A case of tension pneumothorax after general anesthesia

: A 72-year-old male patient was scheduled for extirpation of the right kidney and ureter with partial resection of the bladder. Anesthesia was maintained with general and epidural anesthesia. After the end of surgery, he awoke and his spontaneous ventilation seemed to be good. Soon after extubation, he developed cyanosis and circulatory arrest. Immediately cardiopulmonary resuscitation was performed and regular beating of the heart was restored about 6 minutes after cardiac arrest. A chest x-ray showed pneumothorax on right side and he was diagnosed as tension pneumothorax caused by injury of the right diaphragmatic pleura during surgery. Pneumothorax was improved by drainage of the right thoracic cavity, and he was transferred to the intensive care unit. After 4 days of hypothermic therapy, he showed no neurological deficit and recurrence of pneumothorax was not observed. We should be aware of the occurrence of pneumothorax during perioperative period in the patients who underwent surgical procedure in the vicinity of the diaphragm.