Tension pneumothorax and pneumoperitoneum after double-lumen endotracheal intubation

Description

A 75-year-old woman with a history of hypertension was admitted to our hospital for video-assisted thoracic surgery of the right caudal lung lobe because of a pT4N0M0 adenocarcinoma. After uneventful induction of anaesthesia, a difficult intubation was encountered due to a short stature and limited mobility of the neck. After multiple attempts a 35 French double-lumen tube was placed over a gum-elastic bougie with help of a video laryngoscope. To confirm correct placement a bronchoscopy was performed; however, the carina could not be visualised and the tube was repositioned several times.

Suddenly a swelling of the abdomen and subcutaneous emphysema in the neck were noticed, ventilation pressures increased, and the patient developed bradycardia. A tension pneumothorax was suspected and bilateral needle thoracentesis was performed. The double-lumen tube was replaced by a size 6.5 single-lumen tube. Bilateral thorax drains were placed and the patient was admitted to the intensive care....

http://ift.tt/2zAlMVL