Severe Subcutaneous Emphysema Caused by Explosive Coughing Immediately after Extubation Following 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, the patient experienced explosive coughing following extubation, which resulted in extensive subcutaneous emphysema (SCE) and pneumomediastinum. This emergence-related coughing and the subsequent SCE were both unexpected and unusual. While several factors may have contributed, inadequate adjustment of anesthesia during emergence likely played a significant role. Key lessons include considering the continuation of remifentanil administration until after the removal of the endotracheal tube and staggering doses of sugammadex to minimize coughing.