom to blame”, the interscalene block, intubation and pressures assisted ventilation, recruitment manoeuvres, or surgery? In this paper we discuss possible causes that should raise the suspicion around pneumothorax in patients exhibiting unexpected low saturation perioperatively. CONCLUSION: Compromised oxygenation during surgery that not respond to recruitment should raise suspicion about pneumothorax. |
format | Online Article Text |
id | pubmed-4885014 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-48850142016-06-07 Pneumothorax following shoulder arthroscopy under combined regional and general anaesthesia—A case report Leander-Olsson, Oskar Borglund-Hemph, Anna Jakobsson, Jan G. Int J Surg Case Rep Case Report INTRODUCTION: Pneumothorax is a most rare intraoperative event but jeopardise safety. Risk factors for its occurrence should be acknowledged and it should be considered in cases of unexpected deterioration of oxygenation that not respond to standard management to improve oxygenation. PRESENTATION OF CASE: We describe a patient with mild obesity and recent shoulder trauma scheduled for elective arthroscopy under combined interscalene block and general anaesthesia in the beach chair position. The block was performed with ultrasound guidance in accordance with the departmental routines and before the induction of general anaesthesia. The patient experienced low saturation shortly after administration of general anaesthesia. A thoracic ultrasound was performed in order to rule out pneumothorax and recruitment manoeuvres was done based on the suspicion of atelectasis. Surgery was commenced under pressure controlled ventilation and saturation was kept around 90 at FiO2 1.0 after recruitment manoeuvres. An initial postoperative lung X-ray on the operating table showed subcutaneous emphysema but no pneumothorax. A postoperative CT-thorax, patient still intubated, showed an extensive pneumothorax that was treated with pulmonary drainage. Patient had subsequently an uncomplicated postoperative course. DISCUSSION: We can not state “whom to blame”, the interscalene block, intubation and pressures assisted ventilation, recruitment manoeuvres, or surgery? In this paper we discuss possible causes that should raise the suspicion around pneumothorax in patients exhibiting unexpected low saturation perioperatively. CONCLUSION: Compromised oxygenation during surgery that not respond to recruitment should raise suspicion about pneumothorax. Elsevier 2016-05-11 /pmc/articles/PMC4885014/ /pubmed/27218200 http://dx.doi.org/10.1016/j.ijscr.2016.05.012 Text en © 2016 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Case Report Leander-Olsson, Oskar Borglund-Hemph, Anna Jakobsson, Jan G. Pneumothorax following shoulder arthroscopy under combined regional and general anaesthesia—A case report |
title | Pneumothorax following shoulder arthroscopy under combined regional and general anaesthesia—A case report |
title_full | Pneumothorax following shoulder arthroscopy under combined regional and general anaesthesia—A case report |
title_fullStr | Pneumothorax following shoulder arthroscopy under combined regional and general anaesthesia—A case report |
title_full_unstemmed | Pneumothorax following shoulder arthroscopy under combined regional and general anaesthesia—A case report |
title_short | Pneumothorax following shoulder arthroscopy under combined regional and general anaesthesia—A case report |
title_sort | pneumothorax following shoulder arthroscopy under combined regional and general anaesthesia—a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885014/ https://www.ncbi.nlm.nih.gov/pubmed/27218200 http://dx.doi.org/10.1016/j.ijscr.2016.05.012 |
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