14. Hypercapnia-An Enigma In The Diagnosis Of Expanding Pneumothorax During One Lung Anesthesia,

Gaddam Madhavi, Pavani Kalyanam, Subhakar Kandi,

Ind Res Pub Med Sci, 2015;1(3):90-94

ABSTRACT

Pneumothorax is a potentially dangerous condition, which may arise during general anaesthesia. Intraoperative diagnosis of pneumothorax is dif?cult due to inadequate access to the chest. The diagnosis is one of exclusion, as the changes in vital signs are non-speci?c, and other causes of such changes re?ecting abnormalities in hemodynamics and ventilation are more common.1 We report a case of intraoperative pneumothorax in a 52 yr old female patient with paraplegia secondary to spinal tuberculosis, posted for 'Anterior Spinal Fusion'. The patient was taken up for surgery after preoperative assessment. Intubation was attempted with 35Fr left double lumen tube (DLT), but could not succeed. In view of the limited experience of the surgeon, to facilitate surgery, intubation was attempted with 28Fr left DLT and isolation con?rmed clinically. Later patient was placed in right lateral decubitus position and left lung was isolated to facilitate surgery. The patient desaturated after isolation of the lung. Saturation improved promptly with oxygen supplementation to the non-dependent lung; but ETCO2 and airway pressures gradually increased. This has prompted us a possibility of pneumothorax and was con?rmed by detailed clinical examination and chest xray which showed right sided 'pneumothorax'. Pneumothorax was successfully managed with tube thoracostomy.

Key-words: Pneumothorax, Double lumen tube, Lung isolation, Lateral decubitus position, anterior spinal fusion.

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