Carbon Dioxide Absorption During Laparoscopic Donor Nephrectomy: A Comparison Between Retroperitoneal and Transperitoneal Approaches

Kadam, Prachi; Marda, Manish; Shah, Veena R

doi:10.1016/j.transproceed.2008.03.024

Cited by 17 publications

(12 citation statements)

References 6 publications

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“…But most of these happened intraoperatively and implemented thoracocentesis or chest tube placement [8–11], or had confirmed diaphragm injury and recovered after converting to open surgery [12]. Although study showed CO 2 absorption during laparoscopy did not depend on the route of surgery [13, 14], for retroperitoneal route, the restriction on working space and field of view may increase the risk of inadvertent organ damage.…”

Section: Discussionmentioning

confidence: 99%

Carbon dioxide pneumothorax following retroperitoneal laparoscopic partial nephrectomy: a case report and literature review

Zhang

2018

BMC Anesthesiol

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BackgroundLaparoscopy has many advantages when used to assist surgery. However, pneumothorax, as a rare but potentially life-threatening complication, it requires rapid recognition and treatment. CO2 pneumothorax may be distinct from air pneumothorax. Here we present a case with unexpected large and symptomatic CO2 pneumothorax and treated successfully in a conservative way.Case presentationA 27-year-old woman who was scheduled a laparoscopic partial nephrectomy received general anesthesia. At the end of surgery, she waked up and got spontaneous breathing. However, she developed a sudden fall in SpO2 (approximately 30%) and blood pressure with subsequent unconsciousness after switching mechanical ventilation to spontaneous mode. With immediate manual ventilation, SpO2 and blood pressure recovered simultaneously and the patient regained consciousness. Point-of-care chest X-ray revealed a large, right pneumothorax occupying 70% of the hemi-thorax. Without chest drainage, she was extubated in the operating room and treated with supplemental facial mask oxygen therapy in PACU. On the postoperative 5th day, she was discharged without any further complication.ConclusionRetroperitoneal laparoscopic surgeries are likely to bring about severe capno-thorax, which could be absorbed rapidly. Chest X-ray could be used to assist diagnosis but point-of-care transthoracic ultrasound is recommended. Even severe capno-thorax could be treated conservatively. This case highlights the awareness and therapeutic choice of noninvasive management for capno-thorax.

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Section: Discussionmentioning

confidence: 99%

Carbon dioxide pneumothorax following retroperitoneal laparoscopic partial nephrectomy: a case report and literature review

Zhang

2018

BMC Anesthesiol

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“…Kadam et al . [ 6 ] and Ng et al . [ 7 ] have reported a similar absorption of carbon-di-oxide in either route.…”

Section: Discussionmentioning

confidence: 99%

Pediatric retroperitoneoscopic nephrectomy: An initial experience of 15 cases

Maitra

Khanna

Baidya

et al. 2015

J Anaesthesiol Clin Pharmacol

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Retroperitoneoscopic approach of nephrectomy in pediatric patients is a debatable issue from surgical point of view. Experience of anesthetic management of 15 such patients from a tertiary care teaching hospital has been described here. We found that capno-retroperitoneum increases end-tidal carbon-di-oxide, but normocapnea was achieved in the most of the patients. No significant hemodynamic changes were noted in any patients. However, subcutaneous emphysema was common, but self-limiting without any serious consequence. Postoperative pain after this procedure is usually manageable by nonopioid analgesics.

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“…More recently, surgical interest has focused on the CO 2 absorption from extra-peritoneal insufflation with particular interest in renal and transplant surgery 6,13,16 . Although reports are conflicting, CO 2 production is greater than for intra-abdominal laparoscopy and increases, rather than plateaus, during surgery.…”

Section: Discussionmentioning

confidence: 99%

Surgical Emphysema as a Cause of Severe Hypercapnia during Laparoscopic Surgery

Critchley

2010

Anaesth Intensive Care

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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.

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Carbon Dioxide Absorption During Laparoscopic Donor Nephrectomy: A Comparison Between Retroperitoneal and Transperitoneal Approaches

Cited by 17 publications

References 6 publications

Carbon dioxide pneumothorax following retroperitoneal laparoscopic partial nephrectomy: a case report and literature review

Carbon dioxide pneumothorax following retroperitoneal laparoscopic partial nephrectomy: a case report and literature review

Pediatric retroperitoneoscopic nephrectomy: An initial experience of 15 cases

Surgical Emphysema as a Cause of Severe Hypercapnia during Laparoscopic Surgery

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