|
1
|
Garioud A, Kristensen MS. Oxygen insufflation via the working channel during tracheal intubation guided by a flexible optical scope and benefits, dangers, and future of the method: a narrative review. BJA OPEN 2024; 12:100346. [PMID: 39469423 PMCID: PMC11513500 DOI: 10.1016/j.bjao.2024.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 08/30/2024] [Indexed: 10/30/2024]
Abstract
When performing tracheal intubation guided by a flexible optical scope, the operator may lose the anatomical orientation and hypoxia may occur. Oxygen insufflation through the working channel of the flexible optical scope is used by anaesthetists to prevent blurring of the lens and to prevent hypoxia. However, fatal iatrogenic injuries from this method are reported. Our aim is to review the current literature on oxygen insufflation through the working channel during tracheal intubation guided by a flexible optical scope, to identify its benefits and the source of its dangers, and ultimately to provide a basis for the development of a safer technique. We conducted a literature search of databases, guidelines, and textbooks using search terms related to oxygen insufflation through the working channel during intubation guided by a flexible optical scope. Clinical trials confirm that the technique results in better visibility and better oxygenation during intubation. Gastric rupture and pneumothorax were the most frequent types of injury. We identified that oxygen insufflation without pressure limitation during accidental misplacement of the flexible optical scope in the oesophagus, deep in the lower airways, or via a tear of the airway mucosa was the cause of barotrauma. We conclude that a delivered pressure below 40 cm H2O will likely carry a low risk of serious adverse outcomes. The technique in its current form seems unsafe, and future research should aim at developing a system that delivers oxygen at pressures respecting gastric and airway physiologic pressure thresholds with a flow sufficient to obtain the documented advantages of the technique.
Collapse
Affiliation(s)
- Alexandre Garioud
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Michael Seltz Kristensen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
|
2
|
Baima YJ, Shi DD, Shi XY, Yang L, Zhang YT, Xiao BS, Wang HY, He HY. How to manage isolated tension non-surgical pneumoperitonium during bronchoscopy? A case report. World J Clin Cases 2022; 10:12717-12725. [PMID: 36579118 PMCID: PMC9791527 DOI: 10.12998/wjcc.v10.i34.12717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Tension pneumoperitonium is a rare complication during bronchoscopy that can cause acute respiratory and hemodynamic failure, with fatal consequences. Isolated pneumoperitonium during bronchoscopy usually results from ruptures of the abdominal viscera that need surgical repair. Non-surgical pneumoperitoneum (NSP) refers to some pneumoperitoneum that could be relieved without surgery and only by conservative therapy. However, the clinical experience of managing tension pneumoperitonium during bronchoscopy is limited and controversial.
CASE SUMMARY A 51-year-old female was admitted to our hospital for cough with bloody sputum of seven days. On the 8th day of her admission, a bronchoscopy was arranged for bronchial-alveolar lavage to detect possible pathogens in the lower respiratory tract, as oxygen was delivered via a 12 F nasopharyngeal cannula, approximately 5-6 cm from the tip of the catheter, with a flow rate of 5-10 L/min. After four minutes of bronchoscopy, the patient suddenly vomited 20 mL of water, followed by severe abdominal pain, while physical examination revealed obvious abdominal distension, as well as hardness and tenderness of the whole abdomen, which was considered pneumoperitonium, and the bronchoscopy was terminated immediately. A computer tomography scan indicated isolated tension pneumoperitonium, and abdominal decompression was performed with a drainage tube, after which her symptoms were relieved. A multidisciplinary expert consultation discussed her situation and a laparotomy was suggested, but finally refused by her family. She had no signs of peritonitis and was finally discharged 5 d after bronchoscopy with a good recovery.
CONCLUSION The possibility of tension pneumoperitonium during bronchoscopy should be guarded against, and given its serious clinical consequences, cardiopulmonary instability should be treated immediately. Varied strategies could be adopted according to whether it is complicated with pneumothorax or pneumomediastinum, and the presence of peritonitis. When considering NSP, conservative therapy maybe a reasonable option with good recovery. An algorithm for the management of pneumoperitonium during bronchoscopy is proposed, based on the features of the case series reviewed and our case reported.
