IATROGENIC RESPIRATORY-ACIDOSIS DURING LAPAROSCOPIC PREPERITONEAL HERNIA REPAIR

This is the first report, to our knowledge, of a case of massive subcu taneous emphysema during totally preperitoneal laparoscopic hernia rep air causing a ''respiratory acidosis'' with a systemic pH 7.20 and a p CO(2) of 64 and PO2 of 84. The acidosis was corrected by increased mec hanical ventilation. It appears that because of its lack of defined bo rders, the preperitoneal space is particularly vulnerable to the forma tion of massive subcutaneous emphysema. Thus, there is a large potenti al surface area for CO2 absorption. The complication may be prevented by increased attention to the length of fascial incisions, inflation o f balloon expanding devices, and securing gripping devices in the port sites.