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[Sudden difficulty in ventilation due to massive subcutaneous emphysema during laparoscopic cholecystectomy]
Hiroto Imai1, Naomi Nakatani, Shinya Matsuda
1Department of Anesthesia, Sanda Municipal Hospital, Sanda.
Masui. the Japanese Journal of Anesthesiology
|June 22, 2005
Summary
During laparoscopic cholecystectomy, sudden increases in airway pressure and PETCO2 indicate massive subcutaneous emphysema. Discontinue pneumoperitoneum immediately to manage ventilation difficulties.
Area of Science:
- Anesthesiology
- Surgical Complications
- Respiratory Physiology
Background:
- Laparoscopic cholecystectomy involves inducing pneumoperitoneum, which can affect respiratory parameters.
- Maintaining adequate ventilation is crucial during insufflation procedures.
Observation:
- A patient undergoing laparoscopic cholecystectomy developed a sudden increase in peak airway pressure and end-tidal carbon dioxide (PETCO2) to 70 mmHg.
- Severe subcutaneous emphysema extending from the thorax to the head and neck was observed, causing difficult manual lung ventilation.
Findings:
- Massive subcutaneous emphysema significantly decreased lung compliance and potentially compressed the tracheal tube.
- Discontinuation of pneumoperitoneum led to a gradual decrease in PETCO2 and improvement in ventilation.
Implications:
- Immediate cessation of pneumoperitoneum is recommended upon detecting sudden increases in peak airway pressure or PETCO2 concurrent with subcutaneous emphysema.
- This case highlights the critical need for prompt recognition and management of barotrauma during laparoscopic surgery.