Spontaneous postpartum pneumomediastinum: beware of too much diagnostics

Brussa, Alessandro; Marangone, Anna; Vetrugno, Luigi; Dogareschi, Teresa; Bove, Tiziana

doi:10.21037/jtd.2019.02.42

Cited by 3 publications

(1 citation statement)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, these three pathological entities have also been reported in contexts other than ATS, either caused by tracheal damage-almost always associated with orotracheal intubation-or other causes. Sporadic cases secondary to barotrauma-for example, due to particularly vigorous Valsalva maneuvers, such as during the delivery or use of a laryngeal mask in spontaneous breathingcould induce other pathogenetic processes in addition to the direct pleural damage being considered [21,22]. Furthermore, tracheal damage does not seem to be due to endotracheal intubation.…”

Section: Discussionmentioning

confidence: 99%

Tracheal lesion during shoulder surgery: a case report and systemic review of the literature

Vetrugno

Divella²,

Orso

et al. 2021

J Anesth Analg Crit Care

Self Cite

View full text Add to dashboard Cite

Pneumomediastinum (PNM) and pneumothorax (PNX) are documented complications of arthroscopic shoulder surgery (ATS). Plexus anesthetic block and tracheal lesions during endotracheal intubation are hypothesized to be the underlying risk factors; however, the actual evidence supporting this hypothesis is scarce.A case of bilateral laterocervical emphysema, subcutaneous edema, and signs of PNM after ATS performed under general anesthesia and supra-scapular nerve block is presented. An up-to-date systematic review of PNM/PNX during orthopedic surgery was performed, involving six databases: PubMed (1996–present), Embase (1974–present), Scopus (2004–present), SpringerLink (1950–present), Ovid Emcare (1995–present), and Google Scholar (2004–present).Twenty-five case studies met the eligibility criteria. In 24 cases, the patient underwent general anesthesia and orotracheal intubation; in 9 of these, a plexus anesthetic block was also performed. One case involved ATS under plexus anesthetic block only. In 10 cases, the diagnostic finding was PNM. In 5 cases, the diagnostic finding was associated with PNX. PNX was detected in 17 cases. In 2 cases, SE was found in the absence of any evidence of either PNM or PNX. A tracheal lesion was identified in 3 cases.Endotracheal intubation and loco-regional anesthesia are not the only predisposing risk factors at play in the pathogenesis of PNM/PNX. Rather, multi-factorial pathogenesis seems more probable, necessitating that specific attention is paid during ATS to the change in patient position on the operating bed, to any slipping of the endotracheal tube, to patient monitoring whilst under the drapes, and to the cuff pressure. PROSPERO registration number: CRD42021260370.

show abstract

Section: Discussionmentioning

confidence: 99%