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.

Thoracic aortic diseases involving the thoracic aorta, from the ascending aorta, the aortic arch to the descending aorta, can present in the form of aneurysms, dissection, tear and coarctation which usually lead to various complications, requiring surgical intervention. The same can be addressed surgically by ascending aorta replacement or reduction aortoplasty with/without Aortic Valve Replacement (AVR). The anaesthetic implications might vary depending on the pathology of the thoracic aortic disease which can be acute or chronic and, silent or symptomatic. Anaesthetic management of four patients (1 female and 3 males) with varied thoracic aortic diseases have been described in the series, including bicuspid aortic valve with severe aortic stenosis, Ischaemic Heart Disease (IHD) with severe Aortic Regurgitation (AR) with ascending aortic aneurysm, ascending aortic dilatation in a known Takayasu arteritis patient and coarctation of aorta with atrial septal defect. These patients underwent aortoplasty with or without aortic root replacement. Full cardiopulmonary bypass with Deep Hypothermic Circulatory Arrest (DHCA) at 16-20°C was the technique used for these procedures as it prevents stroke and ensures cognitive function. This technique had no additional cannulas, less chances of intimal injury or embolisation and clear surgical fields. During the process of rewarming, Inj. nitroglycerine was started which reduced preload, conserving the myocardium against ischaemic injuries. These patients were successfully managed perioperatively and were discharged with good outcomes postoperatively