Hypercarbia is a potential complication during laparoscopic surgery. However, is more likely to occur in extraperitoneal surgery than in intraperitoneal surgery because insufflated CO2 gas can diffuse easily into the surrounding tissues. We report the anesthetic course and complications encountered during endoscopic harvesting of a saphenous vein with CO2 insufflation in coronary artery bypass surgery. Although the surgery was successful, the patient developed signs and symptom of CO2 absorption: tachycardia, hypertension, hypercarbia and acidosis. Possible mechanisms are presented, along with a discussion of the prompt diagnosis and treatment. For the management of laparoscopic extraperitoneal surgery, care must be taken to monitor the CO2 insufflation pressure, perform a routine examination and palpation of the chest wall, use of N2O with caution, increase the level of ventilation to eliminate CO2, and excluding other causes of subcutaneous emphysema and hypercarbia.
Absorption ; Acidosis ; Coronary Artery Bypass* ; Coronary Vessels* ; Diagnosis ; Endoscopy ; Humans ; Hypertension ; Insufflation ; Laparoscopy ; Palpation ; Saphenous Vein* ; Subcutaneous Emphysema ; Tachycardia ; Thoracic Wall ; Ventilation

BACKGROUND: The purpose of this study was to investigate the effectiveness of ondansetron and midazolam in the prevention of PONV after thyroidectomy. METHODS: One hundred nineteen women undergoing thyroidectomy under general anesthesia were randomized to receive midazolam 0.075 mg/kg (Group M, n = 41), ondansetron 4 mg (Group O, n = 39), or normal saline 10 ml (Group C, n = 39) intravenously. The incidence and severity of nausea, vomiting, and pain were assessed as 6 and 24 h after the end of surgery. RESULTS: The incidence of PONV was 34% in Group M, 46% in Group O, and 64% in Group C, which showed a significant difference between Group C and Group M, but not Group O. However, there were no significant differences between groups in pain scores and the incidence of sedation. CONCLUSIONS: We recommend the use of midazolam as an effective antiemetic after thyroidectomy.
Anesthesia, General ; Female ; Humans ; Incidence ; Midazolam* ; Nausea ; Ondansetron* ; Postoperative Nausea and Vomiting* ; Thyroidectomy* ; Vomiting