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Differential diagnosis of hypercarbia during laparoscopic and robotic surgery

Differential diagnosis of hypercarbia during laparoscopic and robotic surgery
Increased CO2 absorption
  • CO2 insufflation (extraperitoneal insufflation > intraperitoneal insufflation)
  • Subcutaneous emphysema
  • CO2 embolism
  • Capnothorax, capnomediastinum, capnopericardium
Decreased CO2 removal (ie, hypoventilation, V/Q mismatch)
  • Endobronchial intubation
  • Atelectasis
  • Airway obstruction
  • Reduced cardiac output
Increased CO2 production
  • Obesity
  • Malignant hyperthermia
  • Fever
  • Thyrotoxicosis
CO2 rebreathing
  • Defective CO2 absorber
  • Malfunctioning breathing circuit valves
CO2: carbon dioxide; V/Q: ventilation/perfusion.
Adapted with permission from: Joshi G, Cunningham A. Anesthesia for laparoscopic and robotic surgeries. In: Clinical Anesthesia, 7th ed, Barash PG, Cullen BF, Stoelting RK, et al (Eds), Lippincott Williams & Wilkins, Philadelphia 2013. Copyright © 2013 Lippincott Williams & Wilkins. www.lww.com.
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