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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References and Recommended Reading
Soper NJ, Brunt LM, Kerb K: Laparoscopic general surgery. N Engl J Med 1994, 330:409–419.
Curete MJ, Allen D, Josloff RK, et al.: Laparoscopy during pregnancy. Arch Surg 1996, 131:546–550.
Steinbrook RA, Brooks DC, Datta S: Laparoscopic cholecystectomy during pregnancy. Surg Endosc 1996, 10:511–515.
Eichenberg RJ Vanderlinden J, Bianchi MC, et al.: Laparoscopic cholecystectomy in the third trimester of pregnancy. Am Surg 1996, 62:874–877.
Lanzafame RJ: Laparoscopic cholecystectomy during pregnancy. Surgery 1995, 118:627–631.
Soper NJ, Hunter JG, Petrie RH: Laparoscopic cholecystectomy during pregnancy. Surg Endosc 1992, 6:115–117.
Dhoste K, Lacoste L, Karayan J, et al.: Hemodynamic and ventila-tory changes during laparoscopic cholecystectomy in elderly ASA III patients. Can J Anaesth 1996, 43:783–788.
Wahba RWM, Berque F, Kleiman SJ: Cardiopulmonary function and laparoscopic cholecystectomy [review article]. Can J Anaesth 1995, 42:51–63.
Feig BW, Berger DH, Dupuis JF, et al.: Hemodynamic effects of CO2 abdominal insufflation (CAI) during laparoscopy in high-risk patients. Anesth Analg 1994, 78:S109.
Fox LG, Hein HAT, Gawey BJ, et al.: Physiologic alterations during laparoscopic cholecystectomy in ASA III & IV patients [abstract]. Anesthesiology 1993, 79:A55.
Hsing CH, Hseu SS, Tsai SK, et al.: The physiological effect of CO2 pneumoperitoneum in pediatric laparoscopy. Acta Anaesthesiol Scand 1995, 33:1–6.
Resinoso-Barbero F, Diez A, Paz JA, et al.: Physiopathologic implications of the anesthesiologic management of pediatric laparoscopic surgery. Rev Esp Anestesiol Reanim 1995, 42:277–282. Discusses the physiologie consequences of pneumoperitoneum in children and concludes that laparoscopic surgery in children diminishes thoracic distensibility and causes hypercapnia, making it necessary to measure PETco2 to regulate ventilation.
Ikeya K, Kashimoto S, Takahashi M, et al.: Anesthetic management of laparoscopic ovarian cystectomy in a 2-year-old child. Mosul 1994, 43:778–780.
Fahy BG, Barnas GM, Flowers JL, et al.: The effects of increased abdominal pressure on lung and chest wall mechanics during laparoscopic surgery. Anesth Analg 1995, 81:744–750.
Cunningham AJ, Brull SJ: Laparoscopic cholecystectomy: anesthetic implications. Anesth Analg 1993, 76:1120–1133.
Wahba WM, Tessler MJ, Kleiman SJ: Acute ventilatory complications during laparoscopic upper abdominal surgery. Can J Anaesth 1996, 43:77–83.
Wahba RWM, Mamazza J: Ventilatory requirements during laparoscopic cholecystectomy. Can J Anaesth 1993, 40:206–210.
Wittgen CM, Andrus CH, Fitzgerald SD, et al.: Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 1992, 126:997–1001.
Joris JL, Noirot DP, Legrand MJ, et al.: Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg 1993, 76:1067–1071.
Breton G, Poulin E, Fortin C, et al.: Evaluation clinique et hemodynamique des cholecystectomies par voie laparoscopique. Ann Chir 1991, 45:783–790.
Reid CW, Martineau RJ, Hull KA, Miller DR: Haemodynamic consequences of abdominal insufflation with CO2 laparoscopic cholecystectomy [abstract]. Can J Anaesth 1992, 39:A132.
Cunningham AJ, Turner J, Rosenbaum S, Rafferty T: Transoesophageal echocardiographic assessment of haemodynamic function during laparoscopic cholecystectomy. Br J Anaesth 1993, 70:621–625.
