Hypercapnia as the Only Early Sign of Pneumothorax in Patient under General Anaesthesia

  • Lin Jett Hau Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
  • Ahmad Rusmili Hasyimah Siti Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
  • Palamong Nurhafizah Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
  • Mat Sani Fauzy Mohd Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
  • Han Yeh Poh Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
  • Tat Boon Yeap Medicine Based Discipline Department Faculty of Medicine and Health Sciences Universiti Malaysia Sabah 88400 Kota Kinabalu Sabah
Keywords: Hypercapnia, pneumothorax, general anaesthesia

Abstract

Pneumothorax is a well-known but rare complication of general anaesthesia (GA). Its presentation can be subtle and difficult to diagnose especially under GA. We present a case of a 50-year-old man who is a chronic smoker, underwent an emergency exploratory laparotomy for perforated gastric ulcer. After induction, there was hypercapnia which progressively worsened. Common causes of hypercapnia were excluded. Unequal breath sounds and tracheal deviation presented late and there was never desaturation. Bedside lung ultrasound showed absence of sliding sign and presence of bar-code sign over right lung which suggested right pneumothorax. Needle thoracocentesis and chest tube insertion were done upon diagnosis. We recommend that pneumothorax be suspected early in patient with persistent unexplained hypercapnia under GA and anaesthesiologists to be able to perform lung ultrasound as early intervention could be life saving.

Author Biographies

Lin Jett Hau, Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
Senior Medical Officer Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
Ahmad Rusmili Hasyimah Siti, Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
Senior Medical Officer Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
Palamong Nurhafizah, Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
Senior Medical Officer Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
Mat Sani Fauzy Mohd, Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
Senior Consultant Anaesthesiologist Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
Han Yeh Poh, Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
Senior Medical Officer Department of Anaesthesiology and Intensive Care, Hospital Lahad Datu, Sabah
Tat Boon Yeap, Medicine Based Discipline Department Faculty of Medicine and Health Sciences Universiti Malaysia Sabah 88400 Kota Kinabalu Sabah
Anaesthesiologist and Senior Lecturer Medicine Based Discipline Department Faculty of Medicine and Health Sciences Universiti Malaysia Sabah 88400 Kota Kinabalu Sabah

References

Bacon AK, Paix AD, Williamson JA, Webb RK, Chapman MJ. Crisis management during anaesthesia: Pneumothorax. Qual Saf Health Care 2005; 14:18

Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting pneumothorax. Chest 1987; 92:1009-12.

Cheng YL, Huang TW, Lin CK, Lee SC, Tzao C, Chen JC, et al. The impact of smoking in primary spontaneous pneumothorax. The Journal of Thoracic and Cardiovascular Surgery 2009; 138: 192-5

Fettal N and Taleb A. Pneumothorax secondary to chronic obstructive pulmonary disease. European Respiratory Journal 2012; 40: 558

Wauters J, Claus P, Brosens N, McLaughlin M, Hermans G, Malbrain M, et al. Relationship between Abdominal Pressure, Pulmonary Compliance, and Cardiac Preload in a Porcine Model. Critical Care Research and Practice 2012; 763181

Tautz TJ, Urwyler A, Antognini JF. Case Scenario: Increased end-tidal carbon dioxide; a diagnostic dilemma. Anesthesiology 2010; 112:440-6

Kline JP, Dionisio D, Sullivan K, Early T, Wolf J, Kline D. Detection of Pneumothorax with Ultrasound. AANA Journal 2013; 81: 265-71

Published
2019-03-25