Anaes Cases · Volatile & inhalational agents
Nitrous oxide and the expanding pneumothorax
The hot, time-pressured scenario — nitrous oxide diffusing into and expanding an occult pneumothorax to a tension pneumothorax, the recognition, and the immediate needle decompression and discontinuation of the nitrous oxide.
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ANZCAFRCAABAEDAIC
Prompt
A trauma patient with an undiagnosed pneumothorax is anaesthetised with a volatile and 70 per cent nitrous oxide. Twenty minutes in, the blood pressure falls, the airway pressures rise, the saturation drops, and the neck veins are distended. Manage.
Presentation
A young man anaesthetised for the fixation of a femoral fracture after a fall is being maintained on a volatile with 70 per cent nitrous oxide. He had a chest radiograph in the emergency department reported as normal. Twenty minutes into the anaesthetic, the blood pressure falls, the peak airway pressure rises sharply, the saturation drops, and the neck veins become visibly distended.[2]
References2ShowHide
- [1]Myles PS, Leslie K, Chan MT, Forbes A, et al. The safety of addition of nitrous oxide to general anaesthesia in at-risk patients (ENIGMA-II). The Lancet, 2014.PMID 25142708
- [2]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.