1/56. Successful use of high frequency oscillatory ventilation for pneumomediastinum.An infant with pneumomediastinum due to mechanical ventilation was successfully treated using high frequency oscillatory ventilation (HFOV). The 3-month-old male had undergone ligation of a patent ductus arteriosus and suffered from barotraumatic pneumomediastinum in the postoperative period. Computed tomography of the chest confirmed the diagnosis. While using conventional mechanical ventilation the respiratory failure worsened. HFOV was instituted and the patient improved. A lower airway pressure by this mode of ventilation provided significant advantages in the patient with an air leak. He was subsequently extubated and discharged home.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/56. Pneumomediastinum, pneumothorax and subcutaneous emphysema complicating MIS herniorrhaphy.PURPOSE: Videoscopic herniorrhaphy is being performed more frequently with advantages claimed over the conventional open approach. This clinical report describes a pneumothorax, pneumomediastinum and subcutaneous emphysema occurring at the end of an extraperitoneal videoscopic herniorrhaphy. CLINICAL FEATURES: A 25 yr old ASA I man presented for elective extraperitoneal videoscopic hernia repair. Following intravenous induction with fentanyl, midazolam and propofol a balanced anesthetic technique using enflurane in N2O and O2 was used. Apart from a prolonged operating time (195 min), the procedure and anesthetic was uneventful. At the conclusion of the operation, prior to reversal of neuromuscular blockade extensive subcutaneous emphysema was noted on removal of the surgical drapes. Chest radiography revealed a pneumomediastinum and pneumothorax. A 25 FG intercostal tube was inserted and connected to an underwater seal drain. Sedation and positive pressure ventilation was maintained overnight to permit resolution and avoid airway compromise. The clinical and radiological features had resolved by the next morning and the patient's trachea was extubated. His subsequent recovery was uneventful. CONCLUSION: pneumothorax and pneumomediastinum are well recognised complications of laparoscopic techniques but have not been described following extraperitoneal herniorrhaphy. In this report we postulate possible mechanisms which may have contributed to their development, including inadvertent breach of the peritoneum and leakage of gas around the diaphragmatic herniae or tracking of gas retroperitoneally. The case alerts us to the possibility of this complication occurring in patients undergoing videoscopic herniorrhaphy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/56. Pneumomediastinum after injection injury to the hand.Pneumomediastinum as a consequence of injection injury to the hand has not been previously reported. We present a 22-year-old male who developed pneumomediastinum when a high pressure hose injected air into his hand. The anatomic continuity between peripheral ulnar neurovascular bundle and the hilar vessels provided the route for air entering the hypothenar eminence to penetrate the mediastinum. After ruling out life-threatening causes of pneumomediastinum such as esophageal perforation, his management included observation and serial radiographs. By one week there was complete resolution of the mediastinal air. This report demonstrates that pneumomediastinum may be associated with air injection injury of the hand, and that expectant management is appropriate.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/56. A case of pneumomediastinum in paediatric ARDS: to oscillate or not?An 18-month-old was transferred (intubated and ventilated) to our hospital with staphylococcal tracheitis, which progressed to a necrotizing pneumonitis, complicated by surgical emphysema and pneumomediastinum. Maximum conventional ventilation on a Servo 300 failed. Treatment with high frequency oscillatory ventilation (for 10 days) with a permissive hypercarbia and hypoxaemia strategy to limit mean airway pressure facilitated recovery in our patient.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/56. Cervical emphysema, pneumomediastinum, and pneumothorax following self-induced oral injury: report of four cases and review of the literature.Spontaneous rupture of the pulmonary alveoli after a sudden increase in intra-alveolar pressure is a common cause of pneumomediastinum, which is usually seen in healthy young men. Other common causes are traumatic and iatrogenic rupture of the airway and esophagus; however, pneumomediastinum following cervicofacial emphysema is much rarer and is occasionally found after dental surgical procedures, head and neck surgery, or accidental trauma. We present four cases of subcutaneous emphysema and pneumomediastinum with two secondary pneumothoraces after self-induced punctures in the oral cavity. They constitute an uncommon clinical entity that, to our knowledge, has not been reported in the literature. Its radiologic appearance, clinical presentation, and diagnosis are described.