Surgical emphysema as a cause of severe hypercapnia during laparoscopic surgery

Surgical emphysema is a well-recognised complication of laparoscopic surgery, but its impact on end-tidal carbon dioxide levels and carbon dioxide elimination is seldom reported and may not be fully appreciated by anaesthetists. Four cases are presented where extensive surgical emphysema occurred du...

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Bibliographic Details
Published in:Anaesthesia and intensive care 2010-11, Vol.38 (6), p.1094-1100
Main Authors: CRITCHLEY, L. A. H, HO, A. M-H
Format: Article
Language:English
Subjects:
Aged
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Carbon Dioxide - metabolism
Care and treatment
Causes of
Emphysema - complications
Emphysema, Pulmonary
Female
Humans
Hypercapnia
Hypercapnia - etiology
Laparoscopic surgery
Laparoscopy
Laparoscopy - adverse effects
Male
Medical sciences
Middle Aged
Patient outcomes
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Summary:Surgical emphysema is a well-recognised complication of laparoscopic surgery, but its impact on end-tidal carbon dioxide levels and carbon dioxide elimination is seldom reported and may not be fully appreciated by anaesthetists. Four cases are presented where extensive surgical emphysema occurred during laparoscopic surgery. The visual display of the anaesthetic record using the software program Monitor showed substantial rises in end-tidal carbon dioxide levels and allowed calculation of the carbon dioxide elimination, which increased two- to three-fold above normal levels. Having a visual record of carbon dioxide changes facilitated the recognition of surgical emphysema in three out of the four cases. Strategies such as estimating and tracking changes in carbon dioxide elimination from the minute ventilation and end-tidal carbon dioxide levels may assist in early identification, and palpating for surgical emphysema is recommended during laparoscopy if other causes of increased carbon dioxide levels are excluded.
ISSN:0310-057X
1448-0271
DOI:10.1177/0310057X1003800622