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    Pneumomediastinum, pneumothorax and subcutaneous emphysema complicating MIS herniorrhaphy.

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    Authors
    Browne, J
    Murphy, D
    Shorten, G
    Affiliation
    Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, and University College Cork, Wilton, Ireland.
    Issue Date
    2012-02-03T15:13:05Z
    MeSH
    Adult
    Hernia, Inguinal/*surgery
    Humans
    Male
    Mediastinal Emphysema/*etiology
    Pneumothorax/*etiology
    Postoperative Complications/*etiology
    Subcutaneous Emphysema/*etiology
    
    Metadata
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    Citation
    Can J Anaesth. 2000 Jan;47(1):69-72.
    Journal
    Canadian journal of anaesthesia = Journal canadien d'anesthesie
    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
    ISSN
    0832-610X (Print)
    0832-610X (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1007/BF03020737
    Scopus Count
    Collections
    Cork University Hospital

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