We successfully treated a 59-year-old male with adenocarcinoma in the right lower lobe who had developed a dead space with prolonged air-leak, which continued for 21 days after lower and middle lobectomy, by creating artificial pneumoperitoneum. He had a history of subtotal gastrectomy due to stomach cancer 5 years ago. Artificial pneumoperitoneum was made after introducing a peritoneal dialysis catheter into the right upper quardrant. The chest tube was removed 14 days after creating pneumoperitoneum.
Adenocarcinoma ; Catheters ; Chest Tubes ; Gastrectomy ; Humans ; Male ; Middle Aged ; Peritoneal Dialysis ; Pneumoperitoneum ; Pneumoperitoneum, Artificial* ; Stomach Neoplasms

Pulmonary resection often leaves a pleural space problem that can cause prolonged air leaks. We describe a patient with lung cancer undergoing a right middle and lower lobectomy complicated by prolonged air leaks. He had a history of pulmonary tuberculosis and COPD. Artificial pneumoperitoneum was made by instillation of air via a small central vein catheter into the left lower quadrant on postoperative day(POD) 21. The air leak ceased on POD 23 and the chest tube was removed on POD 25.
Catheters ; Chest Tubes ; Humans ; Lung Neoplasms ; Pneumoperitoneum ; Pneumoperitoneum, Artificial* ; Pulmonary Disease, Chronic Obstructive ; Tuberculosis, Pulmonary ; Veins

BACKGROUND: Laparoscopic surgery is replacing conventional surgical techniques due to its many advantages. However the possibility of respiratory complications during CO2-induced pneumoperitoneum remain. Tracheal gas insufflation (TGI) has been shown to be a useful adjunct to mechanical ventilation in hypercapneic patients. This study investigated the effectiveness of TGI in reducing the PaCO2 level in hypercapneic patients during laparoscopic surgery without increasing the peak inspiratory pressure (PIP) and usefulness of a Univent tube(R) as a device for TGI. METHODS:Twenty-four patients who were scheduled to undergo gynecological laparoscopic surgery, were enrolled in this study. Anesthesia was induced and maintained with propofol, rocuronium and N2O-O2-sevoflurane. The suction port of the endobronchial blocker of the Univent tube(R) was used for the path of TGI. Data including the ABGA and respiratory parameters were measured three times, the pre-CO2 peritoneum (pre-CO2 pneumoperitoneum point, PCP), 15 min after CO2 peritoneum (after-CO2 pneumoperitoneum point, ACP) and after 15 min TGI (TGI point, TGIP). RESULTS: At ACP, the PaCO2 and PIP had increased more significantly than PCP. After TGI, the PaCO2 was decreased more significantly than ACP, but the PIP did not increased. CONCLUSIONS: TGI is a useful adjunct to mechanical ventilation in hypercapneic patients during laparoscopic surgery, and a univent tube(R) is an economic and convenient device for TGI.
Anesthesia ; Humans ; Insufflation* ; Laparoscopy* ; Peritoneum ; Pneumoperitoneum ; Propofol ; Respiration, Artificial ; Suction

Hernia, Inguinal ; surgery ; Humans ; Male ; Middle Aged ; Pneumoperitoneum, Artificial ; Scrotum ; surgery

Spontaneous gastric perforation of the newborn is a rare, serious and life-threatening problem. This is surgical emergency because of high mortality. Most historical reports have described gastric perforation in the neonate as spontaneous cause. But, recent reviews report the contributing factor including prematurity and mechanical ventilation. Usually clinician identifies the pneumoperitoneum in simple abdomen X-ray. The final diagnostic method is surgical finding and the treatment of gastric perforation is immediate surgical correction. Early diagnosis, hemodynamic monitoring and fluid therapy for hypovolemia improve outcome. Pseudocyst formation after gastric perforation is very rare in newborn. We report a rare case of pseudocyst formation after spontaneous gastric perforation in full term newborn.
Abdomen ; Early Diagnosis ; Emergencies ; Fluid Therapy ; Hemodynamics ; Humans ; Hypovolemia ; Infant, Newborn ; Mortality ; Pneumoperitoneum ; Respiration, Artificial

Colectomy ; Embolism, Air ; etiology ; Humans ; Laparoscopy ; Male ; Middle Aged ; Pneumoperitoneum, Artificial ; adverse effects

