Broad subcutaneous emphysema with airway obstruction during robot‐assisted partial nephrectomy: A case report and literature review

Introduction Subcutaneous emphysema is a relatively common complication in laparoscopic surgery. However, airway obstruction secondary to subcutaneous emphysema is rare. Case presentation A 63‐year‐old woman with a 56‐mm left renal tumor underwent a robot‐assisted partial nephrectomy. The operative time was 155 min, the insufflation time was 108 min, and the estimated blood loss was 70 mL. The pneumoperitoneum pressure was maintained at 12 mmHg, except at 15 mmHg for 19 min during tumor resection. The end‐tidal CO2 was <47 mmHg throughout the procedure. Postoperatively, broad subcutaneous emphysema from the thigh to the eyelid was observed. Computed tomography revealed airway obstruction, and extubation was aborted. On postoperative day 1, emphysema around the trachea and neck improved and the intubation tube was successfully removed. Conclusion Both laryngeal emphysema and physical compression secondary to emphysema can cause airway obstruction. To reduce gas‐related complications, the risk of developing subcutaneous emphysema should be properly assessed during robot‐assisted laparoscopic surgery

Identification of Novel Phosphorus-Based Flame Retardants in Curtains Purchased in Japan Using Orbitrap Mass Spectrometry

An analytical method was developed for screening and identifying novel flame retardants in curtains purchased in Japan in 2014 by use of a liquid chromatograph interfaced with a hybrid quadrupole Orbitrap mass spectrometer (LC–Orbitrap-MS; Q Exactive Plus). To enable complete extraction of flame retardants in curtains, we used an extraction method developed earlier, in which a solvent mixture of 1,1,1,3,3,3-hexafluoro-2-propanol/chloroform (1:4, v/v) was used to completely dissolve the curtain matrix. An initial gas chromatography–MS scan analysis confirmed the presence of several unidentified flame retardants in curtains. We then determined the precise masses of the detected compounds by use of a LC–Orbitrap-MS and used that information to construct chemical formula of the detected compounds. The MAGMa online spectral data annotation was then used to generate a list of candidate compounds. For the determination and confirmation of the chemical structures of the candidate compounds, we reviewed the literature and acquired standards and compared mass fragment patterns of the most probable candidate compounds with those of standards. We unequivocally identified the compounds in curtain samples as (5-ethyl-2-methyl-2-oxido-1,3,2-dioxaphosphorinan-5-yl)­methyl-methyl-methylphosphonate (PMMMP), naphthalen-2-yl diphenyl phosphate (NDPhP), and 6-benzyl benzo­[<i>c</i>]­[2,1]­benzoxaphosphinine 6-oxide (BzlDOPO). This study elucidates the occurrence of three novel phosphorus-based flame retardants in curtains, and the technique we proposed here can be applied for the detection of environmental chemicals in other products