Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942008000100009
Brazilian Journal of Anesthesiology
Clinical Information

Barotrauma pulmonar no intra-operatório de procedimento cirúrgico oftalmológico: relato de caso

Intraoperative pulmonary barotrauma during ophthalmologic surgery: case report

Affonso Henrique Zugliani; Flávia Claro; Ana Cláudia C. Mega; Marcelo F. Rodrigues; Gilblainer Ancelmé

http://dx.doi.org/10.1590/S0034-70942008000100009 Braz J Anesthesiol, vol.58, n1, p.63-68, 2008
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Resumo

JUSTIFICATIVA E OBJETIVOS: Acidentes anestésicos graves por mau funcionamento de ventiladores mecânicos tornaram-se raros nos tempos atuais. Porém, detalhes técnicos, mesmo em aparelhos de fabricação recente, podem resultar em armadilhas para o anestesiologista e ameaçar a segurança do paciente. O objetivo deste relato de caso foi enfatizar a necessidade de análise criteriosa do material em uso, assim como de detectar e tratar o pneumotórax hipertensivo intra-operatório. RELATO DO CASO: Paciente do sexo feminino, 16 anos, estado físico ASA I, submetida a recobrimento conjuntival de córnea sob anestesia geral. A manutenção foi feita com isoflurano e ventilação controlada mecânica. A anestesia transcorreu sem anormalidades. Na fase final do procedimento cirúrgico, após mobilização do aparelho de anestesia para o início do procedimento de despertar, observou-se quadro de hipóxia, hipotensão arterial e dificuldade ventilatória. Retirados os campos cirúrgicos, evidenciou-se importante enfisema subcutâneo, envolvendo a face, o pescoço e o membro superior. Procedeu-se à troca da cânula traqueal, observando-se a presença de sangue em seu interior. A radiografia de tórax confirmou o diagnóstico de pneumotórax, que foi prontamente drenado. A inspeção no equipamento revelou acotovelamento da mangueira que liga a região inferior do canister ao corpo do aparelho, em função da mobilização do braço articulado, bloqueando o fluxo normal de gases e levando a barotrauma pulmonar. CONCLUSÕES: O pneumotórax hipertensivo durante anestesia geral com ventilação com pressão positiva deve ser sempre um acidente a ser considerado. Múltiplos fatores podem precipitá-lo, o que exige alto grau de suspeição sempre que estiverem envolvidos no ato anestésico-cirúrgico. O equipamento de anestesia deve ser cuidadosamente examinado para que sejam detectadas potenciais causas de acidentes anestésicos.

Palavras-chave

COMPLICAÇÕES, EQUIPAMENTOS, EQUIPAMENTOS

Abstract

BACKGROUND AND OBJECTIVES: Nowadays, severe anesthetic complications caused by the improper use of mechanical ventilators are rare. However, technical details even in recent models can be a trap for the anesthesiologist and threaten patient safety. The objective of this report was to demonstrate the importance of a careful analysis of the device to be used, as well as to detect and treat intraoperative tension pneumothorax. CASE REPORT: A 16-year old female patient, physical status ASA I, underwent corneal conjunctival covering under general anesthesia. Anesthesia was maintained with isoflurane and controlled mechanical ventilation. No abnormalities were observed during anesthesia. At the final phase of the surgery, after mobilizing the anesthesia device to start the awakening process, the patient developed hypoxia, hypertension and ventilatory difficulties. After removal of the sterile drapes from the surgical field, subcutaneous emphysema was evident in the face, neck and upper limb. The tracheal cannula, which contained blood, was changed. A chest X-ray confirmed the diagnosis of pneumothorax that was immediately drained. Inspection of the equipment revealed the presence of a kink in the tubing connecting the inferior portion of the canister to the equipment itself caused by mobilization of the articulated arm, blocking the normal flow of gases and leading to pulmonary barotrauma. CONCLUSIONS: The development of tension pneumothorax during general anesthesia with positive pressure ventilation should always be considered. Several factors can contribute to the development of this condition, which should be considered when they are present during surgeries. The anesthesia equipment should be examined carefully to detect potential causes of anesthetic complications.

Keywords

COMPLICATIONS, EQUIPMENT, EQUIPMENT

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