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
