Subcutaneous Emphysema in face, neck, chest, upper arm developed after laparoscopy myomectomy under G.A., duration f surgery 2&1/2 hr.gas- co2 used. 4 nos of myoma at ant. wall n fundus. Now BP-124/84,PR-90,spo2-90-95%.. pt irritable..how to manage n within wat time d emphysema resolve?? is der any CNS complications?? plz help....

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No need to put ICD directly.. Surgical emphysema secondary to laproscopy is relatively common.. If CXR shows no pneumo or hydro & If pts o2 saturation is good and respiratory efforts are good then no need for ICD. Patient can be observed for 24 to 48 hrs for spontenious resolution.. Multiple needle punctures and evacuation of empysema can be. done. The ideal site for multiple needle puncturs are Infraclavicular area, supra scapular area, periumbilical area. Apply 2% xylocain jelly first and cover it with betadine ointment.

However there is possibility of pneumothorax, pnemomediastinum, etc in cases of massive subcutaneous emphysema.Since CO2 is highly soluble it will get rapidly absorbed and hence in majority of cases no invasive procedure is required. The chances of subcutaneous emphysema increase with prolonged operative time, high in sufflation pressures, improper tracer placement, more number of ports, procedures near diaphragm, high IAP etc. It will be detected intraopetatively by rise in End tidal CO2 by more than 25 percent after more than 30 min of surgery , rise in airway pressures, decreased compliance, swelling in subcutaneous tissue etc. if detected intraopetatively management is by stopping CO2 in sufflation, continue mechanical ventilation till hypercapnia is resolved. In massive cases one may have to abandon laparoscopy and go for open surgery.

oxygen saturation & ABG chest x-ray have to be done if surgical emphysema icd

I agree with Dr whatkar and Dr Chinchkhede. No need to insert ICD at all

Vitals Stable O2 Supplement for 6hrs.

there is absolute unnecessity in inserting ICD at initial stage.surgical emphysema, according to pat face, has developed under SUBCUTANEOUS tissue. dr.sahu has not posted CXR. For SUBCUTANEOUS emphysema, more common in lap surgery,no need for ICD. treatment will be.. admit her in Icu monitor vitals most imp.continue oxygen supplementation by mask and observe.....it will resolve by itself CXR lz do it and if pneumothorax,only then put ICD.

sir now pt z improving...signs gradually subsiding...pt talking normally..giving o2 n observation...
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Surgical Emphysema not associated with pneumothorax does not require Tube Thoracostomy Management is wait and watch but if progressive can be managed by multiple subcutaneous incisions In progressive subcutaneous Emphysema I would suggest to look for Laryngeal and esophageal injuries

First of all do cxr if pneumothorax is there than only icd insertion give O2 2-3 lit watch for distress if it cause significant compression over neck do tracheostomy for airway management usually it resolve within 2-4 days

The cause of subcutaneous emphysema during laparascopic surgery is extraperitoneal insufflation of CO2 which may occur due to wrong insertion of port .It can also occur if one is operating on extraperitoneal structures

very true wrong plane of the port while co2 insuf.
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Wait and watch Monitor vitals Ideally it should resolve within 24-48 hrs without further symptoms No need of urgent invasive treatment

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