Bilateral tension pneumothorax caused by an abrupt increase in airway pressure during cervical spine surgery in the prone position: A case report / 대한마취과학회지

Elevated peak inspiratory airway pressure (PIP) can occur during general anesthesia and is usually easily rectified. In rare circumstances it can lead to potentially fatal conditions such as tension pneumothorax. We report on a 77-year-old male patient admitted for a cervical laminoplasty. The preoperative chest radiograph showed normal findings and there was no medical history of allergy or underlying airway inflammation. Anesthesia induction and maintenance progressed uneventfully. However, 5 minutes after prophylactic antibiotic administration, PIP suddenly increased and blood pressure dropped. The operation was abandoned and the patient was moved to a supine position to perform chest radiography. Cardiac arrest occurred, and cardiopulmonary resuscitation was performed. The radiograph showed bilateral tension pneumothorax. Needle aspiration was immediately performed, and chest tubes were inserted. Ventilation rapidly improved and the vital signs normalized. The patient was discharged without sequelae on postoperative day 36.

Comparison of volume-control and pressure-control ventilation during one-lung ventilation / 대한마취과학회지

BACKGROUND: We hypothesized that pressure control ventilation allows a more even distribution in the lung and better maintenance of the mean airway pressure than is achieved with volume control ventilation. We try to compare the effect of pressure control ventilation (PC) with that of volume control ventilation without an end-inspiratory pause (VC) during one-lung ventilation (OLV) in an anesthetized, paralyzed patient for performing thoracopic bullectomy of the lung. METHODS: We ventilated 20 patients with VC and PC after the insertion of a thoracoscope in continual order for, at least for 15 minutes, for each, VC and PC procedure. At the end of VC and PC, the respiratory mechanics, gasometrics, and hemodynamic parameters were measured and collected. RESULTS: We found no significant differences between VC and PC except for the peak inspiratory airway pressure (PIP), the mean airway pressure and the arterial oxygen partial pressure (PaO2). The PIP was significantly decreased from 27.0 +/- 6.0 cmH2O (VC) to 21.8 +/- 5.4 cmH2O (PC). The mean airway pressure was significantly increased from 8.6 +/- 1.6 cmH2O (VC) to 9.4 +/- 2.0 cmH2O (PC), and the PaO2 was significantly increased from 252.9 +/- 97.3 mmHg (VC) to 285.2 +/- 103.8 mmHg (PC). CONCLUSIONS: If PC allows mechanical ventilation with the same tidal volume and respiratory rate as VC during OLV, then PC significantly increases the PaO2 but this is not clinically significant, and the PC significantly decreases the PIP, which induces barotrauma or volutrauma when the PIP is excessively high.

Subcutaneous Emphysema, Hypercarbia and Increased Peak Inspiratory Airway Pressure during Endoscopic Thyroidectomy : A case report

Endoscopic thyroidectomy has been increasingly used because it is minimally invasive, provides better cosmetic results as well as less, post-operative pain. However, the technique is associated with complications that, include subcutaneous emphysema, hypercarbia and pneumothorax. We treated a 45 year-old female patient who had subcutaneous emphysema, hypercarbia and increased peak inspiratory airway pressure due to carbon dioxide administered during the endoscopic thyroidectomy. After the above problems occurred, we increased the minute ventilation with 100% O2. The operation was over after about one hundred twenty minutes and ventilation was adequate so that arterial blood gas findings returned to the normal range in the recovery room. The patient was treated conservatively with oxygen and recovered completely at the time of discharge from the Hospital

Change of the Peak Inspiratory Airway Pressure and Exhaled Volume during One Lung Ventilation / 대한마취과학회지

BACKGROUND: Airway pressure increases during one-lung ventilation compared to two-lung ventilation. We measured the peak inspiratory airway pressure and the actual exhaled volume during one-lung and two-lung ventilation. And then we evaluated the loss of the exhaled volume according to the increase of peak insphatory airway pressure. METHODS: Left-sided double lumen endobronchial tube (male 37 Fr., female 35 Fr.) was inserted in 62 patients and then proper position of double lumen tube was confirmed with the fiberoptic bronchoscopy. After setting the tidal volume (10 ml/kg), respiratory rate 12/min, inspiratory: expiratory ratio (1: 2) and oxygen 2 1/min, we measured exhaled volume and peak inspiratory airway pressure during two-lung and one-lung ventilation in the supine and lateral decubitus position. RESULTS: The increase of the peak inspiratory airway pressure was ranged from 33.7% to 52.1% and exhaled volume decreased 9.5% to 14.8% in one-lung ventilation compared to two-lung ventilation. CONCLUSIONS: The decrease of actual tidal volume according to the increase of peak inspiratory airway pressure during one-lung ventilation would result in carbon dioxide retention. Therefore we should readjust ventilatory setting during one-lung ventilation.