Collapse
Affiliation(s)
- Yang-Jin Baima
- Department of Pulmonary Medicine, Lhasa People’s Hospital, Lhasa 850013, Tibet Autonomous Region, China
| | - Dan-Dan Shi
- Department of Pulmonary Medicine, Lhasa People’s Hospital, Lhasa 850013, Tibet Autonomous Region, China
| | - Xing-Ya Shi
- Department of Pulmonary Medicine, Lhasa People’s Hospital, Lhasa 850013, Tibet Autonomous Region, China
| | - Li Yang
- Department of Pulmonary Medicine, Lhasa People’s Hospital, Lhasa 850013, Tibet Autonomous Region, China
| | - Yun-Tao Zhang
- Department of Pulmonary Medicine, Lhasa People’s Hospital, Lhasa 850013, Tibet Autonomous Region, China
| | - Ba-Sang Xiao
- Department of Pulmonary Medicine, Lhasa People’s Hospital, Lhasa 850013, Tibet Autonomous Region, China
| | - He-Yan Wang
- Department of Critical Care Medicine, The Sixth Hospital of Guiyang, School of Basic Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang 550002, Guizhou Province, China
| | - Hang-Yong He
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| |
Collapse
|
|
3
|
Roh GU, Kang JG, Han JY, Chang CH. Utility of oxygen insufflation through working channel during fiberoptic intubation in apneic patients: a prospective randomized controlled study. BMC Anesthesiol 2020; 20:282. [PMID: 33167909 PMCID: PMC7654027 DOI: 10.1186/s12871-020-01201-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Airway management is a part of routine anesthetic procedures; however, serious complications, including hypoxia and death, are known to occur in cases of difficult airways. Therefore, alternative techniques such as fiberoptic bronchoscope-assisted intubation (FOB intubation) should be considered, although this method requires more time and offers a limited visual field than does intubation with a direct laryngoscope. Oxygen insufflation through the working channel during FOB intubation could minimize the risk of desaturation and improve the visual field. Therefore, the aim of this prospective randomized controlled study was to evaluate the utility and safety of oxygen insufflation through the working channel during FOB intubation in apneic patients. METHODS Thirty-six patients were randomly allocated to an N group (no oxygen insufflation) or an O group (oxygen insufflation). After preoxygenation, FOB intubation was performed with (O group) or without (N group) oxygen insufflation in apneic patients. The primary outcome was the velocity of decrease in the partial pressure of oxygen (PaO2) during FOB intubation (VPaO2, mmHg/sec) defined as the difference of PaO2 before and after intubation divided by the time to intubation. The secondary outcomes included the success rate for FOB intubation, time to intubation, visual field during FOB intubation, findings of arterial blood gas analysis, and occurrence of FOB intubation-related complications. RESULTS We found that VPaO2 was significantly greater in the N group than in the O group (1.0 ± 0.4 vs. 0.4 ± 0.4; p < 0.001), while the visual field was similar between groups. There were no significant intergroup differences in the secondary outcomes. CONCLUSIONS These findings suggest that oxygen insufflation through the working channel during FOB intubation aids in extending the apneic window during the procedure. TRIAL REGISTRATION ClinicalTrials.gov , NCT02625194 , registered at December 9, 2015.
