Effects of sevoflurane and propofol anaesthesia on cerebral oxygenation during normocapnia and mild hypercapnia: a pilot study.

ly. Physical examination showed that the patient could freely uplift his head for more than 5 s, and had a strong handshake with the normal train-of-four ratio. Although snoring persisted, the patient could not tolerate oropharyngeal airway. Marked subcutaneous crepitus was now obvious, especially in the area of the cheek, neck, chest, abdomen, and limbs. Subcutaneous emphysema was apparent. After monitoring NAP, heart rate, SpO2 , and arterial blood gas analysis in the operating theatre, and using mask pressure breathing assistor with high-flow oxygen on and off for 2 h, the subcutaneous crepitus started to reduce significantly, and also the snoring started to resolve with the return of adequate breathing. The upper respiratory tract obstruction is a risk factor that may result in serious consequences. During the postanaesthesia recovery period, many factors may lead to upper respiratory tract obstruction. In this patient, retroperitoneal insufflated with CO2 induced buccopharyngeal submucosal emphysema, which was found after operation, led to respiratory tract obstruction. The reasons for buccopharyngeal submucosal emphysema and upper respiratory tract obstruction in this case could be the long time of retroperitoneum laparoscopic surgery, and high airway pressure. The ECO2 increased implying CO2 absorption. The patient had no previous history of obstructive airway disease, and because the muscle power had returned to normal, the snoring could only be attributed to upper airway emphysema. According to reports in the literature, subcutaneous emphysema can lead to pneumopericardium and pneumomediastinum. – 6 In this case, maxillofacial subcutaneous emphysema was severe, and submucosal emphysema as a complication occurred at the same time.