Bilateral tension pneumothorax following rigid bronchoscopy: A report of an epignathus in a newborn delivered by the EXIT procedure with a fatal outcome

Abstract

We describe a case of a newborn baby with a prenatal diagnosis of an epignathus (oropharyngeal teratoma). With the potential for airway problems at birth, he was delivered by an elective EXIT (Extra Utero Intrapartum Treatment) procedure at 38 weeks of pregnancy. The airway was secured and rigid bronchoscopy performed. Initially he was stable, but developed cardiorespiratory difficulties 40 minutes after birth and died from a cardiac arrest 17 minutes later. Tension pneumothorax is a devastating complication that can occur with lower airway manipulation for anaesthesia and rigid bronchoscopy. The addition of positive pressure during mechanical ventilation converts the pneumothorax into a tension pneumothorax. The possibility of tension pneumothorax should be entertained in a mechanically ventilated patient whose ventilatory pressures are increasing, with diminishing cardiac output. A complicated case is presented, where the diagnosis was missed with a fatal outcome.

Post-intubation tension pneumothorax and pneumoperitoneum in a low birth weight neonate with giant epulis

“…Fatal outcome has been reported in a neonate with bilateral tension pneumothorax, following rigid bronchoscopy. [ 7 8 ] Multiple airway manipulations, use of fibre-optic bronchoscopy and positive pressure ventilations causing barotrauma could have contributed to the development of tension pneumothorax and pneumoperitoneum in our case.…”

Cardiac arrest induced by tension pneumothorax during ventilating bronchoscopy -A case report-

“…Tension pneumothorax is a rare but life-threatening complication [3,4]. Rothmann and Boeckman [6] reported that the probability of pneumothorax during rigid bronchoscopy for the removal of a foreign body is approximately 1%.…”

“…Many complications can occur during ventilating bronchoscopy [2], and tension pneumothorax during ventilating bronchoscopy is a rare but a life-threatening complication [3,4]. Early diagnosis and prompt management are essential for a good outcome.…”

Tension Pneumothorax During Rigid Bronchoscopy for Chronic Foreign Body Removal in a Child: A Case Report

“…Performing these procedures in airway of pediatric patients poses a special challenge to both the anesthesiologist and the surgeon. Pneumothorax remains a rare but devastating complication instigating from lower airway manipulation during rigid bronchoscopy [2]. Rothmana and Boeckman reported that the probability of developing pneumothorax during rigid bronchoscopy for the removal of foreign body is approximately one in 100 cases [3].…”