Anaesthetic implications on cardiorespiratory and hemodynamic physiology in minimal access surgery – a review article

Laparoscopic surgical procedures aim to minimize the trauma of the open conventional procedures. Advantages of laparoscopy include smaller incisional sites, lower risks of wound complications, reduced postoperative pain and complications, improved recovery, shorter hospital stays, more rapid return to normal activities, and significant cost savings. Endoscopic surgery also involves complications. Apart from entry complications of laparoscopy, hemodynamic and cardiorespiratory alterations cannot be under estimated and pose a significant risks especially in patients with pre existing cardiac and respiratory ailments. Risks are associated with Laparoscopic Surgery especially when extended periods of carbon dioxide insufflation are used, and especially with the patient in the steep head-down position. In such circumstances, adverse haemodynamic and respiratory effects are more prone to occur. Cardiorespiratory changes associated with laparoscopy include those associated with tilting the patient to facilitate instrumentation and surgical exposure, and pressure effects of the instilled gas into peritoneum. The operative technique requires inflating gas into the abdominal cavity to provide a surgical procedure. An intra-abdominal pressure (IAP) of 10-15 mmHg is used. Carbon dioxide (CO2) is commonly used because it does not support combustion, is cleared more rapidly than other gases, and is highly soluble in blood. However, the disadvantage of CO2 is that the absorption of CO2 can cause hypercapnia and respiratory acidosis.