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/56. Pneumorachis and pneumomediastinum caused by repeated Muller's maneuvers: complications of marijuana smoking.Pneumomediastinum may occur during marijuana inhalation but only rarely has pneumorachis (epidural pneumatosis or aerorachia) been reported. The usual mechanisms that produce pneumomediastinum include severe acute asthma, toxic-induced bronchial hyperreactivity, and barotrauma caused by Valsalva's maneuver (expiration through resistance). We report a case in which barotrauma resulted from repeated deep inspiration through a device with airflow resistance equivalent to Muller's maneuver. Inspiration occurred through a homemade apparatus resembling a narrow outlet bong with 2 piled compartments. Pneumomediastinum combined with subcutaneous emphysema and pneumorachis occurred, without identified pneumothorax. There were no neurologic complications. Because of the absence of bronchospasm, expiration either through the apparatus or actively against a closed glottis, or apnea, this phenomenon is likely a result of repeated Muller's maneuvers. Successive inhalation through resistance could have resulted in extreme negative intrathoracic pressure, which would have caused a transmural pressure gradient inducing barotrauma and release of extrarespiratory air. High-concentration oxygen therapy to achieve nitrogen washout was used.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
7/56. carbon dioxide pneumothorax during laparoscopic surgery.BACKGROUND: Anesthetic considerations for laparoscopic cholecystectomy are similar to those for other laparoscopic procedures and result from the creation of a pneumoperitoneum by insufflation of carbon dioxide (CO 2) into the abdominal cavity. The resultant problems such as decreased functional residual capacity, increased airway pressure, hypercarbia, and circulatory impairment are well known [1]. The reported case is that of a healthy 45-yr-old man who underwent elective laparoscopic cholecystectomy under general anesthesia. As surgery proceeded he developed hypercapnia (arterial blood partial pressure of CO 2 [pCO] 2], 97.1 mmHg; extrapolated end-tidal CO 2 tension [P ETCO 2], 90 mmHg) and hypoxemia (partial pressure of oxygen [pO 2], 53.1 mmHg). The cause was attributed to absorption of CO 2 directly related to the surgical pneumoperitoneum. This report illustrates the diagnosis and management of an unusual case of CO 2 absorption, resulting in hypercapnia and hypoxemia, and a spontaneous recovery within 30 to 60 min without need of thoracentesis.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
8/56. Management of an unusual presentation of foreign body aspiration.Foreign body aspiration is a very common problem in children and toddlers and still a serious and sometimes fatal condition. We are reporting on a 2-year-old white asthmatic male who choked on a chick pea and presented with subcutaneous emphysema, and on chest X-ray with an isolated pneumomediastinum but not pneumothorax. On review of the literature an isolated pneumomediastinum without pneumothorax was rarely reported. This presented a challenge in management mainly because of the technique that we had to use in order to undergo bronchoscopy and removal of the foreign body. Apnoeic diffusion oxygenation was used initially while the foreign body was removed piecemeal, and afterwards intermittent positive pressure ventilation was used. The child did very well, and his subcutaneous emphysema and pneumomediastinum remarkably improved immediately post surgery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/56. Pneumomediastinum and cervical emphysema associated with unusual clinical and electrocardiographic manifestations--a case report.This is the first case reported of combined cervical emphysema and pneumomediastinum associated with unusual electrocardiographic and local neurologic findings. These may be the result of an increase in intracervical and intrathoracic pressure induced by the dissecting air.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/56. Idiopathic spontaneous pneumomediastinum: an uncommon emergency in children.Spontaneous pneumomediastinum (SPM) occurs rarely in children. The diagnosis is based on physical examination and chest radiography. Conservative therapy usually leads to recovery. However, SPM in association with severe hypoxia, tachycardia, metabolic acidosis, and high ventilation pressures indicates clinically significant tension in the mediastinum. A collar mediastinotomy is the treatment of choice in these circumstances.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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