Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations

Abstract

In recent years, laparoscopic surgery has gained popularity in clinical practice. The key element in laparoscopic surgery is creation of pneumoperitoneum and carbon dioxide is commonly used for insufflation. This pneumoperitoneum perils the normal cardiopulmonary system to a considerable extent. Every laparoscopic surgeon should understand the consequences of pneumoperitoneum; so that its untoward effects can be averted. Pneumoperitoneum increases pressure on diaphragm, leading to its cephalic displacement and thereby decreasing venous return, which can be aggravated by the position of patient during surgery. There is no absolute contraindication of laparoscopic surgery, though we can anticipate some problems in conditions like obesity, pregnancy and previous abdominal surgery. This review discusses some aspects of the pathophysiology of carbon dioxide induced pneumoperitoneum, its consequences as well as strategies to counteract them. Also, we propose certain guidelines for safe laparoscopic surgery.

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

“…Problems during and after laparoscopic surgery are commonly due to pneumoperitoneum induced by CO 2 insufflation, making lower insufflation pressures desirable [5][6][7][8]10 . At the same time, restricted working space can make laparoscopic dissection steps difficult and result in longer operating time, potentially increasing the risk of complications 12,13 .…”

Evaluation of Effect of Infusion of Dexmedetomidine on Attenuation of Hemodynamic Response During Laparoscopic Surgeries

“…The systemic vascular resistance is increased not only due to increased abdominal pain but also because of an increase in the release of circulating catecholamines. The increasing systemic vascular resistance, raised blood pressures and tachycardia results in a increase in myocardial workload [6] .…”

Combined Oocyte Retrieval and Robot-assisted Hysterectomy in a Super Morbidly Obese Patient with Endometrial Carcinoma

“…Particularly in robot-assisted laparoscopic gynecologic surgeries, steep Trendelenburg positioning along with peritoneal CO2 insufflation leads to decreased lung volumes and increased venous return. This can lead to severe hypercarbia, respiratory acidosis, hypoventilation-related hypoxia and severe head and neck edema (15).…”

“…This patient's super morbid obesity provides an added level of complexity to this clinical scenario. Multiple studies attest to the difficulties associated with each procedure alone (12)(13)(14)(15)(16). Intra-and post-operative complications of oocyte retrieval, noted more frequently in obese patients, include oxygen desaturations both during and after surgery, conversions from total IV to general anesthesia with endotracheal intubation, resorting to the transabdominal approach for oocyte retrieval, as well as increased postoperative pain and need for additional analgesia, occurred more frequently in the obese patients (16).…”