Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report two cases of marked hypercapnia of more than 60 mm Hg (PaCO2) and extensive subcutaneous emphysema noted during laparoscopic cholecystectomy. The first case, a 55-year-old man was diagnosed as having cholecystolithiasis and had hypercapnia up to 83.5 mm Hg (PaCO2) during laparoscopic cholecystectomy. The patient resumed spontaneous respiration under controlled ventilation accompanied by persistent bigeminal pulse. Soon after deflation, CO2 returned to normal range, and extensive subcutaneous emphysema was detected in the recovery room. The second patient, a 53-year-old woman, had cholecystolithiasis and also underwent laparoscopic cholecystectomy. Both hypercapnia rising to 61.1 mm Hg (PaCO2) and extensive subcutaneous emphysema appeared just before completion of resection of the gallbladder. Mild hypercapnia during pneumoperitoneum of about 50 mm Hg (PaCO2) has been reported previously. As compared with cases in the literature, the present cases suggest that hypercapnia is due to extensive subcutaneous emphysema. The large absorption surface area in the subcutaneous tissue and the large difference in the partial pressure cause the extensive gaseous interchange of CO2 between subcutaneous tissue and blood perfusing into it at the moment between peritoneal cavity and blood perfused the peritoneum.
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PMID:Extensive subcutaneous emphysema and hypercapnia during laparoscopic cholecystectomy: two case reports. 763 43

A 56-year-old man with cholecystolithiasis was scheduled for laparoscopic cholecystectomy. Anesthesia was induced with pentazocine and propofol i.v., and the trachea was intubated using vecuronium i.v. Anesthesia was maintained with 70% nitrous oxide and 1-3% sevoflurane in oxygen, and vecuronium was used for muscle relaxation. The lungs were mechanically ventilated with a tidal volume of 600 ml and a respiratory rate of 8 cycles.min-1. Following induction of carbon dioxide pneumoperitoneum, blood pressure, PETCO2 and peak inspiratory pressure gradually increased. PETCO2 increased from 33 mmHg to 48 mmHg despite increase in the respiratory rate to 20 cycles.min-1. By 45 minutes after the beginning of surgery, PETCO2 had increased to 60 mmHg, and ventilation of the lungs was impossible. Bronchofiberscopy revealed obstruction of the endotracheal tube by tracheal mucosa. The endotracheal tube was then drawn out by 2 cm with slight recovery of ventilation. After 1 h 16 min of surgery, it was observed that the patient had developed pneumoscrotum and subcutaneous emphysema extending from femoral area, abdomen, and thorax to the right neck. Chest rentogenography revealed a slight tracheal shift and subcutaneous emphysema. One hour after the end of surgery, PaCO2 was 48.9 mmHg under spontaneous respiration. We speculate that the pneumoperitoneum shifted the tracheal carina cephalad, causing obstruction of the endotracheal tube. Our findings show that displacement of the endotracheal tube must be carefully monitored during laparoscopic cholecystectomy.
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PMID:[A case of endotracheal tube obstruction caused by pneumoperitoneum during laparoscopic cholecystectomy]. 999 Feb 20

A 56-year-old woman with cholecystolithiasis was scheduled for laparoscopic cholecystectomy. Anesthesia was induced with fentanyl and propofol IV, and the trachea was intubated using vecuronium IV. Anesthesia was maintained with 60% nitrous oxide and propofol intravenously, and vecuronium was used for muscle relaxation. Following induction of carbon dioxide pneumoperitoneum, PETCO2 slightly increased. During pneumoperitoneum PETCO2 as easily controlled by increasing minute volume of ventilation. Fifty minutes after the start of pneumoperitoneum, suddenly the peak airway pressure increased and PETCO2 reached 70 mmHg continuously. At this time, severe massive subcutaneous emphysema from the anterior thorax to the head and neck was noted, and the manual lung ventilation was very difficult. After discontinuation of pneumoperitoneum, PETCO2 gradually decreased with improvement of the neck subcutaneous emphysema. At the same time the lung ventilation improved. We speculate that major causes of difficulty in ventilation were the decreased compliance and the tracheal tube comppression, which were due to massive subcutaneous emphysema. Our findings show that we have to stop pneumoperitoneum immediately, when we find a sudden increase of the peak airway pressure or PETCO2 with subcutaneous emphysema during laparoscopic cholecystectomy.
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PMID:[Sudden difficulty in ventilation due to massive subcutaneous emphysema during laparoscopic cholecystectomy]. 1596 85