Collapse
Affiliation(s)
- Go Un Roh
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnami-si, Gyeonggi-do, 13496, Korea
| | - Joon Gwon Kang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnami-si, Gyeonggi-do, 13496, Korea
| | - Jung Youn Han
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnami-si, Gyeonggi-do, 13496, Korea
| | - Chul Ho Chang
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
| |
Collapse
|
|
4
|
Kumar A, Kumar N, Sinha C. Oxygen through suction port: use of a three way stopcock during fiberoptic bronchoscopy. Anaesth Crit Care Pain Med 2019; 38:83-84. [PMID: 29864553 DOI: 10.1016/j.accpm.2018.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/06/2018] [Accepted: 04/26/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Amarjeet Kumar
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, India
| | - Neeraj Kumar
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, India.
| | | |
Collapse
|
|
5
|
Lee D, Baik J, Yun G, Kim E. Oxygen insufflation via working channel in a fiberscope is a useful method: A case report and review of literature. World J Clin Cases 2018; 6:1189-1193. [PMID: 30613680 PMCID: PMC6306641 DOI: 10.12998/wjcc.v6.i16.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/02/2018] [Accepted: 11/23/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Fiberoptic bronchoscopic intubation is the gold standard for endotracheal intubation in difficult or compromised airway situations. However, oxygen insufflation through the working channel of a fiberscope is a controversial method because of the possibility of gastric distention and rupture during an awake fiberoptic bronchoscopic intubation, despite the advantages of preventing fogging of the fiberoptic bronchoscopic lens, blowing oral secretions away, and oxygenation of patients. CASE SUMMARY Here, we describe a case of cervical instability where we rapidly performed fiberoptic bronchoscopic intubation using oxygen insufflation through working channel of the broncoscopy to administer general anesthesia after two previous failures due to low visibility. A 50-year-old man with a non-specific medical history underwent emergency cervical spine surgery for posterior fusion of the C2 and C3 vertebrae. After two unsuccessful attempts at intubation using the fiberoptic broncoscopy, we performed it successfully using the oxygen insufflation via the working channel, instead of using suction to remove the secretion from the lens. CONCLUSION Oxygen insufflation via the working channel of the broncoscopy is a useful method for assisting with difficult intubation cases.
Collapse
Affiliation(s)
- Dowon Lee
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Jiseok Baik
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Giyoung Yun
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| |
Collapse
|
|
6
|
Pirlich N, Lohse JA, Noppens RR. Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow. J Vis Exp 2017. [PMID: 28117793 DOI: 10.3791/55116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A patient's willingness to cooperate is an absolute precondition for successful awake intubation of the trachea. Whilst drug-sedation of patients can jeopardize their spontaneous breathing, topical anesthesia of the airway is a popular technique. The spray-as-you-go technique represents one of the simplest opportunities to anesthetize the airway mucosa. The application of local anesthetic through the working channel of the flexible endoscope is a widespread practice for anesthetists as well as pulmonologists. There is neither need for additional devices nor special training as a pre-requisite to perform this technique. However, a known clinical problem is the coughing and gagging reflex that may occur when the liquid anesthetic strikes the airway mucosa and other sensitive structures like the vocal cords. This can be avoided by the use of oxygen applied through the working channel with the aim of fogging the local anesthetic into finer particles. Furthermore, the oxygen flow provides a higher oxygen supply and contributes to a better view, dispersing mucus secretions and blood away from the lens. Using an atomizer with a high oxygen flow of 10 L/min we maximized these benefits, caused less coughing and had more satisfied and therefore cooperative patients. Possible, but very rare complications of using oxygen flow including gastric insufflation, organ rupture or barotrauma did not arise. We attribute the complication-free use of high oxygen flow to the design of the set, which permits flow and pressure release.
