Electrographic lead I and V5 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.n/a
Main Authors: Lee, Chihjen, Yumul, Roya, Vongchaichinsri, Colby, Tsai, Kevin, Wang, Lena
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Anesthesia
Blood pressure
Blood tests
Case Report
Case Reports
Dyspnea
EKG
electrocardiographic changes
Heart rate
intraoperative monitoring
Intubation
Ischemia
Medical personnel
Metabolism
Monitoring
nephrectomy
Oxygen saturation
Patient positioning
Pneumothorax
Robotics
Surgery
Ultrasonic imaging
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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 V5. We recommend lead V5 be added to the continuous monitoring and lead I be periodically checked for surgeries known to potentially cause pneumothorax. Postoperative EKG showed a new right superior axis at 268 degrees and markedly reduced R wave amplitude in lateral leads I and aVL, and precordial leads V 2 through V 6. Also noted were T wave flattening/inversion in lead I, lead II and precordial leads Electrical alternans were most visible in V 6. These EKG findings were consistent with left‐sided pneumothorax. Stat chest X‐ray was ordered, which revealed a large left‐sided pneumothorax and a nearly total collapsed left lung.
ISSN:1082-720X
1542-474X
DOI:10.1111/anec.13017