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Anesthetic Considerations Laparoscopic Abdominal Surgery

Anesthetic Considerations: Laparoscopic abdominal surgery – healthy adult Authors: Madison Amyotte, Tracey Rice, Priyanka Grewal, Luiza Radu Reviewers: Jasleen Brar, Leyla Baghirzada* * MD at time of publication Hypercarbia (↑ CO2 in bloodstream) Cardiovascular Effects Positional Pneumoperitoneum (introduction of gas eg. CO2 in the abdominal cavity for easier access to organs during laparoscopy) Systemic vasodilation ↓ Systemic vascular resistance ↑ Systemic blood flow & oxygen delivery Respiratory acidosis Acidosis leads to ↓ cardiac contractility Arrhythmia Cardiac arrest Reverse Trendelenburg positioning of patient (patient supine with head of OR table ↑) ↑ Venous pooling (accumulation of blood in veins) ↓ Venous return (blood returning to the heart) ↓ Preload ↓ Blood pressure Trendelenburg positioning of patient (patient supine with head of OR table ↓) Low fluid status Compression of large abdominal vessels ↓ Preload ↓ Blood pressure High fluid status ↑ Venous return (blood returning to the heart) ↑ Preload (ventricle filling pressure prior to contraction) ↑ Blood pressure ↑ Venous return ↑ Preload ↑ Blood pressure Vagus nerve stimulation Bradyarrhythmia (slow and irregular heart rate) Asystole (absence of electrical activity and contractility of the heart) ↑ Cerebral blood flow Cephalad (upward) displacement of diaphragm & compression of thoracic cavity ↓ Functional residual capacity (volume remaining after expiration) & pulmonary compliance ↓ Tidal volumes (air inhaled per breath) Atelectasis (partial or full collapse of lung) V/Q mismatch (lung ventilation & perfusion imbalance) Respiratory Effects ↑ Intraocular pressure (e.g. papilledema) Ophthalmic compromise (visual system impairment) ↑ Intracranial pressure Compression of renal vessels à↓ Renal blood flow Release of catecholamines (norepinephrine & dopamine) Renin angiotensin aldosterone system activation Aldosterone & vasopressin release ↑ Blood pressure Renal System Effects Neurologic Effects Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Nov 25, 2024on www.thecalgaryguide.com