Bilateral pneumothoraces in a patient undergoing minimally invasive parathyroidectomyduring monitored anesthesia care

Factors that may further augment the incidence of pneumothorax during MIP are extensive dissection at the thoracic inlet, widespread scar tissue from previous surgical or radiation therapy, cervical thymectomy, and a superior mediastinal ectopic parathyroid gland [4]. Before conducting their prospective analysis of MIP, Shindo et al [5] established these exclusion criteria for patient selection: 1) suspected multiple gland pathology or parathyroid carcinoma, 2) moderate to severe sleep apnea, 3) moderate to severe gastroesophageal reflux, 4) an extremely anxious or uncooperative patient, 5) a patient who is a child, 6) thyroid pathology detected preoperatively and requiring thyroidectomy, and 7) a patient who specifically requests general anesthesia.