[Bilateral pneumothorax following lower neck and upper mediastinal surgery]

A 46-year-old male underwent resection of parathyroid tumor under general anesthesia. The preoperative chest radiography was normal. Arterial blood pressure, heart rate, and arterial oxygen saturation (SpO2) were stable during the operation. Because the tumor was in the mediastinum, incision was made behind the sternum and a drainage catheter was placed. At the completion of the surgery, spontaneous breathing began immediately. The neuromuscular blockade was reversed, and severe bucking was noted. Although the patient was not fully recovered from anesthesia, he was extubated because of his stable respiration and SpO2. Soon after the extubation, the patient developed cyanosis and the SpO2 declined to less than 50%. Chest radiography revealed bilateral pneumothorax, which was successfully treated by inserting bilateral chest tubes. Injury of parietal pleura, which might have been associated with the surgery and/or postoperative bucking, may be the main cause of the pneumothorax. Anesthetists should be aware of the occurrence of pneumothorax during neck surgery and have to avoid bucking postoperatively.