Massive Subcutaneous Emphysema and Uncontrolled Hypercarbia during Laparoscopic Assisted Distal Gastrectomy: A case report / 대한마취과학회지

ABSTRACT

We experienced a case of massive subcutaneous emphysema and marked hypercarbia during a laparoscopic assisted distal gastrectomy. Forty minutes after the start of pneumoperitoneum, the end-tidal carbon dioxide (CO2) tension was raised rapidly up to 70 mmHg. At this time, subcutaneous emphysema was detected on the neck and anterior chest of the patient. Carbon dioxide insufflation was then stopped, and surgery was restarted when the end-tidal CO2 level was normalized. During a second laparoscopic trial, the patient developed hypercarbia unresponsive to marked hyperventilation. As the laparoscopic procedure terminated, the end-tidal CO2 level no longer increased. Subcutaneous emphysema remained even at the recovery room. The patient was transferred to a ward in the usual procedure, and was discharged uneventfully nine days thereafter.