title: Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema following intubation with a double-lumen endotracheal tube for thoracoscopic anterior spinal release and fusion in a patient with idiopathic scoliosis.
abstract: Recently, thoracoscopic approaches to the spine have taken on greater clinical applications in the treatment of spinal deformity with generally good results. However, the steep learning curve must be ascended by the surgeon and may lead to complications early in one's experience. There also exists a learning curve for the anesthesiologist to become adept at obtaining single lung ventilation and managing this throughout the operative procedure. We report a case of an 11-year-old patient with severe scoliosis who developed air in both chest cavities, mediastinum, peritoneum, retroperitoneum, and subcutaneous tissue after intubation with a double-lumen endotracheal tube. The patient remained hemodynamically stable throughout this period, and bilateral chest tubes were placed. The patient remained on the ventilator for 24 hours and was extubated without sequelae. Complications from a thoracoscopic approach to the spine for deformity are most often attributed to the learning curve of the surgeon; however, the entire operative team becomes exposed to the challenges of performing this procedure. This report documents a life-threatening complication of air throughout the chest, mediastinum, abdomen, and subcutaneous tissues in a patient with severe scoliosis.
authors.affiliation: Texas Scottish Rite Hospital, Dallas, Texas 75219, USA. dsucato@airmail.net
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sucato
authors.forename: Magda
authors.initials: M
authors.lastname: Girgis
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D008478:Mediastinal Emphysema / Q000209:etiology*; D011027:Pneumoperitoneum / Q000209:etiology*; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D012188:Retropneumoperitoneum / Q000209:etiology*; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D013352:Subcutaneous Emphysema / Q000209:etiology*; D013906:Thoracoscopy / Q000009:adverse effects* / Q000379:methods