Korean J Anesthesiol.  1997 Mar;32(3):467-472. 10.4097/kjae.1997.32.3.467.

Subcutaneous Emphysema and Pneumomediastinum during Laparoscopic Burch Operation

• Yang MK
• Hong JS
• Lee BD
• Shin BH

• KMID: 2033337
• DOI: http://doi.org/10.4097/kjae.1997.32.3.467

Abstract

Laparoscopic Burch operation is one of laparoscopic surgery for stress urinary incontinence. Subcutaneous emphysema and hypercarbia are potential complications of laparoscopic surgery, but are more likely to occur in extraperitoneal surgery than in intraperitoneal surgery, since insufflated CO2 can diffuse easily into the surrounding tissues. We report a patient in whom pneumomediastinum and extensive subcutaneous emphysema developed during laparoscopic Burch operation. Transient hypoxemia was also accompanied with hypercarbia. Possible mechanisms are presented, along with discussion of prompt diagnosis and treatment. For the management of laparoscopic extraperitoneal surgery, it is necessary to be careful with monitoring of CO2 insufflation pressure, routine examination and palpation of chest wall, use of N2O with caution, increase of ventilation to eliminate CO2, and excluding other causes of subcutaneous emphysema and hypercarbia.

Keyword

Carbon dioxide; hypercarbia; Complications; pneumomediastinum; subcutaneous emphysema; Surgery; extraperitoneal; laparoscopy; urologic

MeSH Terms

Anoxia
Carbon Dioxide
Diagnosis
Humans
Insufflation
Laparoscopy
Mediastinal Emphysema*
Palpation
Subcutaneous Emphysema*
Thoracic Wall
Urinary Incontinence
Ventilation
Carbon Dioxide