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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : UD01 - UD03 Full Version

A Rare Presentation of Controlled Chaos: Spontaneous Pneumothorax Under General Anaesthesia


Published: December 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/59224.17339
S Mano Praveen, S Ajanth, Mangesh S Gore, Lipika A Baliarsing, Sneha B Miniyar, Charulata M Deshpapande

1. Senior Resident, Department of Anaesthesia, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India. 2. Senior Resident, Department of Anaesthesia, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India. 3. Associate Professor, Department of Anaesthesia, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India. 4. Professor, Department of Anaesthesia, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India. 5. Junior Resident, Department of Anaesthesia, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India. 6. Professor and Head, Department of Anaesthesia, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India.

Correspondence Address :
Dr. S Mano Praveen,
Nair Hospital, Mumbai Central, Mumbai, Maharashtra, India.
E-mail: surya390688@gmail.com

Abstract

Perioperative pneumothorax is a potentially dangerous and rare complication during general anaesthesia. Hereby, the authors report a case of 25-year-old female, who was posted for a dental procedure, and developed spontaneous pneumothorax under general anaesthesia. The patient had no co-morbidities or risk factors during the perioperative period and classified as American Society of Anaesthesiologist’s (ASA) class I. She was planned under general anaesthesia with an orotracheal intubation with controlled positive pressure ventilation. At the end of the surgery, she developed significant respiratory changes, which rose the suspicion of pneumothorax and later, it was confirmed radiologically. This early suspicion and early intervention by tube thoracostomy in Postanaesthesia Care Unit (PACU) stabilised the patient and resolved eventually. Early recognition and appropriate intervention can mitigate the perioperative outcome and reduce morbidity. Positive pressure ventilation, Positive End Expiratory Pressure (PEEP) and airway handling being the major predisposing factors for the development of pneumothorax. This further reiterates the need for keen perioperative vigilance for early recognition and appropriate management. Although rare, pneumothorax should be considered as differential diagnosis in crisis scenarios like tight bag.

Keywords

Anaesthetic challenges, Bronchospasm, Positive pressure ventilation, Positive end expiratory pressure

Case Report

A 25-year-old female weighing 45 kg, was scheduled for a surgery to treat her cleft lip and palate. She was operated for cleft lip and palate at 10 months of age and revision cleft palate surgery at 15 years of age under general anaesthesia and both were uneventful. She was planned for transport distraction of the left cleft alveolus under general anaesthesia, in view of persistent nasal regurgitation through the remnant cleft palate. On examination, the patient had fair physical status, effort tolerance of more than three flights of stairs and no co-morbidities/addictions.

The vitals were, heart rate was 76/min, blood pressure was 100/60 mmHg and respiratory rate was 12/min. Cardiovascular and respiratory system examination were not significant. Airway examination revealed three fingers mouth opening, modified Mallampatti grade I, adequate neck movements, thyromental distance >6 cm, normal dentition with braces on both jaws. A small cleft of size 1×1.2 cm was noted in the hard palate. Bilateral nasal patency was confirmed (right>left). Blood investigations, chest X-ray and 12-lead Electrocardiogram (ECG) were within normal limits.

On the day of the surgery, an informed consent was taken after confirming preoperative fasting and it was planned to do orotracheal intubation. After establishing a 20 Gauge intravenous line and standard American Society of Anaesthesiologists (ASA) monitoring, the patient was premedicated with Inj. glycopyrrolate 0.2 mg i.v and Inj. midazolam 1 mg i.v. Anaesthetic induction was done after preoxygenation for three minutes, with Inj. fentanyl 100 mcg i.v and Inj. propofol 100 mg i.v. Muscle relaxation was achieved with Inj. atracurium 30 mg i.v. After confirming bag and mask ventilation, orotracheal intubation was achieved with the flexometallic 6.5 mm cuffed Endotracheal Tube (ETT) and secured at 20 cm mark after confirming bilateral air entry. Maintenance of anaesthesia was achieved with Oxygen:Air (50:50), sevoflurane (1-2%) with target Minimum Alveolar Concentration (MAC) of 1.0 and connected to mechanical ventilation using the volume-controlled ventilation with settings of Tidal Volume (VT) was 380 mL, respiratory rate was 14/min. The surgery was in supine position and the patient’s haemodynamic and respiratory markers were within normal limits throughout the procedure. It lasted for approximately 150 minutes and went uneventfully.