Collapse
Affiliation(s)
- Nina Pirlich
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University
| | - Jana A Lohse
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University
| | - Rüdiger R Noppens
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University;
| |
Collapse
|
|
7
|
Pirlich N, Noppens RR. Local airway anaesthesia for awake fibreoptic intubation. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
|
8
|
Pirlich N, Lohse JA, Schmidtmann I, Didion N, Piepho T, Noppens RR. A comparison of the Enk Fiberoptic Atomizer Set(™) with boluses of topical anaesthesia for awake fibreoptic intubation. Anaesthesia 2016; 71:814-22. [PMID: 27150724 DOI: 10.1111/anae.13496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 01/04/2023]
Abstract
We compared the Enk Fiberoptic Atomizer Set(™) with boluses of topical anaesthesia administered via the working channel during awake fibreoptic tracheal intubation in 96 patients undergoing elective surgery. Patients who received topical anaesthesia via the atomiser, compared with boluses via the fibreoptic scope, reported a better median (IQR [range]) level of comfort: 1 (1-3 [1-10]) vs. 4 (2-6 [1-10]), p < 0.0001; experienced a reduced total number of coughs: 6 (3-10 [0-34]) vs. 11 (6-13 [0-25]), p = 0.0055; and fewer distinct coughing episodes: 7% vs. 27% respectively, p = 0.0133. The atomiser technique was quicker: 5 (3-6 [2-12]) min vs. 6 (5-7 [2-15]) min, p = 0.0009; and required less topical lidocaine: 100 mg (100-100 [80-160]) vs. 200 mg (200-200 [200-200]), p < 0.0001. Four weeks after nasal intubation, the incidence of nasal pain was less in the atomiser group compared with the control group (8% vs. 50%, p = 0.0015). We conclude that the atomiser was superior to bolus application for awake fibreoptic tracheal intubation.
Collapse
Affiliation(s)
- N Pirlich
- Department of Anaesthesiology, University Medical Centre Mainz, Mainz, Germany
| | - J A Lohse
- Department of Anaesthesiology, University Medical Centre Mainz, Mainz, Germany
| | - I Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - N Didion
- Department of Anaesthesiology, University Medical Centre Mainz, Mainz, Germany
| | - T Piepho
- Department of Anaesthesiology, University Medical Centre Mainz, Mainz, Germany
| | - R R Noppens
- Department of Anaesthesiology, University Medical Centre Mainz, Mainz, Germany
| |
Collapse
|
|
9
|
Randomised Controlled trial Comparing the Ambu® aScope™2 with a Conventional Fibreoptic Bronchoscope in Orotracheal Intubation of Anaesthetised Adult Patients. Anaesth Intensive Care 2015; 43:479-84. [DOI: 10.1177/0310057x1504300410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fibreoptic intubation remains an essential skill for anaesthetists to master. In addition to the reusable fibrescope, an alternative disposable videoscope is available (aScope™2, Ambu®, Ballerup, Denmark). A total of 60 anaesthetised adult patients were randomised to either having orotracheal intubation using the aScope 2 or a Karl Storz fibrescope. Intubations were performed by experienced operators who were familiar with both devices. The primary outcome was the Global Rating Scale score. Secondary outcomes included intubation success, number of intubation attempts and intubation time. Other subjective outcomes including practicality, useability and image quality were also recorded. There was no significant difference in the Global Rating Scale score, intubation success or intubation time between the aScope 2 or Karl Storz fibrescope. Global Rating Scale scores were three and two in the aScope 2 and Karl Storz groups respectively ( P=0.14). All of the other subjective outcomes were similar between the two groups, except that operators found it easier to use the aScope 2 compared to the fibrescope. There was no significant difference in clinical performance between the aScope 2 and the Karl Storz fibreoptic bronchoscope. The aScope's practicality, disposability and recently improved version (aScope™3) potentially make it an acceptable alternative to the reusable fibrescope.
Collapse
|
|
10
|
Yao HHI, Tuck MV, Mcnally C, Smith M, Usatoff V. Gastric Rupture following Nasopharyngeal Catheter Oxygen Delivery—A Report of Two Cases. Anaesth Intensive Care 2015; 43:244-8. [DOI: 10.1177/0310057x1504300216] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Iatrogenic gastric distension and subsequent rupture following nasal or nasopharyngeal catheter oxygen delivery is a rare but life-threatening condition that requires urgent laparotomy. We report two cases recently encountered at our institution. Both patients exhibited symptoms of abdominal pain and distension following oxygen delivery involving a nasopharyngeal catheter during procedural sedation. Oxygen flow rates were 4 l/minute in both cases. The diagnosis was made by urgent imaging. Both patients survived following laparotomy and repair of gastric rupture. Seventeen cases have been reported previously in the literature. We recommend avoidance of nasal or nasopharyngeal catheters and the use of alternative oxygen delivery methods such as nasal prongs and face masks.
