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Anesthetic Considerations for Minimally Invasive Surgery

  • Chapter
Current Review of Minimally Invasive Surgery

Abstract

During the past decade, the scope of minimally invasive surgery has expanded from gynecologic surgery to include a variety of general as well as thoracic surgical procedures. This expansion has occurred principally because endoscopic surgery is less invasive than conventional open surgery (allowing for earlier recovery), there is less postoperative pain, and hospital stays and costs are minimized [1,2,3••,4,5•,6]. Minimally invasive surgery includes laparoscopic as well as mediastinal and thoracoscopic surgical procedures. Laparoscopic surgery involves intraoperative intraperitoneal gaseous insufflation of CO2, often in reverse Trendelenburg position. Laparoscopic surgery is being performed with increasing frequency in elderly patients, patients with respiratory and cardiac diseases (American Society of Anesthesiologists [ASA] classes III and IV), in pregnant women, and in infants and children. Hemodynamic and respiratory alterations as a result of intraperitoneal CO2 insufflation may be potentially deleterious in these patients. Therefore, to provide anesthesia safely it has become increasingly important to understand the physiologic consequences of intraperitoneal CO2 insufflation in pregnant women, elderly patients with coexisting diseases, and infants and children [3••,7•,8••,9-11,12••,13-15,16••,17,18]. Further, a majority of patients undergoing endoscopic surgery are discharged on the same day, which mandates adequate control of postoperative pain and minimal postoperative nausea and vomiting (PONV). Hence, an understanding of the factors responsible for PONV and pain following laparoscopic surgery is also necessary.

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Authors
  1. K. Bhavani-Shankar
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  2. Richard A. Steinbrook
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Editors and Affiliations

  1. Department of Surgery, Harvard Medical School Brigham and Women’s Hospital, Boston, Massachusetts, USA

    David C. Brooks MD (Associate Professor of Clinical Surgery) (Associate Professor of Clinical Surgery)

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Bhavani-Shankar, K., Steinbrook, R.A. (1998). Anesthetic Considerations for Minimally Invasive Surgery. In: Brooks, D.C. (eds) Current Review of Minimally Invasive Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1692-6_3

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  • DOI: https://doi.org/10.1007/978-1-4612-1692-6_3

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