While closure, the patient developed high peak airway pressure (>40 cm H2O), rise in End-tidal Carbon Dioxide (EtCO2) (>50 mmHg), rise in concentration of inspired carbon dioxide (FiCO2) (>0.1) transiently, fall in SpO2 till 85% and rise in heart rate (110/min). She was ventilated using 100% oxygen, significant resistance was appreciated. On auscultation, signs of bronchospasm were detected. Bronchodilator (salbutamol) puffs were given and ventilated with 100% oxygen and 2% sevoflurane and Inj. aminophylline 125 mg i.v. was given over five minutes. Eventually, the patient’s respiratory parameters were settled and it was decided to extubate the patient. Prior to reversal, a thorough oropharyngeal suctioning was done and extubated on achieving adequate spontaneous respiratory efforts and the patient satisfying all criteria of extubation. After 10 minutes, the patient became restless, tachypnoeic (rate >30/min) and started complaining of left hypochondriac chest pain and SpO2 fell down to 90%. She was given head elevation and oxygenated using 100% oxygen. On auscultation, there was reduced air entry on the right-side significantly. It was decided to shift the patient to Postanaesthesia Care Unit (PACU) for postoperative monitoring and further management (Table/Fig 1).

At PACU, 12-lead ECG, chest X-ray, Arterial Blood Gas (ABG) and Troponin-T were sent immediately. ABG values were, pH-7.413, PCO2-32.5, PO2-84.9, HCO3-20. Chest X-ray revealed right pneumothorax, Pneumomediastenum with right lung collapse. Right tube thoracostomy was performed by cardiothoracic surgeons promptly. Patient vitals were maintained throughout and oxygenation continued with oxygen 10 L/min using Non-Rebreather Mask (NRBM). High Resolution Computed Tomography (HRCT) thorax was done on the next day after stabilisation and revealed bilateral pneumothorax (Right>Left) and pneumomediastenum with right Intercostal Drainage (ICD) tube in-situ and left lower zone atelectasis (Table/Fig 2). Left small pneumothorax and pneumomediastenum was diagnosed after HRCT and treated conservatively on chest physician’s advice. Chest physiotherapy, deep breathing exercises, incentive spirometry and bronchodilator nebulisation was initiated post-ICD insertion. Patient was mobilised early on 4th day and chest X-ray was repeated on the same day. Right ICD tube was clamped on 5th day after confirming complete re-expansion of the lung. Chest X-ray was repeated after 12 hours and ICD was removed on 7th day. The patient was shifted to ward and discharged on 9th day successfully and advised for follow-up after two weeks, with a chest X-ray with the chest physician.

Discussion

Spontaneous pneumothorax under general anaesthesia is one of the rarest and detrimental critical incidents in the perioperative anaesthetic management (1). The incidence of pneumothorax is 7.4 to 18/100,000 per annum in males and 1.2 to 6/100,000 per annum in females (2). The common causes of spontaneous pneumothorax under anaesthesia are iatrogenic ones like laparoscopic procedures and surgeries around the diaphragm or parietal pleura, emphysematous lung diseases, brachial plexus blocks, central venous cannulation, pulmonary tuberculosis, history of smoking, chronic obstructive pulmonary disease, asthma, inexperienced surgeon (1),(2),(3),(4).

In Primary Spontaneous Pneumothorax (PSP), where there is no apparent cause, the diagnosis is misdirected/delayed due to the compounding conditions like airway obstruction, bronchospasm, erroneous right endobronchial intubation, inadequate plane of anaesthesia. The most important risk factors for development of pneumothorax under anaesthesia and in the mechanically ventilated ICU patients are, the usage of Positive Pressure Ventilation and Positive End Expiratory Pressure (PEEP) (3).

The presence of emphysematous bullae and pleural blebs may predispose to the condition. Coughing also may increase intrapleural and intrathoracic pressures up to 400 cm H2O (4). The signs and symptoms include sharp thoracic pain, dyspnoea, tachycardia, hypotension, decreased or absent lung sounds, reduced excursion of the affected lung and reduced pulmonary compliance. The clinical presentations under anaesthesia are elevated peak airway pressure, changes in the EtCO2 and SpO2 with the auscultatory changes (5). The diagnosis of the same is generally masked by the effects of the general anaesthesia, which might lead to delayed diagnosis and additional morbidity.

In the present case, there was no risk factors for the development of pneumothorax and the suspicion was based on the clinical signs perioperatively. Even though, postoperative CT does not reveal any bullae or blebs in the present case, this would not exclude the presence of undetected small blebs or bullae (1). The presence of the bullae would have warranted against the use of controlled positive pressure ventilation in the preoperative stage (6). Alternatively, excess airway manipulation during the intubation can increase the risk of developing pneumothorax (1). The pneumothorax may have developed in the present case due to acute severe bronchospasm with air trapping, causing over-pressurisation of alveoli or tension pneumothorax while manual ventilation with resistance (6). Either of these situations can be impacted by the positive pressure ventilation, resulting in similar cardiorespiratory complications. Tidal volume (VT) of 8 mL/kg used was within the acceptable range, but it can not rule out the possibility of bullae rupture while ventilating manually or even airway handling. Irrespective of the cause, keen perioperative vigilance, early diagnosis and treatment can prevent the dangerous complications of the worsening pneumothorax.

