EXTENSIVE SUBCUTANEOUS EMPHYSEMA AND HYPERCAPNIA DURING LAPAROSCOPIC CHOLECYSTECTOMY - 2 CASE-REPORTS

We report two cases of marked hypercapnia of more than 60 mm Hg (PaCO2 ) and extensive subcutaneous emphysema noted during laparoscopic chole cystectomy. The first case, a 55-year-old man was diagnosed as having cholecystolithiasis and had hypercapnia up to 83.5 mm Hg (PaCO2) durin g laparoscopic cholecystectomy. The patient resumed spontaneous respir ation under controlled ventilation accompanied by persistent bigeminal pulse. Soon after deflation, CO2 returned to normal range, and extens ive subcutaneous emphysema was detected in the recovery room. The seco nd patient, a 53-year-old woman, had cholecystolithiasis and also unde rwent laparoscopic cholecystectomy. Both hypercapnia rising to 61.1 mm Hg (PaCO2) and extensive subcutaneous emphysema appeared just before completion of resection of the gallbladder. Mild hypercapnia during pn eumoperitoneum of about 50 mm Hg (PaCO2) has been reported previously. As compared with cases in the literature, the present cases suggest t hat hypercapnia is due to extensive subcutaneous emphysema. The large absorption surface area in the subcutaneous tissue and the large diffe rence in the partial pressure cause the extensive gaseous interchange of CO2 between subcutaneous tissue and blood perfusing into it at the moment between peritoneal cavity and blood perfused the peritoneum.