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Arch Hellen Med, 22(4), July-August 2005, 325-335


Laparoscopic surgery: Pathophysiologic consequences of pneumoperitoneum

Department of Surgery, University of Patras, Medical School, Patras, Greece

The substantial increase of laparoscopic surgery's clinical applications over the last decade has created interest for the pathophysiologic consequences of pneumoperitoneum. Pneumoperitoneum may create lung atelectasis, reduction of functional residual lung capacity and high pulmonary pressures. Peritoneal CO2 absorption may cause hypercapnia and acidosis, in the absence of adequate hyperventilation. Most studies investigating cardiovascular effects of pneumoperitoneum in healthy individuals, report increase of systemic vascular resistance and mean arterial pressure, accompanied with intraoperative alterations of cardiac index, without significant effect on cardiac frequency. Although main concern is given to global hemodynamic changes, regional circulatory disturbances occurred (i.e. increase of cerebral blood flow, reduction of splanchnic and renal perfusion), which must be considered clinical significant in critical patients who undergo laparoscopic procedures. Complications due to gas insufflation are rare, and can be demonstrated as subcutaneous emphysema, pneumothorax or pneumomediastinum. Air embolism is one of them, and although extremely rare is one of the most serious and lethal complications of laparoscopic procedures. As a conclusion, the most important pathophysiologic alterations during laparoscopy correlate with the increased intra-abdominal pressure and the CO2 usage. It is important for the surgeon, as well as the anesthesiologist to understand the pathophysiology of pneumoperitoneum, concerning its association with the cardiopulmonary function, and the increasing frequency of older patients with serious comorbidities that go through laparoscopic procedures nowadays.

Key words: Laparoscopic surgery, Pathophysiology, Pneumoperitoneum.

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