Laparoscopic general surgery: pneumoperitoneum physiology and anaesthesia

Meet the patient

A 72-year-old with aortic stenosis and old inferior infarcts is listed for laparoscopic colorectal resection in steep Trendelenburg. The surgeon calls it keyhole; the heart does not. You plan a tracheal tube, aggressive CO2 control, and a low threshold to lower the intra-abdominal pressure — with cardiovascular changes generally well tolerated even in elderly or debilitated patients except slight arrhythmia increases.^[4]

Two questions frame the topic: what does a pneumoperitoneum do to the heart and lungs? (raise SVR, push the diaphragm up, load CO2), and what kills the patient if it goes wrong? (gas embolism, cardiac failure against high afterload, or a missed conversion bleed). Answer the physiology in numbers and keep the embolism drill ready — the pneumoperitoneum review's scope is circulatory, respiratory, and splanchnic complications with prevention and treatment.^[4]

References5ShowHide

1. [1]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery Circulation, 1999.PMID 10477528
2. [2]Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial Lancet, 2008.PMID 18479744
3. [3]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial Lancet, 2010.PMID 20554319
4. [4]Gutt CN et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg, 2004.PMID 15010588
5. [5]Valenza F et al. Management of mechanical ventilation during laparoscopic surgery. Best Pract Res Clin Anaesthesiol, 2010.PMID 20608559