Severe Subcutaneous Emphysema Caused by Explosive Coughing Immediately after Extubation Following Video-assisted Thoracoscopic Surgery

• DOI: 10.4103/jmedsci.jmedsci_199_24
• Publication Date: 2025-03-12T06:00:41Z
• Authors: Yi-Hsiung Lu; Po-An Lin; Tsai-Wang Huang; Chun-Chang Yeh
• Keywords: Video-assisted thoracoscopic surgery

Abstract A generally healthy 62-year-old male underwent a video-assisted thoracoscopic wedge resection of the right lower lobe to remove tumor nodules under general anesthesia. Immediately upon emergence from anesthesia, patient experienced explosive coughing following extubation, which resulted in extensive subcutaneous emphysema (SCE) and pneumomediastinum. This emergence-related subsequent SCE were both unexpected unusual. While several factors may have contributed, inadequate adjustment anesthesia during likely played significant role. Key lessons include considering continuation remifentanil administration until after removal endotracheal tube staggering doses sugammadex minimize coughing.