21 yr male, Fall from height, fracture L-1 spine with paraplegia.
All investigations normal. Posted for instrumentation under GA in Prone.
Standard induction with Propofol, Fentanyl, Medaz, Roc intubation, Venti with Gas Oxygen and Iso as needed. Well controlled BP.
Goes on nicely for 100 mins. At this the surgeons drill and put a screw at T 11. The ventilation became difficult, taken over hand ventillation, but desaturates. The surgical team complains about air bubbles in the field of surgery. BP started dropping and the ECG showed patterns. Leading to a flat line.
Pt was made supine and CPR started. Recovered after a DC shock.
On observation, there was a great surgical emphysema all over the body from Eyes to Knee and elbows. few needle punctures were made all over, the patient, gradually sattled. Surgery was finished in lateral position and he needed Dopamine support for a while , patient was reversed and was allowed to go to ICCU with a T- Piece and oxygen.
Portable X ray did not show any tension pneumo after he improved. (now atleast). There was surgical emphe all over in the X ray.
Patient regained full consciousness in next 36 hrs and was extubated.
Our impression on the spot was that either there was some rent in the trachea or some trauma in the lungs during the surgery.
There was no sign of trauma to trachea, no blood in ET tube or throat pack,. No gas in the mediastinum on X ray . Can it be from surgical field???
I am at loss on ideas now. Make geusses.