Manajemen Anestesi pada Operasi Laparoskopi Nefrektomi Donor Hidup dengan Komplikasi Emfisema Subkutis Masif
Abstract
Case Illustration: Laparoscopy can reduce vital capacity, increase dead space, hypercapnia and acidemia due to CO2 absorption. This has the potential to cause massive subcutaneous emphysema which is rarely encountered in laparoscopic surgery. A woman, 47 years old, is a potential kidney donor for her child. The patient was classified as ASA 1, underwent general anesthesia and bilateral quadratus lumborum block. After 2.5 hours of surgery, she had hypertension and tachycardia, and ETCO2 rised up to 49 mmHg. Swelling and crepitus appear in the neck, chest and all four extremities.
Case Management: Blood gas analysis was carried out. Changes in ventilator settings was done to increase ventilation rate and tidal volume, the soda lime was replaced, and we communicated with the operator so the surgery could be postponed temporarily. After ETCO2 returns to normal, the surgery continues with lower CO2 gas insufflation. Patient’s condition was stable during the rest of procedure.
Successful of Management: The patient in this case had no comorbid conditions or risk factors for subcutaneous emphysema. However, massive subcutaneous emphysema still occurred. The conservative anesthetic management carried out is in accordance with the literature and has been proven to improve patient’s outcome.
References
Coronil ÁB, Sanchez-Cañete AM, Bartakke AA, Fernández JG, García AIP. Life- threatening subcutaneous emphysema due to laparoscopy. Indian J Anaesth. 2016;60(4):286–8. Doi: 10.4103/0019-5049.179469
Elsaady A, Elsherbeny R, Elzaeem A. Extensive subcutaneous emphysema after laparoscopic cholecystectomy, two cases reports. Open Access J Surg. 202410(4): 555784. Doi: 10.19080/OAJS.2024.10.555784
Jones A, Pisano U, Elsobky S, Watson AJM. Grossly delayed massive subcutaneous emphysema following laparoscopic left hemicolectomy: A case report. Int J Surg Case Rep. 2015;6C:277-9. Doi: 10.1016/j.ijscr.2014.10.007.
Aldakhil SK, Tashkandi AA, Al Harbi MK, Al Shehri A. Subcutaneous emphysema and hypercarbia as a complication of laparoscopic procedure: case report. J Surg Case Rep. 2020;3:1-3.Doi: 10.1093/jscr/rjz415
Aghajanzadeh M, Dehnadi A, Ebrahimi H, Karkan FM, Jahromi SK, Maafi AA, et al. Classification and management of subcutaneous emphysema: a 10-year experience. Indian J Surg. 2015;(Suppl 2):673-7. doi: 10.1007/s12262-013-0975-4.
Lentine KL, Lam NN, Axelrod D, Schnitzler MA, Garg AX, Xiao H, et al. Perioperative complications after living kidney donation: a national study. Am J Transplant. 2016;16(6):1848–57. Doi: 10.1111/ajt.13687
Saeed S, Godwin O, Adu AK, Ramcharan A. Pneumomediastinum and subcutaneous emphysema after successful laparoscopic supra-cervical hysterectomy. J Surg Case Rep. 2017;7(7):13. Doi: 10.1093/jscr/rjx146
Ott DE. Subcutaneous emphysema-beyond the pneumoperitoneum. JSLS. 2014;18(1):1–7. Doi: 10.4293/108680813X13693422520882
Sood J. Advancing frontiers in anaesthesiology with laparoscopy. World J Gastroenterol. 2014;20(39):14308–14.Doi: 10.3748/wjg.v20.i39.14308
Chandra A, Clarke R, Shawkat H. Intraoperative hypercarbia and massive surgical emphysema secondary to transanal endoscopic microsurgery (TEMS). BMJ Case Rep. 2014;10:1-3. Doi: 10.1136/bcr-2013-202864
O’Reilly P, Chen HK, Wiseman R. Management of extensive subcutaneous emphysema with a subcutaneous drain. Respirol Case Rep. 2013;1(2):28–30. Doi: 10.1002/rcr2.9
Theodoros A, Athanasios K. Surgical treatment of subcutaneous emphysema. In Which Cases? [Internet]. 2017. Available from: http://www.imedpub.com/surgery-and- emergency-medicine/
Copyright (c) 2025 Octava Prima Arta, R.B. Sukmono
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The Contributor and the company/institution agree that all copies of the Final Published
Version or any part thereof distributed or posted by them in print or electronic format as permitted herein will include the notice of copyright as stipulated in the Journal and a full citation to the Journal.
