title: Local anesthesia infiltration as a cause of intraoperative tension pneumothorax in a young healthy woman undergoing breast augmentation with general anesthesia.
abstract: Pneumothorax may be a medical emergency. Iatrogenic pneumothorax is more common than all other forms of spontaneous pneumothorax, and surgical procedures involving the breast are a frequent setting for this. A 32-year-old, 60 kg, woman without any significant medical history underwent a bilateral breast augmentation and rhinoplasty. She underwent a routine general endotracheal anesthetic. Prior to surgical incision, the surgeon infiltrated the breast with lidocaine with epinephrine. Six hours into the surgical procedure, the patient developed hemodynamic compromise and was diagnosed with tension pneumothorax, which was treated emergently with a 14-gauge angiocatheter placed intrapleurally. The patient immediately returned to hemodynamic stability. This case report discusses iatrogenic pneumothoraces as well their most likely causes; which in this specific case was the injection of local anesthetic. Suggestions for prevention and treatment of the unusual complication are discussed.
authors.affiliation: Department of Anesthesiology, Tulane University School of Medicine, New Orleans, LA 70122, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Kaye
authors.forename: W M
authors.initials: WM
authors.lastname: Eaton
authors.forename: J S
authors.initials: JS
authors.lastname: Jahr
authors.forename: B D
authors.initials: BD
authors.lastname: Nossaman
authors.forename: J A
authors.initials: JA
authors.lastname: Youngberg
mesh_terms: D000328:Adult; D000770:Anesthesia, Endotracheal; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000009:adverse effects*; D001794:Blood Pressure; D002404:Catheterization / Q000295:instrumentation; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006339:Heart Rate; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000628:therapy; D008012:Lidocaine / Q000009:adverse effects*; D016462:Mammaplasty; D010100:Oxygen / Q000097:blood; D010994:Pleura; D011030:Pneumothorax / Q000139:chemically induced* / Q000628:therapy; D012225:Rhinoplasty; D013352:Subcutaneous Emphysema / Q000139:chemically induced / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D010100:Oxygen; D004837:Epinephrine