title: Trends in electrocardiographic R-wave amplitude during intraoperative pneumothorax.
abstract: Tension pneumothorax is a rare but potentially life-threating complication of laparoscopic fundoplication. Electrocardiogram (ECG) changes may be used in the diagnosis of intraoperative tension pneumothorax. This case study examines a pediatric patient who underwent laparoscopic fundoplication. Sudden decreases in oxygen saturation were observed during dissection, although the patient's decrease in blood pressure was less marked. Manual ventilation with high inspiratory pressure and inspiratory pause improved oxygenation. The amplitude of the R-wave decreased from 0.8 mV to 0.3 mV in 5 seconds. Twenty minutes later, oxygen saturation decreased again, the R-wave amplitude decreased from 0.3 mV to 0.1 mV in 1 second, and the decrease in blood pressure was marked. Manual ventilation with high inspiratory pressure improved oxygenation, blood pressure, and R-wave amplitude within two minutes. After conversion to open surgery, the cardiorespiratory condition gradually improved, but the R-wave amplitude did not fully recover, even at the end of surgery. Right-side pneumothorax was subsequently confirmed by postoperative chest X-ray. Chest drains were inserted after surgery. This case suggests that trends in R-wave amplitude are potential indicators of intraoperative tension pneumothorax.
authors.affiliation: Division of Surgical Center, Tokushima University Hospital, the University of Tokushima.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Tomiyama
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Higashijima
authors.forename: Takako
authors.initials: T
authors.lastname: Kadota
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Kume
authors.forename: Tomiya
authors.initials: T
authors.lastname: Kawahara
authors.forename: Naohiro
authors.initials: N
authors.lastname: Ohshita
mesh_terms: D004562:Electrocardiography; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011030:Pneumothorax / Q000175:diagnosis* / Q000503:physiopathology