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      Anesthetic course and complications that were encountered during endoscopic thyroidectomy -A case report-

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          Abstract

          Endoscopic thyroidectomy is gaining popularity, but it can increase the risk of certain complications. Carbon dioxide insufflation in the neck may cause adverse effects on hemodynamic and ventilatory aspects. We report the anesthetic course and complications that were encountered during endoscopic thyroidectomy. Although the surgery was successful, the patient developed signs of hypercarbia, subcutaneous emphysema and pneumothorax.

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          Most cited references15

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          Anesthesia for laparoscopy: a review.

          Frederic J. Gerges, Samar Jabbour-Khoury, G Kanazi (2006)
          Laparoscopy is the process of inspecting the abdominal cavity through an endoscope. Carbon dioxide is most universally used to insufflate the abdominal cavity to facilitate the view. However, several pathophysiological changes occur after carbon dioxide pneumoperitoneum and extremes of patient positioning. A thorough understanding of these pathophysiological changes is fundamental for optimal anesthetic care. Because expertise and equipment have improved, laparoscopy has become one of the most common surgical procedures performed on an outpatient basis and to sicker patients, rendering anesthesia for laparoscopy technically difficult and challenging. Careful choice of the anesthetic technique must be tailored to the type of surgery. General anesthesia using balanced anesthesia technique including several intravenous and inhalational agents with the use of muscle relaxants showed a rapid recovery and cardiovascular stability. Peripheral nerve blocks and neuraxial anesthesia were both considered as safe alternative to general anesthesia for outpatient pelvic laparoscopy without associated respiratory depression. Local anesthesia infiltration has shown to be effective and safe in microlaparoscopy for limited and precise gynecologic procedures. However, intravenous sedation is sometimes required. This article considers the pathophysiological changes during laparoscopy using carbon dioxide for intra-abdominal insufflation, outlines various anesthetic techniques of general and regional anesthesia, and discusses recovery and postoperative complications after laparoscopic abdominal surgery.
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            Risk factors for hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during laparoscopy.

            J Wolff, Courtney C. Murdock, Theo van Achterberg (2000)
            To determine independent predictors for the development of hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during laparoscopy. We reviewed 968 laparoscopic cases between January 1, 1997, and December 31, 1998. Patients who had hypercarbia (end-tidal carbon dioxide of 50 mmHg or greater), pneumothorax/pneumomediastinum, and subcutaneous emphysema were compared with controls according to age, operative time, type of surgery, extraperitoneal or intraperitoneal approach, preexisting medical conditions, body mass index, sex, use of Hasson technique, and number of surgical ports. Maximum positive end-tidal CO(2) (PETCO(2)) was added as an independent variable for subcutaneous emphysema, pneumothorax, and pneumomediastinum. Data were analyzed using univariate analysis and then subjected to multivariate analysis using multiple logistic regression analysis. Incidence rates were 5.5% for hypercarbia, 2.3% for subcutaneous emphysema, and 1.9% for pneumothorax/ pneumomediastinum. Independent risk factors for development of hypercarbia were operative time greater than 200 minutes (odds ratio [OR] 2.02), patient age greater than 65 years (OR 2.19), and Nissen fundoplication surgery (OR 3.18). Predictors of the development of subcutaneous emphysema were PETCO(2) greater than 50 mmHg (OR 3.49), operative time greater than 200 minutes (OR 5.27), and the use of six or more surgical ports (OR 3.06). Variables that predicted the development of pneumothorax and/or pneumomediastinum were PETCO(2) greater than 50 mmHg (OR 4. 15) and operative time greater than 200 minutes (OR 20.49). Longer operative times, higher maximum measured end-tidal CO(2), greater number of surgical ports, older patient age, and Nissen fundoplication surgery predispose patients to hypercarbia-related complications during laparoscopy.
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              Pulmonary CO2 elimination during surgical procedures using intra- or extraperitoneal CO2 insufflation.

              C Mullett, J P Viale, P E Sagnard … (1993)
              We examined end-tidal CO2 tension (PETCO2) and pulmonary CO2 elimination of CO2 (VECO2) during CO2 insufflation under general anesthesia for three surgical procedures: gynecologic laparoscopy (intraperitoneal CO2 insufflation for 43 +/- 4 min), laparoscopic cholecystectomy (intraperitoneal CO2 insufflation for 125 +/- 14 min), and pelviscopy (extraperitoneal CO2 insufflation for 45 +/- 3 min). All patients (10 in each group) underwent controlled mechanical ventilation. Oxygen consumption (VO2) and VECO2 were measured at 2-min intervals by a system using a mass spectrometer. For the three surgical procedures, VO2 remained stable, whereas VECO2 and PETCO2 increased in parallel from the 8th to the 10th min after the start of CO2 insufflation. A plateau was reached 10 min later in patients having intraperitoneal insufflation, whereas VECO2 and PETCO2 continued to increase slowly throughout CO2 insufflation during pelviscopy. During pelviscopy, the maximum increase in VECO2 and PETCO2 (76 +/- 5% and 71 +/- 7%) was significantly more pronounced than that observed during cholecystectomy (25 +/- 4% and 25 +/- 4%) and gynecologic laparoscopy (15 +/- 3% and 12 +/- 2%). The authors conclude that CO2 diffusion into the body is more marked during extraperitoneal than during intraperitoneal CO2 insufflation but is not influenced markedly by the duration of intraperitoneal insufflation.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Anesthesiol
                Journal ID (iso-abbrev): Korean J Anesthesiol
                Journal ID (publisher-id): KJAE
                Title: Korean Journal of Anesthesiology
                Publisher: The Korean Society of Anesthesiologists
                ISSN (Print): 2005-6419
                ISSN (Electronic): 2005-7563
                Publication date (Print): October 2012
                Publication date (Electronic): 12 October 2012
                Volume: 63
                Issue: 4
                Pages: 363-367
                Affiliations
                Department of Anesthesiology and Pain Medicine, Korea Cancer Center Hospital, Seoul, Korea.
                Author notes
                Corresponding author: Su-Nam Lee, M.D., Department of Anesthesiology and Pain Medicine, Korea Cancer Center Hospital, 75, Nowon-gil (215-4 Gongneung-dong), Nowon-gu, Seoul 139-706, Korea. Tel: 82-2-970-1259, Fax: 82-2-970-2161, sunamlee@ 123456naver.com
                Article
                DOI: 10.4097/kjae.2012.63.4.363
                PMC ID: 3483498
                PubMed ID: 23115692
                SO-VID: 252f58d8-35b0-439a-ad5f-6b2ff4a76dfc
                Copyright © Copyright © the Korean Society of Anesthesiologists, 2012
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 August 2011
                Date revision received : 12 October 2011
                Date accepted : 23 October 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: hypercarbia,subcutaneous emphysema,endoscopic thyroidectomy,peumothorax
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: hypercarbia, subcutaneous emphysema, endoscopic thyroidectomy, peumothorax

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