Anaesthesia for Laparoscopic General Surgery

Abstract

Laparoscopic surgery minimises postoperative morbidity. Patient benefits include reduction in postoperative pain, better cosmetic result and quicker return to normal activities. Hospital stay is shortened resulting in a reduction in overall medical cost. The intraoperative requirements of laparoscopic surgery however can lead to serious physiological changes and complications. While there is a low but definite perioperative mortality rate associated with minor gynaecologic laparoscopic procedures, laparoscopic general surgical procedures are performed on older patients and patients with acute surgical conditions and are likely to be associated with a higher incidence of perioperative complications. The major problems during laparoscopic surgery are related to the cardiopulmonary effects of pneumoperitoneum, systemic carbon dioxide absorption, extra peritoneal gas inSUfflation, venous gas embolism and unintentional injuries to intra-abdominal structures. An appraisal of the potential problems is essential for optimal anaesthetic care of patients undergoing laparoscopic surgery. Appropriate anaesthetic techniques and monitoring facilitate surgery and allow early detection and reduction of complications. The need for rapid recovery and short hospital stay impose additional demands on the anaesthetist for skiltjul practice.

Experimental carbon dioxide pulmonary embolization after vena cava laceration under pneumoperitoneum

“…Gas bubbles attached to fibrin deposits and platelet aggregates also mechanically obstruct the pulmonary vasculature, further increasing the pulmonary vascular resistance. The increase in right heart afterload leads to acute right heart failure with arrhythmias, electrocardiographic changes of myocardial ischemia, hypotension, and elevated central venous pressure [3].…”

“…lism 1 Transesophageal echocardiography --Pulmonary artery pressure --Venotomy Carbon dioxide (CO2) embolization during laparoscopy is a recognized and potentially lethal complication [3,13]. Injury to the vena cava or a lumbar vein during dissection of retroperitoneal structures while performing laparoscopic aortic surgery [6] might lead to potentially disastrous complications.…”

Urologische Laparoskopie bei marginalen Patienten

“…Rhythmusstörungen können durch eine Hyperkapnie (dann als Tachykardie und ventrikuläre Extrasystolen) aber auch infolge einer vagalen Stimulation (dann als Bradykardie) infolge der peritonealen Irritation entstehen [40]. Diese Veränderungen werden durch den gesunden Patienten gut toleriert und kompensiert, sie können jedoch die kardiovaskuläre Reserve bei vorhandener Vorschädigung über-schreiten [6,11,40].Aus diesen Gründen sind eine Kardiomyopathie, unbehandelte Herzinsuffizienz und mäßige bis schwere koronare Herzerkrankung relative oder sogar absolute Kontraindikationen für die Laparoskopie. Somit kann der offen operative Eingriff bei derartigen Patienten die bessere Lösung darstellen.…”

Adaptive support ventilation for gynaecological laparoscopic surgery in Trendelenburg position: bringing ICU modes of mechanical ventilation to the operating room

“…That might be an expression of a growing interest in improving the mechanical ventilation performance during anaesthesia, especially in those cases of difficult conditions due to features of the surgery or the patient, or both. Pneumoperitoneum and Trendelenburg positioning used for laparoscopic gynaecological surgery have well known negative effects on respiratory mechanics and gas exchange: there is a decrease in functional residual capacity and respiratory compliance [1], an increase in respiratory resistances, impairment of arterial oxygenation and an increase in dead space [2,3]. Adjustment of ventilatory settings in order to prevent these deleterious effects may be difficult, especially when end-tidal CO 2 and intrathoracic pressures (plateau airway pressure) are the only variables traditionally used as reference.…”