A Case of Atypical Electrocardiographic Changes Possibly Caused by Subcutaneous Emphysema during Laparoscopic Hysterectomy

Abstract

 A 48-year-old female was scheduled for laparoscopic hysterectomy. Following induction of pneumoperitoneum using carbon dioxide (CO₂) , end-tidal partial pressure of CO₂ (PETCO₂) gradually increased to 60 mmHg, and was accompanied by the temporary appearance of negative T-waves and RS pattern in the II - and III - leads of the electrocardiogram (ECG) . These ECG changes disappeared after PETCO₂ returned to approximately 40 mmHg.
 When peritoneal insufflation of CO₂ was initiated again, massive subcutaneous emphysema extending from the left thorax to the face was noticed. At this time, the same ECG changes were observed at the PETCO₂ of 40 mmHg.
 These observations raise the possibility that negative T-wave and RS pattern in the II - and III - leads of ECG appeared as a sign of complications of subcutaneous emphysema in the thorax. We conclude that subcutaneous emphysema can modulate the ECG during laparoscopy even in the absence of hypercarbia.