Intraoperative complications of laparoscopic cholecystectomy

Abstract

Laparoscopic cholecystectomy has revolutionized the surgical management of patients with symptomatic cholelithiasis. Its advantages include diminished postoperative pain and wound infections, more rapid recovery of pulmonary function, shorter hospitalization and the associated reduced cost, more rapid return to full activity and superior cosmetic result. 1,2 The first case report of the anaesthetic considerations for this procedure has been reported recently. 3 We would like to report a series of three cases of intraoperative complications resulting from the pneumoperitoneum which is created surgically to facilitate laparoscopic cholecystectomy. Key wordsCase #1 A 28-yr-old woman suffering from chronic cholecystitis was admitted for laparoscopic cholecystectomy. There was a past medical history for asthma triggered by chemicals in the work environment, of angioedema, and migraine headaches. Her medications on admission were salbutamol, budesonide, loratadine, terfenadine, hydroxyzinc, fiorinal-codeine, and domperidone. She had multiple drug allergies which included penicillin, sulphonamides, dextrometorphan, and diphenhydramine. She was a nonsmoker, and had had an uneventful anaesthetic for cervical rib resections for thoracic outlet syndrome. Physical examination was unremarkable; weight was 70 kg, and her height 168 cm.The patient was premedicated with lorazepam 2 mg sublingually and was given salbutamol aerosol one hour before surgery. Routine monitors (ECG, pulse oximetry, noninvasive blood pressure) were placed, and anaesthesia was induced with droperidol 1.25 mg, fentanyl 150 ~g, midazolam 2 mg, d-tubocurarine 3 mg, and ketamine 200 mg/v. Ketamine was chosen for induction to prevent reflex bronchospasm. Succinylcholine 120 mg was given to facilitate tracheal intubation. Anaesthesia was maintained with 60% N20 in oxygen and isoflurane 0.5-2% to maintain normotension. Pancuronium provided muscle relaxation. The initial ventilator settings using a Mapleson D circuit were tidal volume of 700 ml, frequency of 12 per minute, fresh gas flow (FGF) of 4.5 L. rain -I, and inspiratory pressure (IP) of 20/0 cm H20. Capnography was instituted with induction of anaesthesia. Hydrocortisone 100 mg was administered for perioperative steroid coverage. A Foley catheter was inserted, as well CAN J ANAESTH 1993 / 40:5 / pp459-64

Incidence and significance of pneumomediastinum after laparoscopic esophageal surgery

“…There have been numerous reports of extraabdominal collections of gas, including pneumomediastinum, with variable clinical and hemodynamic effects. [1,2,3,5,6,7]. These reports have documented arterial hypercarbia with acidosis, electrocardiograms with decreased voltage, increased inspiratory pressure, tachycardia, and restricted chest wall motion due to the extraabdominal location of the insufflated gas.…”

“…Gas collections may occur in numerous locations with variable clinical implications following laparoscopic procedures; in addition, pneumomediastinum has also been reported following laparoscopic surgery [1,2,5,6,7]. Since laparoscopic operations involving the esophagus have become more frequent in recent years, a low incidence of perforation (<1%) has been reported as a complication when the procedure is performed by experienced surgeons [4].…”

Pneumoscrotum as Complication of Blunt Thoracic Trauma: A Case Report

“…Pathologic pneumoscrotum includes pneumothorax (traumatic or spontaneous), pneumomediastinum, visceral perforation, trauma of the abdomen cavity or the retroperitoneum, direct scrotal injury, perinephric abscess, rapid decompression after diving, and Fournier's gangrene. Procedural causes of pneumoscrotum includes endoscopy and laparoscopic procedures [4,5], retroperitoneal sympathectomy, pacemaker placement, intubation of the trachea, cardiopulmonary resuscitation.…”

Acute ventilatory complications during laparoscopic upper abdominal surgery

“…An increase in airway pressure (Paw) or decreased lung compliance indicate the presence of pneumothorax. 4,6,8 This was found in most instances, but was of the tension type in only two. Bilateral pneumothoraces and pneumomediastinum also occurred (Table I1).…”