An algorithm for management of intraoperative subcutaneous emphysema during robotic surgery

Sir, Subcutaneous emphysema (SCE), also called surgical emphysema, is the sudden onset soft tissue swelling arising when gas is forced under pressure into the subcutaneous fascia because of myriad causes (pneumothorax, ruptured bronchus, facial bone fracture, paranasal sinus pathology, playing a wind instrument after dental extraction, vigorous nose-blowing, coughing, or Valsalva maneuver). The tidal volume was increased in increments of 50 ml to 10 ml/kg body weight while the respiratory rate was increased to 18 breaths per minute in an attempt to wash away the excess CO2 by increasing the minute ventilation. [...]the surgery was halted and the patient was placed in Trendelenburg position in an attempt to vent out the CO2 using the Archimedes' principle.