Peer-reviewed veterinary case report
Dog developed tension pneumothorax after wrong oxygen tube connection
By Bekkat-Berkani, Desislava et al.·Published in Veterinary anaesthesia and analgesia·2025·Anaesthesia and Analgesia Department, United Kingdom·View original on PubMed →
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Original publication title: Iatrogenic tension pneumothorax resulting from misconnection of the endotracheal tube to the auxiliary oxygen flowmeter of the anaesthetic machine.
- Species:
- dog
Plain-English summary
A 1-year-old male English Springer Spaniel was brought in for a CT scan due to problems walking on his back legs. Shortly after being put under anesthesia, he developed a serious condition called tension pneumothorax, which is when air gets trapped in the chest and makes it hard to breathe. This happened because the breathing tube was mistakenly connected to the wrong oxygen source. The veterinary team quickly diagnosed the issue and performed emergency procedures to relieve the pressure in his chest. After treatment, the dog was able to undergo the CT scan as planned.
People also search for: dog breathing problems after anesthesia · tension pneumothorax in dogs · English Springer Spaniel anesthesia risks
Abstract
A 1-year-old, male entire English Springer Spaniel dog, presented for computed tomography investigation of bilateral pelvic limb gait abnormality. The dog developed tension pneumothorax shortly after intubation because of erroneous connection of the endotracheal tube to the auxiliary oxygen flowmeter instead of the breathing circuit. A prompt diagnosis, based on reduced compliance during manual ventilation, bradycardia and second-degree atrioventricular block, combined with barrel-shaped thoracic distension, led to an emergency needle thoracocentesis, followed by bilateral thoracostomy tube placement. Computed tomography was then performed as scheduled with an added scan sequence for the thorax. General anaesthesia was maintained using total intravenous techniques with propofol and ketamine infusions. Hospital morbidity and mortality rounds identified various active and system failures as contributing factors. The 22 mm connector attached to the auxiliary oxygen flowmeter tubing was recognized as the major contributing factor, as it could be connected to both the endotracheal tube and oxygen mask. Consequently, the decision was made to no longer use the auxiliary oxygen flowmeter for preoxygenation. This report discusses the circumstances leading to this adverse event and highlights the danger of anaesthesia-related errors.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/40467436/