Perioperative pneumothorax, when accompanied by decreased heart rate and oxygen saturation, constitutes a critical intraoperative emergency and poses a significant emergency management challenge to the anaesthetist. We report a case of a two-month-old girl who underwent a third endoscopic balloon dilation for oesophageal stricture following surgery for a tracheoesophageal fistula. During balloon dilation, a significant and persistent decrease in heart rate and oxygen saturation occurred. Following cessation of the procedure, we initiated cardiopulmonary resuscitation and administered intravenous medications. Heart rate and oxygen saturation briefly improved then again subsequently declined. After ruling out excessive depth of the endotracheal tube, vagal reactions and airway spasm, a right-sided pneumothorax was identified in the patient. Prompt closed-thoracic drainage was performed, after which the patient's heart rate and oxygen saturation returned to normal. The patient developed right pneumothorax during the fourth balloon dilation. This case highlights that balloon dilation for oesophageal stricture may cause oesophageal rupture and oesophageal fistula, leading to pneumothorax. Prompt diagnosis and thoracostomy were crucial.
Yu et al. (Tue,) studied this question.