Hypercapnia as the only early sign of pneumothorax in patient under general anaesthesia

Abstract

Pneumothorax is a well-known but rare complication of general anaesthesia (GA). Its presentation can be subtle and difficult to diagnose especially under GA. We present a case of a 50-year-old man who is a chronic smoker, underwent an emergency exploratory laparotomy for perforated gastric ulcer. After induction, there was hypercapnia which progressively worsened. Common causes of hypercapnia were excluded. Unequal breath sounds and tracheal deviation presented late and there was never desaturation. Bedside lung ultrasound showed absence of sliding sign and presence of bar-code sign over right lung which suggested right pneumothorax. Needle thoracocentesis and chest tube insertion were done upon diagnosis. We recommend that pneumothorax be suspected early in patient with persistent unexplained hypercapnia under GA and anaesthesiologists to be able to perform lung ultrasound as early intervention could be life saving.