Ultrasound guiding the rapid diagnosis and treatment of perioperative pneumothorax: A case report. Zhang Gang,Huang Xiao-Yan,Zhang Lan World journal of clinical cases BACKGROUND:Pneumothorax is one of the most common causes of acute dyspnea. In patients under general anesthesia, the symptoms may not be obvious, which may delay diagnosis and treatment. Computed tomography is the gold standard for the diagnosis of pneumothorax, but is not suitable for rapid diagnosis of this complication. In contrast, lung ultrasonography can provide rapid diagnosis and treatment of pneumothorax. CASE SUMMARY:The patient was a 53-year-old man admitted for rupture of the spleen caused by an accidental fall and emergency splenectomy was planned. Anesthesia was induced, and tracheal intubation was performed successfully with a video laryngoscope. About 2 min after tracheal intubation, the airway peak pressure increased to 50 cm HO and the oxygen saturation dropped to 70%. According to the BLUE protocol, a recommended area of the chest was scanned by ultrasound. The pleural slide sign disappeared and obvious parallel line sign could be seen in the left lung. The boundary of pneumothorax (lung points) were rapidly confirmed by ultrasound. To avoid lung injury, a closed thoracic drainage tube was placed in the involved area. On day 9 after surgery, the patient was discharged from the hospital without any complications. CONCLUSION:Perioperative pneumothorax is rare but dangerous. It can be rapidly diagnosed and treated with ultrasound guidance. 10.12998/wjcc.v9.i35.11043

Pneumothorax during upper airway stimulation: Does experience make a difference? American journal of otolaryngology OBJECTIVES:Upper airway stimulation is a treatment option for select patients with obstructive sleep apnea. Pneumothorax may occur with UAS implantation during placement of the respiratory sensor. This study aims to evaluate the incidence of pneumothorax during UAS device placement. We hypothesize that sleep surgeons with high implantation volumes experience lower rates of pneumothorax compared to the general population of surgeons. METHODS:We also aim to describe management of pneumothorax when it does occur. The incidence of pneumothorax during UAS implantation among the general population of surgeons was assessed using the TriNetX Research Network. Additionally, a select group of Otolaryngologist sleep surgeons with a high UAS implantation volume were surveyed regarding experiences with UAS related pneumothoraces. RESULTS:8 pneumothoraces occurred among 3823 UAS procedures in the surveyed otolaryngologist sleep surgeon population. 4 required chest tube insertion. Among the general population cohort, 42 of 1233 patients developed pneumothorax after UAS implantation. The rates of pneumothorax between the otolaryngologist sleep surgeon cohort and general population of surgeons cohort were 0.21 % and 3.4 % respectively (p < 0.00001). CONCLUSION:Pneumothorax rarely occurs during UAS implantation. Surgeons with higher implantation volumes showed a lower incidence of pneumothorax. Pneumothorax management is dependent on patient stability, perioperative setting, and degree of injury. The use of needle decompression, chest tube placement, and suture placement also vary with clinical scenario. 10.1016/j.amjoto.2022.103577

Pneumothorax during shoulder surgery. Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke Background:Pneumothorax following shoulder arthroscopy, although rare, is documented in over 30 PubMed case reports as occurring during or within 10 hours post-procedure. Case Presentation:A fit septuagenarian underwent a two-hour arthroscopic rotator cuff repair with IV anaesthesia and laryngeal mask airway, without a nerve block. With one hour remaining of the operation, the patient had desaturation and hypotension. Lung sliding was absent on ultrasound and x-ray confirmed left-sided tension pneumothorax. Successful thoracic drain insertion and lung re-expansion facilitated his recovery, allowing discharge after 24 hours and symptom-free status at 6 months. Interpretation:This case highlights pneumothorax as an uncommon yet possible post-arthroscopic event. The speculated aetiology is the surgical procedure, where pump-induced pressure fluctuations may displace air into surrounding tissue. Instances of pneumomediastinum and subcutaneous emphysema without pneumothorax suggest arthroscopic origin of air. Prompt perioperative ultrasound can aid in detecting such critical complications. 10.4045/tidsskr.23.0542

Perioperative lung injury. Slinger Peter Best practice & research. Clinical anaesthesiology Patients are at risk for several types of lung injury in the perioperative period. These injuries include atelectasis, pneumonia, pneumothorax, bronchopleural fistula, acute lung injury and acute respiratory distress syndrome. Anesthetic management can cause, exacerbate or ameliorate most of these injuries. Clinical research trends show that traditional protocols for perioperative mechanical ventilation, using large tidal volumes without positive end-expiratory pressure (PEEP) can cause a sub-clinical lung injury and this injury becomes clinically important when any additional lung injury is added. Lung-protective ventilation strategies using more physiologic tidal volumes and appropriate levels of PEEP can decrease the extent of this injury. 10.1016/j.bpa.2007.08.004

Tension pneumothorax: a pulmonary complication secondary to regional anesthesia from brachial plexus interscalene nerve block. Childs Sharon G Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses Interscalene brachial plexus anesthesia is often used for surgeries involving the shoulder and upper arm. This method of regional anesthesia decreases pain, nausea, and vomiting associated with general anesthesia. One infrequent complication of interscalene brachial plexus block is tension pneumothorax. Recognition of early signs and symptoms of tension pneumothorax and expeditious treatment for rapid decompression before physiologic decompensation is mandatory. This article discusses the interscalene brachial plexus block procedure leading to the pathogenesis, clinical presentation, diagnosis, and treatment of tension pneumothorax. 10.1053/jpan.2002.36551