Aoki T, Tanil M, Takahashi K, et al.: Cardiovascular changes and plasma catecholamine levels during laparoscopic surgery. Anesth Analg 1994, 78:S8.
Felber AR, Blobner M, Goegier S, et al.: Plasma vasopressin in laparoscopic cholecystectomy [abstract]. Anesthesiology 1993, 79:A32.
Wahba RWM: Perioperative functional residual capacity. Can J Anaesth 1991, 38:384–400.
Makinen MT: Dynamic lung compliance during laparoscopic cholecystectomy. Anesth Analg 1994, 78:S261.
Feinstein R, Ghouri A: Change in pulmonary mechanics during laparoscopic cholecystectomy. Anesth Analg 1993, 76:S102.
Chiche JD, Joris J, Lamy M: PEEP for treatment of intraoperative pneumothorax during laparoscopic fundoplication [abstract]. Br J Anaesth 1994, 72:A38.
Joris J, Honore P, Lamy M: Changes in oxygen transport and ventilation during laparoscopic cholecystectomy [abstract]. Anesthesiology 1992, 77:A149.
Wurst H, Schulte-Steinberg H, Finsterer U: Pulmonary CO2-elimi-nation in laparoscopic cholecystectomy: a clinical study. Anaesthetist 1993, 42:427–434.
Nyarwaya JB, Mazoit JX, Samii K: Are pulse oximetry and endtidal carbon dioxide tension monitoring reliable during laparoscopic surgery? Anaesthesia 1994, 49:775–778.
Baraka A, Jabbour S, Hammoud R, et al.: Can pulse oximetry and end-tidal capnography reflect arterial oxygenation and carbon dioxide elimination during laparoscopic cholecystectomy? Surg Laparosc Endosc 1994, 4:353–356.
Ciofolo MJ, Clergue F, Seebacher J, et al.: Ventilatory effects of laparoscopy under epidural anesthesia. Anesth Analg 1990, 70:357–361.
Watcha MF, While PF: Postoperative nausea and vomiting. Anesthesiology 1992, 77:162–184.
Alexander GD, Skupski JN, Brown EM: The role of nitrous oxide in postoperative nausea and vomiting [abstract]. Anesth Analg 1984, 63:175.
Havorka J, Korttila K, Erkola O: Nitrous oxide does not increase the incidence of nausea and vomiting after gynecological laparoscopy. Can J Anaesth 1989, 36:145–148.
Andrews PLR: Physiology of nausea and vomiting. Br J Anaesth 1992, 69:2S–19S.
Philip BK: Etiologies of postoperative nausea and vomiting. Pharm Ther 1997, 22:18S–25S.
Kapur PA: The big ‘little problem’. Anesth Analg 1991, 73:243–245.
Steinbrook RA, Freiberger D, Gosnell JL, Brooks DC: Prophylactic antiemetics for laparoscopic cholecystectomy: ondansetron versus droperidol plus metoclopramide. Anesth Analg 1996, 83:1081–1083.
Lonie DS, Harper JN: Nitrous oxide anaesthesia and vomiting. Anaesthesia 1986, 41:703–707.
Jenkins JC, Lahay D: Central mechanisms of vomiting related to catecholamine response: anaesthetic implications. Can Anaesth Soc J 1971, 18:434–441.
Perreault L, Normandin N, Plamondon L, et al.: Middle ear pressure variations during nitrous oxide-oxygen anesthesia. Can Anaesth Soc J 1982, 29:428–434.
Egar EI II, Saidman LJ: Hazards of nitrous oxide anesthesia in bowel obstruction and pneumothorax. Anesthesiology 1965, 26:61–66.
Bhandari P, Bingham S Andrews PLR: The neuropharmacology of loperamide-induced emesis in the ferret: the role of the area postrema, vagus, opiate, and 5-HT3 receptors. Neuropharmacology 1992, 31:735–742.
Anderson R, Krohg K: Pain as a major cause of postoperative nausea. Can Anaesth Soc J 1976, 23:366–369.
