Fatal cardiac tamponade that developed in the post‐anesthesia care unit: a rare complication after lung lobectomy

Background and objectives: Cardiac tamponade is potentially fatal medical condition, which rarely occurs as a complication of lung lobectomy. We present the first case of cardiac tamponade to develop in a Post‐Anesthesia Care Unit following a lung lobectomy. Case report: A 54‐year‐old man with pulmonary squamous cell carcinoma underwent an apparently uncomplicated lung lobectomy. His hemodynamics was unremarkable throughout the surgery and initially in the Post‐Anesthesia Care Unit. However, after 5 min in the Post‐Anesthesia Care Unit, he suddenly became hypotensive and dyspneic. He responded poorly to inotropics and fluid resuscitation. Transesophageal echocardiography conducted by an anesthesiologist who suspected a cardiac etiology revealed a pericardial effusion compressing the heart. After a failed attempt of pericardiocentesis, an emergency pericardial window operation was performed. The patient improved dramatically once the heart was decompressed. Conclusion: Since cardiac tamponade is generally not suspected as a cause of hemodynamic instability after a lung lobectomy, as it was in this case, a misdiagnosis of the patient's condition may have led to improper management resulting in death. As anesthesiologists are often involved in the initial resuscitation of morbid patients in Post‐Anesthesia Care Units, their acquaintance with various postoperative complications and competence in echocardiography for assessing cardiac problems may contribute to patient survival.