Special anesthetic complications of laparoscopic surgery

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Special anesthetic complications of laparoscopic
surgery
Reinhard Purschke Dortmund/Germany
Moscow, May 23rd, 2006
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Special anesthetic problems of laparoscopic
surgery

• Hypothermia
• Hypercarbia
• Changes in ventilation
• Changes in hemodynamics
• Special Complications

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Hypothermia

• Insufflated CO2 - 22 C
• Time Flow bodytemperature
• Bodytemperature lt 35ºC

• Shivering
• Impaired bloodclotting
• Immune deficiency
• Postoperative pain

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Hypercarbia

• Acidosis
• Sympathic stimulation
• Changes in cerebral perfusion
• ventilatory minutevolume
• bodytemperature

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Ventilation

• Impaired movement of diaphragm
• Airway pressure
• Danger of barotrauma
• Occlusion of small airways
• Shunting / CO2-Retention

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Hemodynamics

• Venous return
• Peripheral resistance
• Cardiac output
• intraabdominal pressure gt 15 mm Hg
• hemodynamic changes

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Special Complications

• CO2-Gasembolism after puncture of a vessel
• Gut injuries
• CO2-Emphysema cutaneous, mediastinal,
  pericardial
• Pneumothorax
• Atelectasis

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Atelectasis of the left lung
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Atelectasis of the right lower lobe
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So be careful in patients with

• Cardiac diseases
• Pulmonary diseases
• Cerebral risk factors
• Volume deficit

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Planning the Anesthesia

• Kind of operation
• Time needed for the operation
• Positioning of the patient
• For that reason, you have to talk with the surgeon

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