Pneumomediastinum, pneumothorax and subcutaneous emphysema complicating MIS herniorrhaphy.

Hdl Handle:
http://hdl.handle.net/10147/209131
Title:
Pneumomediastinum, pneumothorax and subcutaneous emphysema complicating MIS herniorrhaphy.
Authors:
Browne, J; Murphy, D; Shorten, G
Affiliation:
Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, and University College Cork, Wilton, Ireland.
Citation:
Can J Anaesth. 2000 Jan;47(1):69-72.
Journal:
Canadian journal of anaesthesia = Journal canadien d'anesthesie
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/209131
DOI:
10.1007/BF03020737
PubMed ID:
10626724
Abstract:
PURPOSE: Videoscopic herniorrhaphy is being performed more frequently with advantages claimed over the conventional open approach. This clinical report describes a pneumothorax, pneumomediastinum and subcutaneous emphysema occurring at the end of an extraperitoneal videoscopic herniorrhaphy. CLINICAL FEATURES: A 25 yr old ASA I man presented for elective extraperitoneal videoscopic hernia repair. Following intravenous induction with fentanyl, midazolam and propofol a balanced anesthetic technique using enflurane in N2O and O2 was used. Apart from a prolonged operating time (195 min), the procedure and anesthetic was uneventful. At the conclusion of the operation, prior to reversal of neuromuscular blockade extensive subcutaneous emphysema was noted on removal of the surgical drapes. Chest radiography revealed a pneumomediastinum and pneumothorax. A 25 FG intercostal tube was inserted and connected to an underwater seal drain. Sedation and positive pressure ventilation was maintained overnight to permit resolution and avoid airway compromise. The clinical and radiological features had resolved by the next morning and the patient's trachea was extubated. His subsequent recovery was uneventful. CONCLUSION: Pneumothorax and pneumomediastinum are well recognised complications of laparoscopic techniques but have not been described following extraperitoneal herniorrhaphy. In this report we postulate possible mechanisms which may have contributed to their development, including inadvertent breach of the peritoneum and leakage of gas around the diaphragmatic herniae or tracking of gas retroperitoneally. The case alerts us to the possibility of this complication occurring in patients undergoing videoscopic herniorrhaphy.
Language:
eng
MeSH:
Adult; Hernia, Inguinal/*surgery; Humans; Male; Mediastinal Emphysema/*etiology; Pneumothorax/*etiology; Postoperative Complications/*etiology; Subcutaneous Emphysema/*etiology
ISSN:
0832-610X (Print); 0832-610X (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorBrowne, Jen_GB
dc.contributor.authorMurphy, Den_GB
dc.contributor.authorShorten, Gen_GB
dc.date.accessioned2012-02-03T15:13:05Z-
dc.date.available2012-02-03T15:13:05Z-
dc.date.issued2012-02-03T15:13:05Z-
dc.identifier.citationCan J Anaesth. 2000 Jan;47(1):69-72.en_GB
dc.identifier.issn0832-610X (Print)en_GB
dc.identifier.issn0832-610X (Linking)en_GB
dc.identifier.pmid10626724en_GB
dc.identifier.doi10.1007/BF03020737en_GB
dc.identifier.urihttp://hdl.handle.net/10147/209131-
dc.description.abstractPURPOSE: Videoscopic herniorrhaphy is being performed more frequently with advantages claimed over the conventional open approach. This clinical report describes a pneumothorax, pneumomediastinum and subcutaneous emphysema occurring at the end of an extraperitoneal videoscopic herniorrhaphy. CLINICAL FEATURES: A 25 yr old ASA I man presented for elective extraperitoneal videoscopic hernia repair. Following intravenous induction with fentanyl, midazolam and propofol a balanced anesthetic technique using enflurane in N2O and O2 was used. Apart from a prolonged operating time (195 min), the procedure and anesthetic was uneventful. At the conclusion of the operation, prior to reversal of neuromuscular blockade extensive subcutaneous emphysema was noted on removal of the surgical drapes. Chest radiography revealed a pneumomediastinum and pneumothorax. A 25 FG intercostal tube was inserted and connected to an underwater seal drain. Sedation and positive pressure ventilation was maintained overnight to permit resolution and avoid airway compromise. The clinical and radiological features had resolved by the next morning and the patient's trachea was extubated. His subsequent recovery was uneventful. CONCLUSION: Pneumothorax and pneumomediastinum are well recognised complications of laparoscopic techniques but have not been described following extraperitoneal herniorrhaphy. In this report we postulate possible mechanisms which may have contributed to their development, including inadvertent breach of the peritoneum and leakage of gas around the diaphragmatic herniae or tracking of gas retroperitoneally. The case alerts us to the possibility of this complication occurring in patients undergoing videoscopic herniorrhaphy.en_GB
dc.language.isoengen_GB
dc.subject.meshAdulten_GB
dc.subject.meshHernia, Inguinal/*surgeryen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMediastinal Emphysema/*etiologyen_GB
dc.subject.meshPneumothorax/*etiologyen_GB
dc.subject.meshPostoperative Complications/*etiologyen_GB
dc.subject.meshSubcutaneous Emphysema/*etiologyen_GB
dc.titlePneumomediastinum, pneumothorax and subcutaneous emphysema complicating MIS herniorrhaphy.en_GB
dc.contributor.departmentDepartment of Anaesthesia and Intensive Care Medicine, Cork University Hospital, and University College Cork, Wilton, Ireland.en_GB
dc.identifier.journalCanadian journal of anaesthesia = Journal canadien d'anesthesieen_GB
dc.description.provinceMunster-
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