Abstract
We report a case of mediastinal and subcutaneous emphysema that developed postoperatively in a 52-year-old patient with Down's syndrome. The patient was mentally retarded, and moderately obese (137cm, 47kg), but had no apparent pulmonary or cardiovascular diseases preoperatively. She had undergone uneventful general anesthesia five years previously. She was scheduled for ophthalmic surgery under general anesthesia. On arrival, moderate hypoxia (SpO2 93%) was noted. After administering thiamylal and vecuronium intravenously, the trachea was intubated easily without requiring a stylet. After intubation, auscultation revealed moist vesicular sounds. A suction tube aspirated bloody fluid through the tracheal tube. No other abnormal signs were noted during the operation. The patient was extubated at the end of the operation. After recovering, she started to complain of chest pain 210 minutes later. Six to seven hours postoperatively, profound subcutaneous emphysema and pneumomediastinum were confirmed by physical and radiological examinations. This may be partly attributable to the fragile tissues of Down's syndrome patient, in middle age.
