A Case of an Elderly Patient Who Was Re-Intubated Because of Hypercarbia Due to Subcutaneous Emphysema during Laparoscopic Cholecystectomy

Abstract

  The patient was a 96-year-old woman, 142 cm in height and 35 kg in weight. She was diagnosed as having acute cholecystitis, and emergent laparoscopic cholecystectomy was scheduled. The anesthetic management was done with general anesthesia combined with epidural anesthesia. About fifty minutes after the beginning of pneumoperitoneum, the level of P_EtCO₂ gradually elevated. Subcutaneous emphysema around the right thoracic wall was observed, but the laparoscopic procedure was continued. The range of subcutaneous emphysema was not changed, but the control of P_EtCO₂ by increasing minute volume and respiratory rate of ventilation was not easy. After pneumoperitoneum stopped, the level of P_EtCO₂ gradually decreased. After the patient was extubated, hypoventilation and coma due to hypercarbia were observed, and the patient was re-intubated.
  In the case of subcutaneous emphysema during laparoscopic procedures in elderly patients, we should pay attention to hypoventilation due to hypercarbia, because of the diminished respiratory response due to hypercarbia and the reduced clearance of the narcotics.