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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2020; 7(01): S11
DOI: 10.1055/s-0040-1709597
Abstracts

Pneumothorax: Do not Always Blame the Central Line

Ankita Dey
1   Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
,
Srivats Ramamoorthy
1   Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
,
Prasanna U. Bidkar
1   Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
,
Pranit Patil
1   Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Background: Central venous cannulation is often held responsible for iatrogenic pneumothorax. We present a case where faulty PEEP valve was found to be responsible for the occurrence of pneumothorax.

Case Description: A 50-year-old male, with no known comorbidities, was posted for excision of left vestibular schwannoma. Preoperative investigations were normal. On the day of surgery, the patient was wheeled into the theater and standard monitors were attached. Anesthesia was induced with fentanyl, propofol, and rocuronium. After bag-mask ventilation for 3 minutes, airway was secured with an 8.0-mm endotracheal tube. Chest auscultation revealed bilateral rhonchi with a Shark-fin appearance on capnography; airway pressure was 40 cm H2O. A diagnosis of bronchospasm was made and was treated by deepening the plane of anesthesia and administration of salbutamol and hydrocortisone. A right subclavian vein cannulation was done, at second attempt. The patient was positioned right lateral position, immediately after which the airway pressure was increased to 37 cm H2O. Hence, he was reverted back to supine position, but the airway pressure remained persistently elevated. Despite no application of PEEP, it was noted in the monitor of a PEEP value of 12 to 15 cm H2O. Ventilation was then performed manually with bag, but the bellows continued to move. At this point, the hemodynamic parameters worsened. A provisional diagnosis of right pneumothorax was made and needle thoracostomy was done followed by placement of an ICD. The hemodynamic parameters improved and airway pressures settled.

Conclusion: Although central venous cannulation is often implicated in iatrogenic pneumothorax, we should look for other possibilities with an open mind. In our case, a diagnosis of pneumothorax was made presumably due to more than one attempt during subclavian vein cannulation. However, further analysis suggested a faulty PEEP valve to be responsible for it.



Publication History

Article published online:
25 March 2020

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