Ding Y, Terkonda R, White PF: Use of ketorolac and dezocine as alternatives to fentanyl during outpatient anesthesia [abstract]. Anesth Analg 1992, 74(suppl):S67.
Watcha MF, Jones MB, Lagueruela R, et al.: A comparison of ketorolac and morphine when used during pediatric anesthesia [abstract]. Anesthesiology 1991, 75:A942.
Buckley MMT, Brogden RN: Ketorolac: a review of pharmacodynamic and pharmacokinetic properties and therapeutic potential. Drugs 1990, 39:86–109.
Helvacioglu A, Weis R: Operative laparoscopy and postoperative pain relief. Obstet Gynecol 1986, 67:447–479.
Spielman FJ, Hulka JF, Ostheimer GW, Mueller RA: Pharmacokinetics and pharmacodynamics of local analgesia for laparoscopic tubal ligations. Am J Obstet Gynecol 1983, 146:821–824.
Rothenberg DM, Parnass SM, Litwak K, et al.: Efficacy of ephedrine in the prevention of postoperative nausea and vomiting. Anesth Analg 1991, 72:58–61.
Korttila K, Ostman P, Faure E, et al.: Randomized comparison of recovery after propofol-nitrous oxide versus thiopentone-isoflu-rane-nitrous oxide anaesthesia in patients undergoing ambulatory surgery. Acta Anaesthesiol Scand 1990, 34:400–403.
Doze VA, Westphal LM, White PF: Comparison of propofol with methohexital for outpatient anesthesia. Anesth Analg 1986, 65:1189–1195.
Watcha MF, Simeon RM, White PF, Stevens JL: Effect of propofol on the incidence of postoperative vomiting after strabismus surgery in pediatric outpatients. Anesthesiology 1991, 75:204–209.
Chettleborough MC, Osborne GA, Rudkin GE, et al.: Doubleblind comparison of patient recovery after induction with propofol or thiopentone for day-case relaxant general anaesthesia. Anaesth Intens Care 1992, 20:160–173.
Borgeat A, Wilder-Smith OHG, Saiah M, Rifat K: Subhypnotic doses of propofol possess direct antiemetic properties. Anesth Analg 1992, 74:539–541.
Iwase K, Takenaka H, Yagura A, et al.: Hemodynamic changes during laparoscopic cholecystectomy in patients with heart disease. Endoscopy 1992, 24:771–773.
Safran D, Sgambati S, Orlando R III: Laparoscopy in high-risk cardiac patients. Surg Gynecol Obstet 1993, 176:548–554.
Duale C, Bazin JE, Ferrier C, et al.: Hemodynamic effects of laparoscopic cholecystectomy in patients with coronary disease [abstract]. Br J Anaesth 1993, 72:A31.
Litwin DEM, Girotti MJ, Poulin EC, et al.: Laparoscopic cholecystectomy: trans-Canada experience with 2201 cases. Can J Surg 1992, 35:291–296.
Feig BW, Berger DH, Dougherty TB, et al.: Pulmonary effects of CO2 abdominal insufflation (CAI) during laparoscopy in high-risk patients. Anesth Analg 1994, 78(suppl):S108.
Wittgen CM, Naunheim KS, Andrus CH, Kaminski DL: Preoperative pulmonary function evaluation for laparoscopic cholecystectomy. Arch Surg 1993, 128:880–885.
Monk TG, Weldon BC, Lemon D: Alterations in pulmonary function during laparoscopic surgery. Anesth Analg 1993, 76(suppl):S274.
Levinson G, Shnider SM, de Lorimer AA, Steffenson JL: Effects of maternal hyperventilation on uterine blood flow and fetal oxygenation and acid-base status. Anesthesiology 1974, 40:340–347.
Hunter JG, Swanstrom L, Thornburg K: Carbon dioxide pneu-moperitoneum induces fetal acidosis in a pregnant ewe model. Surg Endosc 1995, 9:272–279.
Martin LVH, Jurand A: The absence of teratogenic effects of some analgesics used in anaesthesia. Anaesthesia 1992, 47:473–476.
Brooks DC, Becker JM: A simplified technique for open laparoscopy using disposable trocar. J Laparoendosc Surg 1992, 2:357–359.
