I'm mobilized working at an Army Hospital where usual case length is redefined daily. Anyway, I have recently been in a 4 and 6 hour lap inguinal repair and lap hysterectomy. In both instances about 2.5 hrs into the case etco2 levels creep up into the 50-55 range and stay within that range even after adjusting volume, rate, etc.

The first patient had a significant pneumoperitoneum and crepitus in the thorax and neck. The second case also had crepitus but was a bit milder. The first patient maintained etco2 of around 50-55 even after the gas was off and lengthy closure. I did perform a leak test to make sure there were no airway issues and the guy had no problems. Honestly, I have never seen this because I work on the civilian side and these long cases are extremely rare. Is there any potential issues with this and is this simply related to length of case?