19 November 2024 : Review article
Optimizing Anesthetic Management for Laparoscopic Surgery: A Comprehensive Review
Paweł Radkowski
123ABCDEFG, Hubert Oniszczuk 4ABCDEF*, Justyna Opolska 1BCDEF, Aleksandra Kłosińska 1BCDEF, Tariq Dabdoub 1BEF, Dariusz Onichimowski 15AE
DOI: 10.12659/MSM.945951
Med Sci Monit 2024; 30:e945951
Introduction
Pathophysiology of Pneumoperitoneum
Effects of Peritoneal Emphysema on the Cardiovascular System and Visceral Circulation
Respiratory Effects
Neurological Effects
Contraindications for Laparoscopic Operation
Perioperative Management
Ventilation Pressure-Controlled or Volume-Controlled
Use of Muscle Relaxants for Laparoscopy
Postoperative Management
Enhanced Eecovery After Surgery (ERAS) Protocol in Laparoscopic Operations
Analgesia and Pain Management
Prevention of Postoperative Nausea and Vomiting (PONV)
Complications
Conclusions
Future Directions
References
Table 1 Complications of laparoscopic surgery related to pneumoperitoneum and hypercarbia.
| Venous return and CO and CI decrease |
| MAP increase |
| Changes in SVR, increase in pulmonary vascular resistance |
| Arrhythmias – bradycardia, tachyarrhythmias |
| Impaired tissue perfusion (myocardial ischemia, GFR decrease) |
| Oxidative stress |
| Hypercapnia, acidosis and impaired oxygen transport |
| CO embolism |
| Atelectasis, FRC decrease, impaired ventilation-to-perfusion ratio |
| Hypoxemia |
| Impairment of chest elasticity, lung compliance decrease, and airway pressure increase |
| ICP increased and CPP decrease, cerebral vessels vasodilatation |
| Pain complaints |
| Regurgitation, vomiting, aspiration of gastric contents, PONV |
| CO – cardiac output; CI – cardiac index; SVT – systemic vascular resistance; MAP – mean arterial pressure; GRF – glomerular filtration rate; CO – carbon dioxide; FRC – functional residual capacity; ICP – intracranial pressure; CPP – cerebral perfusion pressure; PONV – postoperative nausea and vomiting. |