Anesthesia crisis in laparoscopic surgery: Bilateral spontaneous pneumothorax. Diagnosis and management, case report

Abstract

Introduction: Laparoscopic surgery as a minimally invasive technique has shown considerable benefit in terms of patient outcomes. However, major complications have been described, including spontaneous pneumothorax, with a 0.4% incidence. An unusual crisis in laparoscopic surgery - spontaneous bilateral pneumothorax - and an updated literature review are discussed with a view to identify the factors related to its occurrence and the prevention and management measures involved.

Case presentation: A young man undergoing emergency laparoscopic surgery for abdominal pain. During the intraoperative period the patient developed respiratory impairment and subcutaneous emphysema. Bilateral pneumothorax was documented on chest X ray, though the etiology could not be established. Early diagnosis allowed for timely management with bilateral thoracotomy and extubation at the end of surgery.

Conclusion: Spontaneous pneumothorax has been recognized as a potential crisis in laparoscopic procedures. There are multiple cases of this intraoperative complication reported in the literature since 1939. It is worth highlighting that to this date, and despite the advances in surgical techniques, monitoring and anesthetic agents, few elements may be manipulated and only an insightful anesthesiologist may prevent the condition from evolving into major hemodynamic and respiratory morbidity and even death. Few factors such as establishment of pneumoperitoneum and pressure, length of the procedure and type of surgery have been identified. Early diagnosis is based on a high suspicion due to subtle changes in respiratory and hemodynamic parameters that require radiographic confirmation if the patient's condition permits, followed by immediate decompression through thoracotomy.