The left small pneumothorax and pneumomediastenum in the patient was managed conservatively following a chest physician’s advice and it resolved gradually within a week. Ennis SL and Dobler CC (7) and Brown SGA et al., (8) demonstrated in a multicentric study of moderate to large pneumothorax that the conservative management of PSP is a safer alternative to interventional management with fewer adverse effects, less hospital stay and early discharge. The British Thoracic Society describes that, certain asymptomatic patients with PSP can be considered for conservative management with initiation of 100% oxygen via a non rebreather mask and cardiopulmonary monitoring (2).

Pneumothorax is a potentially dangerous complication for patients with mechanical ventilation, more often in the setting of Acute Respiratory Distress Syndrome (ARDS), interstitial lung diseases, Chronic Obstructive Pulmonary Disease (COPD) and asthma. These patients are prone to develop pulmonary barotrauma, ultimately ending in pneumothorax, pneumomediastenum and subcutaneous emphysema. Optimisation of ventilator settings is the efficient strategy to prevent barotrauma and ARDS network group suggests that the goal plateau pressure to be below 35 cm H2O and ideally, below 30 cm H2O in patients with mechanical ventilation (3).

Though, the cause may not be obvious always readily, it should not exclude the presence of rare causes. Sharma M et al., described a young male with history of electronic cigarettes use, presenting with vape induced bilateral pneumonitis which progressed to right pneumothorax and was treated with right ICD insertion. He underwent bleb removal and right pleurectomy due to the presence of multiple thin walled bullae (9). Larger PSP can be managed with Video Assisted Thoracoscopic Surgery (VATS) or thoracotomy to perform bullectomy, pleurectomy and mechanical pleurodesis (2).

The significant haemodynamic collapse during the event necessitate the need for emergency needle thoracostomy, at the second intercostal space, followed by tube thoracostomy at the fifth intercostal space and should not be delayed for the radiological confirmation. The haemodynamic stability of the patient allowed us time to do confirmation, by radiological diagnosis and treated with tube thoracostomy, later. The diagnosis of pneumothorax under anaesthesia is usually by clinical signs and symptoms, which is confirmed by chest X-ray and chest CT scans (2). Point of Care ultrasonography (POCUS) can be used as a portable bedside assessment tool to enhance perioperative clinical decision making (10). The use of the structured core critical incident algorithm like cover ABCD a swift check (1) and high degree of clinical suspicion can help in early diagnosis and appropriate management. As per this algorithm, the clinical diagnosis and patient management go hand in hand.

Conclusion

In conclusion, despite the rare presentation, pneumothorax is potentially a dangerous complication which needs early diagnosis, clinical suspicion even without any specific risk factors and appropriate time-bound management to prevent the significant morbidities. Usage of the necessary diagnostic tools along with urgent intervention and proper communication with the team would help in the appropriate management and prevent catastrophic events.

References

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Heyba M, Rashad A, Al-Fadhli AA. Detection and management of intraoperative pneumothorax during laparoscopic cholecystectomy. Case Rep Anesthesiol. 2020;2020:9273903. [crossref] [PubMed]
2.
Costumbrado J, Ghassemzadeh S. Spontaneous Pneumothorax. [Updated 2021 Jul 26]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459302/.
3.
Diaz R, Heller D. Barotrauma and Mechanical Ventilation. [Updated 2022 May 1]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545226/.
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Stecka AM, Grabczak EM, Michnikowski M, Zieliń ska-Krawczyk M, Krenke R, Gólczewski T, et al., The impact of spontaneous cough on pleural pressure changes during therapeutic thoracentesis. Sci Rep. 2022;12(1):11502. [crossref] [PubMed]
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McKnight CL, Burns B. Pneumothorax. 2022. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
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Amaniti E, Provitsaki C, Papakonstantinou P, Tagarakis G, Sapalidis K, Dalakakis I, et al., Unexpected tension pneumothorax-hemothorax during induction of general anaesthesia. Case Rep Anesthesiol. 2019;2019:5017082. [crossref] [PubMed]
7.
Ennis SL, Dobler CC. Conservative versus interventional treatment for spontaneous pneumothorax. Breathe (Sheff). 2020;16(3):200171. [crossref] [PubMed]
8.
Brown SGA, Ball EL, Perrin K, Asha SE, Braithwaite I, Egerton-Warburton D, et al. Conservative versus interventional treatment for spontaneous pneumothorax. N Engl J Med. 2020;382(5):405-15. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2022/59224.17339

Date of Submission: Jul 21, 2022
Date of Peer Review: Aug 27, 2022
Date of Acceptance: Oct 17, 2022
Date of Publishing: Dec 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 23, 2022
• Manual Googling: Sep 23, 2022
• iThenticate Software: Oct 14, 2022 (3%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
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