Images in anesthesia: Bilateral pneumothorax following tracheal extubation

Abstract

gency.1 Iatrogenic pneumothorax is more common than all forms of spontaneous pneumothorax.2 – 5 A 55-yr-old, 101 kg, male underwent cardiac surgery under general anesthesia. Examination of the heart and lungs showed no abnormality and the patient’s past medical history did not indicate any respiratory disease. The preoperative chest radiograph was normal. Arterial blood pressure, heart rate, and arterial oxygen saturation (SpO2) were stable during the operation. Because of hemodynamic instability extubation was possible only six days postoperatively. Soon after extubation, the patient developed cyanosis and SpO2 declined to 90%. Chest radiography revealed bilateral pneumothorax, which was treated successfully by inserting bilateral chest tubes. In the absence of chronic lung disease, especially bronchitis and emphysema, a diagnosis of iatrogenic pneumothorax was made.