Massive pneumopritoneum developing immediately following initiation of artificial ventilation is an unusual sign of lung barotrauma and must be distinguished from pneumoperitoneum following rupture of a hollow abdominal viscus. Besides, pneumoperitoneum occurring in a mechanically ventilated asthmatic patient can present a diagnostic dilemma as the usual signs of an intestinal perforation may be masked by steroid therapy, sedation or paralysis, or combination of all three. We report a case of massive pneumoperitoneum after initiation of mechanical ventilation in a child with severe asthmatic attack.
Asthma* ; Barotrauma ; Child* ; Humans ; Intestinal Perforation ; Lung ; Masks ; Paralysis ; Pneumoperitoneum* ; Respiration, Artificial* ; Rupture ; Ventilation

Despite numerous benefits of laparoscopic procedures, during carbon dioxide-induced pneumoperitoneum, the serious hypercapnia and respiratory acidosis in hypercapnic patients with decreased pulmonary compliance may be developed. Tracheal gas insufflation (TGI) has been shown to be a useful adjunct to controlled mechanical hypoventilation. However, the utility of TGI in hypercapnic management during laparoscopic surgery was not reported yet. We report a case that TGI superimposed on controlled mechanical ventilation corrected hypercapnia induced by carbon dioxide-induced pneumoperitoneum during laparoscopic salphingo-oophorectomy. There was no specific anesthetic problem during operation, patients was discharged uneventfully.
Acidosis, Respiratory ; Carbon ; Carbon Dioxide ; Compliance ; Humans ; Hypercapnia* ; Hypoventilation ; Insufflation* ; Laparoscopy* ; Pneumoperitoneum ; Respiration, Artificial

Laparoscopic surgery is a frequently used technique in surgery. But artificial pneumoperitoneum with CO2 causes cardiovascular complication. We experienced two cases of cardiac arrests after gas insufflation. In first case, end tidal CO2 concentration increased rapidly and then immediately cardiac arrest occurred. We performed cardiac resuscitation with epinephrine and cardiac compression and result in good recovery. A rapid rise in end tidal concentration is suggested as a useful early sign of CO2 embolism. In second case, cardiac arrest occurred after gas insufflation, too. We used atropine and ephedrine but severe bradycardia and hypotension was not recovered. After removal of CO2, heart rate and blood pressure restored. We found that flow rate of CO2 was 50 L/min. The operation was started again, we used flow rate of CO2 at 1 L/min. The operation was successful uneventfully. Slow insufflation combined with close monitoring is important to prevent cardiovascular collapse during laparoscopic surgery.
Atropine ; Blood Pressure ; Bradycardia ; Carbon Dioxide ; Embolism ; Ephedrine ; Epinephrine ; Heart Arrest* ; Heart Rate ; Hypotension ; Insufflation* ; Laparoscopy* ; Pneumoperitoneum, Artificial ; Resuscitation

OBJECTIVETo study effects of different intraabdominal pressure of carbon dioxide (Cq2) pneumoperitoneum on hemorrheology and microcirculation in rabbits.

METHODSEighteen female healthy rabbits weighing 2.2 kg to 3.5 kg were randomly divided into three groups equally based on pneumoperitoneum pressure: 0 mmHg group (group I),10 mmHg group (group II) and 15 mmHg (group III). Each group received 1 h pneumoperitoneum under different pressure. Blood samples were taken at 5 min before CO2 pneumoperitoneum, at 30 and 60 min after pneumoperitoneum for the measurements of indexes of hemorrheology. Hemodynamics including heart rate (HR), mean arterial pressure (MAP) and the volume and velocity of the microcirculation of auricle were continuously monitored, such indexes were recorded at the related time.

RESULTSAfer pneumoperitoneum at 30 and 60 min, compared with group I, HR, MAP, the whole blood viscosity, the aggregation and rigid indexes of RBC were significantly raised in group II (P < 0.05), the deformability indexes of RBC, the volume and velocity of the microcirculation were markedly decreased (P < 0.05). Even more significant changes were observed in group III (P < 0.01). The plasma viscosity and the hematocrit changed little.

CONCLUSIONAfter CO2 pneumoperitoneum, hemorrheology is decreased; Although HR, MAP are raised, the volume and velocity of the microcirculation are decreased.

Abdomen ; blood supply ; Animals ; Blood Viscosity ; Carbon Dioxide ; Female ; Hematocrit ; Hemorheology ; Microcirculation ; Pneumoperitoneum, Artificial ; methods ; Pressure ; Rabbits