Collapse
Affiliation(s)
- H. H. I. Yao
- Department of Surgery, Cabrini Hospital, Malvern, Victoria
| | - M. V. Tuck
- Department of Anaesthesia and Pain Management, Cabrini Hospital, Malvern, Victoria
| | - C. Mcnally
- Department of Anaesthesia and Pain Management, Cabrini Hospital, Malvern, Victoria
| | - M. Smith
- Department of Surgery, Cabrini Hospital, Malvern, Victoria
| | - V. Usatoff
- Department of Surgery, Cabrini Hospital, Malvern, Victoria
| |
Collapse
|
|
11
|
Muliterno E, Pardina B, Virolés G, Villalonga A. [Massive pneumoperitoneum due to gastric perforation after difficult tracheal intubation]. ACTA ACUST UNITED AC 2013; 61:411-2. [PMID: 24365643 DOI: 10.1016/j.redar.2013.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/08/2013] [Accepted: 09/06/2013] [Indexed: 12/20/2022]
Affiliation(s)
- E Muliterno
- Servicio de Anestesiología y Reanimación, Hospital Universitario Dr. Josep Trueta, Girona, España.
| | - B Pardina
- Servicio de Anestesiología y Reanimación, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - G Virolés
- Servicio de Anestesiología y Reanimación, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - A Villalonga
- Servicio de Anestesiología y Reanimación, Hospital Universitario Dr. Josep Trueta, Girona, España
| |
Collapse
|
|
12
|
Transbronchoscopic oxygen insufflation-induced barotrauma during endobronchial silicon spigot removal. J Bronchology Interv Pulmonol 2013; 20:179-82. [PMID: 23609258 DOI: 10.1097/lbr.0b013e31828ab8f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While transbronchoscopic air insufflation has been described in refractory atelectasis as a therapy without any serious complications, 3 cases of gastric rupture during the same procedure have been reported when it was used to support tracheal intubation by employing the jet of oxygen from the wall pipeline. Here, we report a 66-year-old woman who underwent transbronchoscopic oxygen insufflation using a flexible fiberscope to clear away secretions during an endobronchial silicon spigot removal procedure. She suffered a sudden drop of blood pressure with pneumomediastinum, subpleural and subcutaneous emphysema, and bilateral pneumothorax. Blood pressure recovered rapidly when we stopped the insufflation. Tube thoracostomy was initiated, and she recovered well without systemic air embolism. We conclude that transbronchoscopic oxygen insufflation using the wall pipeline does carry a potential risk of serious barotrauma, and is not to be recommended except with the use of a pressure monitor or pop-off valve.
Collapse
|
|
13
|
Mourissoux G, Schlumberger S, De Lentdecker P, Fischler M. Fatal pneumoperitoneum caused by nasopharyngeal oxygen delivery after transoesophageal echocardiography for cardiac surgery. Acta Anaesthesiol Scand 2009; 53:1223-5. [PMID: 19650802 DOI: 10.1111/j.1399-6576.2009.02056.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a case of fatal post-operative pneumoperitoneum in a patient who had undergone urgent mitral valve surgery. In the absence of a proven cause of the pneumoperitoneum (refusal by the family of an autopsy), we can only propose a hypothesis for its origin. The most probable one is that forceful or sustained retrograde flexion of the transoesophageal echocardiographic probe created a lower oesophagus or gastric rupture and that oxygen flow administered by the nasal cannula went straight to the abdominal cavity, leading to tension pneumoperitoneum.
Collapse
Affiliation(s)
- G Mourissoux
- Department of Anesthesia, Hôpital Foch, Suresnes, France
| | | | | | | |
Collapse
|