Cruz AM, Sutherland LC, Duke T, et al.: Intraabdominal carbon dioxide insufflation in the pregnant ewe. Anesthesiology 1996, 85:1395–1402.
Bhavani Shankar K, Mushlin PS: Arterial to end-tidal carbon dioxide gradients in pregnant subjects. Anesthesiology 1997, 87:1596–1597.
Bhavani-Shankar K, Moseley H, Kumar Y, et al.: Arterial to endtidal carbon dioxide tension difference during anaesthesia for tubal ligation. Anaesthesia 1987, 42:482–486.
Bhavani-Shankar KB, Moseley H, Kumar Y, Vemula V: Arterial to end-tidal carbon dioxide tension difference during Caesarean section anaesthesia. Anaesthesia 1986, 41:698–702.
Bhavani-Shankar K, Moseley H, Kumar AY, Delph Y: Capnometry and anaesthesia. Can J Anaesth 1992, 39:617–632.
Bhavani-Shankar K, Steinbrook RA, Mushlin PS, Freiberger D: Transcutaneous PCO2 monitoring during laparoscopic cholecystectomy in pregnancy. Can J Anaesth 1998, 45:164–169.
Harned HS, Rowshan G, MacKinney LC, Sugioka K: Relationship of PO2, Pco2, and pH to onset of breathing of the term lamb as studied by a flow-through cuvette electrode assembly. Pediatrics 1964, 33:672–681.
Ivankovic AD, Elam JO, Huffman J: Effect of maternal hypercar-bia on the newborn infant. Am J Obstet Gynecol 1970, 107:939–945.
Newman W, Braid D, Wood C: Fetal acid-base status: 1. Relationship between maternal and fetal Pco2. Am J Obstet Gynecol 1967, 97:43–51.
Walker AM, Oakes GK, Ehrenkranz R, et al.: Effects of hypercarbia on uterine and umbilical circulations in conscious pregnant sheep. J Appl Physiol 1976, 41:727–733.
Pintus C, Coppola R, Talamo M, Perrelli L: Laparoscopic chole-cystectomy in a 23-month-old infant. Surg Laparosc Endosc 1995, 5:148–150.
Radke M, Helms B, Czarnetzki HD, et al.: Laparoscopic cholecys-tectomy in a young girl. J Pediatr Surg 1994, 4:108–109.
Rosser JC Jr, Boeckman CR, Andrews D: Laparoscopic cholecystectomy in an infant. Surg Laparosc Endosc 1992, 2:143–147.
Holcomb GW, Naffis D: Laparoscopic cholecystectomy in infants. Pediatr Surg 1994, 29:86–87.
Peterson HB, De Stefano F, Rubin GL, et al.: Deaths attributable to tubal sterilization in United States, 1977 to 1981. Am J Obstet Gynecol 1983, 146:131–136.
Couture P, Boudreault D, Derouin M, et al.: Venous carbon dioxide embolism in pigs: an evaluation of end-tidal carbon dioxide, transesophageal echocardiography, pulmonary artery pressure, and precordial auscultation as monitoring modalities. Anesth Analg 1994, 79:867–873.
Ehrenwerth J, Brull SJ: Anesthesia for thoracic diagnostic procedures. In Thoracic Anesthesia, edn 2. Edited by Kaplan JA. New York: Churchill Livingstone; 1991:321–346.
Petty C: Right radial artery pressure during mediastinoscopy. Anesth Analg 1979, 58:428–430.
Piro AJ, Weiss DR, Hellman S: Mediastinal Hodgkin’s disease: a possible danger for intubation anesthesia. Int J Radiat Oncol Biol Phys 1976, 1:415–419.
Neuman GG, Weingarten AE, Abramowitz RM, et al.: The anesthetic management of the patient with an anterior mediastinal mass. Anesthesiology 1984, 60:144–147.
Wilson RF, Steiger Z, Jacobs J, et al.: Temporary partial cardiopul-monary bypass during emergency operative management of near total tracheal occlusion. Anesthesiology 1984, 61:103–105.
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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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