Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2022; 10(21): 7592-7598
Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7592
Considerations of single-lung ventilation in neonatal thoracoscopic surgery with cardiac arrest caused by bilateral pneumothorax: A case report
Xu Zhang, Hai-Cheng Song, Kui-Liang Wang, Yue-Yi Ren
Xu Zhang, Hai-Cheng Song, Kui-Liang Wang, Yue-Yi Ren, Department of Heart Center, Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
Author contributions: Zhang X and Ren YY, the patient’s anesthesiologists, acquired the patient consent, and drafted and revised the manuscript; Wang KL and Song HC took responsibility for investigation and data curation; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient’s parent or guardian for publication of this case report and any accompanying images.
Conflict-of-interest statement: No conflict of interest exits in the submission of this manuscript, and manuscript is approved by all authors for publication.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yue-Yi Ren, MD, Associate Chief Physician, Associate Professor, Department of Heart Center, Women's and Children's Hospital Affiliated to Qingdao University, No. 217 Liaoyang West Road, Shibei District, Qingdao 266034, Shandong Province, China. xxgmz1173@126.com
Received: February 23, 2022
Peer-review started: February 23, 2022
First decision: March 25, 2022
Revised: March 29, 2022
Accepted: June 18, 2022
Article in press: June 18, 2022
Published online: July 26, 2022
Abstract
BACKGROUND

Tension pneumothorax of the contralateral lung during single-lung ventilation (SLV) combined with artificial pneumothorax can cause cardiac arrest due to bilateral pneumothorax. If not rapidly diagnosed and managed, this condition can lead to sudden death. We describe the emergency handling procedures and rapid diagnostic methods for this critical emergency situation.

CASE SUMMARY

We report a case of bilateral pneumothorax in a neonatal patient who underwent thoracoscopic esophageal atresia and tracheoesophageal fistula repair under the combined application of SLV and artificial pneumothorax. The patient suffered sudden cardiac arrest and received emergency treatment to revive her. The recognition of dangerous vital sign parameters, rapid evacuation of the artificial pneumothorax, and initiation of lateral position cardiopulmonary resuscitation while simultaneously removing the endotracheal tube to the main airway are critically important. Moreover, even though the sinus rhythm was restored, the patient’s continued tachycardia, reduced pulse pressure, and depressed pulse oximeter waveform were worrisome. We should highly suspect the possibility of pneumothorax and use rapid diagnostic methods to make judgment calls. Sometimes thoracoscopy can be used for rapid examination; if the mediastinum is observed to be shifted to the right, it may indicate tension pneumothorax. This condition can be immediately relieved by needle thoracentesis, ultimately allowing the safe completion of the surgical procedure.

CONCLUSION

Bilateral pneumothorax during SLV combined with artificial pneumothorax is rare but can occur at any time in neonatal thoracoscopic surgery. Therefore, anesthesiologists should consider this possibility, be alert, and address this rare but critical complication in a timely manner.

Keywords: Neonatal thoracoscopic surgery, Bilateral pneumothorax, Single-lung ventilation, Cardiac arrest, Case report

Core Tip: Tension pneumothorax on the contralateral lung during single-lung ventilation (SLV) combined with artificial pneumothorax can lead to cardiac arrest due to bilateral pneumothorax. If not rapidly diagnosed and managed, it can lead to sudden death. Bilateral pneumothorax during SLV combined with artificial pneumothorax is rare but can occur at any time in neonatal thoracoscopic surgery. We describe the emergency handling procedures and rapid diagnostic methods for this critical emergency situation.