Electrographic lead I and V 5 monitoring could have detected a missed left-side pneumothorax intraoperatively

We present an EKG monitoring strategy to detect pneumothorax during high-risk surgery. In the literature, EKG changes and pneumothorax are well-described. However, anesthesiologists only monitor lead II on a three-lead EKG system in the operating room. In our case, there was only a subtle change in...

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Bibliographic Details
Published in:Annals of noninvasive electrocardiology 2023-03, Vol.28 (2), p.e13017
Main Authors: Lee, Chihjen, Yumul, Roya, Vongchaichinsri, Colby, Tsai, Kevin, Wang, Lena
Format: Article
Language:English
Subjects:
Arrhythmias, Cardiac
Electrocardiography
Humans
Pneumothorax - diagnostic imaging
Pneumothorax - etiology
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Summary:We present an EKG monitoring strategy to detect pneumothorax during high-risk surgery. In the literature, EKG changes and pneumothorax are well-described. However, anesthesiologists only monitor lead II on a three-lead EKG system in the operating room. In our case, there was only a subtle change in lead II for a left-sided pneumothorax, which could have been easily missed. On the contrary, there was a marked QRS amplitude reduction and T wave flattening/inversion in lead I and V . We recommend lead V be added to the continuous monitoring and lead I be periodically checked for surgeries known to potentially cause pneumothorax.
ISSN:1082-720X
1542-474X
DOI:10.1111/anec.13017