2008 年中华医学会全国麻醉学术年会

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    ·参选优秀论文·

    A strange death during laparoscopic prostatectomy

    Yi Zhang M.D., Wang Mao M.D., Xian-Wei Zhang M.D. (Associate Professor),Xue-Ren Wang M.D.( Associate Professor), Yu-ke Tian M.D.( Professor)

    Department of Anaesthesia, Tongji Hospital ,Huazhong University of Science and

    Technology, Wuhan, China

    Case report

    A 52-year-old male, weighting 67kg, and with cancer of the prostate, underwent a laparoscopic

    prostatectomy. The same as the history disease, no other systemic diseases were revealed by the

    examinations before operation. Before anesthesia induction, we got the data of the vital sign:

    BP120/80mmHg, HR80bpm and SpO298%. Midazolam,fentanyl, vecuronium and propofol were used

    during induction, and followed by successful endotrachial intubation. Ventilator parameters were set up

    (Vt600ml, RR12bpm, I:E 1:2, P 11mmH2O) and 1% isoflurane , propofol and remifentanil were used

    during the maintenance of anesthesia. After 5 minutes when the pneumoperitoneum was established, we

    monitored a sudden decreased blood pressure(30/20mmHg) with tachycardia (120-130 bpm) and low

    SpO2(95-100%), drugs those were used to maintain an esthesia were stopped , ephedrine and dopamine

    were given, blood pressure was still at low level, then mechanical ventilation was stopped and assistant

    ventilation showed a high airway resistance, low breath sound was auscultated on bilateral chest wall, a

    bilateral tention pneumothorax was confirmed by a bilateral tube thoracostomy, but bad condition of the

    circulation had no changes after the puncture: BP29/15mmHg, HR130bpm, SpO275-88%. ECG showed a

    ventricular rhythm. Closed cardiac massage and drug resuscitation continued for 43 minutes after cardiac

    arrest, but CPR was failed, chest cardiac compression was performed and we found bilateral bunamiodyl,when the pericardium cavity was opened, supraventricular rhythm came back. BP(80-40/40-20mmHg),HR (150-160bpm) and SpO2100% was maintained by vasoconstriction agents, the patient was delivered

    into the ICU, and died 2 hours later.

    Discussion

    Laparoscopy was early used in the diagnosis and treatment of gynecological diseases in 1970s. With a

    lot of advantage, such as less trauma, small scar, less influence to the body internal environment, a short

    time of hospitalization, early rehabilitation, the laparoscope was gradually widely applied in many fields

    such as genecology & obstetrics, general surgery and urinary surgery. However, laparoscopic operation

    might be performed at the condition of pneumoperitoneum, increased peritoneum pressure, which led bad

    influence to the physiopathologic condition of the patients, might be the main causes of the complications

    of laparoscopic surgery, and the fatal complications mainly included pneumothorax, pneumomediastinum,pneumopericardium and gas embolism.

    For this patient, without autopsy, death cause was uncertain. Through the review of the CPR, we

    could only get some conclusions:(1) bilateral tention pneumothorax after pneumoperitoneum;(2)No

    changes of circulatory collapse after bilateral tube thoracostomy;(3) bilateral bunamiodyl;(4) return to

    supraventricular rhythm after pericardium cavity was opened. 2008 年中华医学会全国麻醉学术年会

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    There were some factors related to the pneumothorax during laparoscopic surgery:(1)There were

    special history diseases such as bunamiodyl;(2)Gas from peritoneum leaked into thorax through the ......