Tension pneumothorax occurred by tumescent solution injection during delay extended latissimus dorsi flap : A case report

Lee, Joo Yeon; Moon, Jeong Eun; Lee, Sang Min

Case Report

Cardiothoracic and Vascular Anesthesia

Anesthesia and Pain Medicine 2009;4(1):36-39.
Published online January 30, 2009.

Tension pneumothorax occurred by tumescent solution injection during delay extended latissimus dorsi flap : A case report

Joo Yeon Lee, Jeong Eun Moon, Sang Min Lee

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. marialee@skku.edu.

Abstract

Tension pneumothorax is known as a rare complication of breast augmentation surgery, but can occur more than expected. This is a case of a 34-year-old woman who was to receive delay extended latissimus dorsi flap under general anesthesia. The patient was injected the tumescent solution by 25 gauge spinal needle preoperatively. In the course of operation, the peak inspiratory pressure was increased gradually. At the moment of changing the position from supine to sitting position, the blood pressure decreased to 75/45 mmHg. We took the chest radiography, which showed typical findings of tension pneumothorax of right side. Prompt needle aspiration and chest tube insertion relieved tension pneumothorax. The patient's vital signs got stabilized and there was no visible remained pneumothorax at following chest radiography taken. We should pay attention to the possible occurrence of devastating pneumothorax during breast augmentation surgery, especially local infiltration using long needle is performed.

Key Words: airway pressure, breast augmentation surgery, tension pneumothorax, tumescent solution