SUMMARY

Laparoscopy results in multiple postoperative benefits including less trauma, less pain, less pulmonary dysfunction, quicker recovery, and shorter hospital stay. These advantages are regularly emphasized and explain the increasing success of laparoscopy, which is proposed for many surgical procedures. Intraoperative cardiorespiratory changes occur during pneumoperitoneum. PaCO₂ increases because of CO₂ absorption from the peritoneal cavity. In compromised patients, cardiorespiratory disturbances aggravate this increase in PaCO₂ . Hemodynamic changes are accentuated in high-risk cardiac patients. Improved knowledge of the pathophysiologic hemodynamic changes in healthy patients allows for successful anesthetic management of cardiac patients, by optimizing preload before pneumoperitoneum and through judicious use of vasodilating drugs. Alternative insufflating gases (e.g., He, Ar, N₂ O) do not seem to reduce the hemodynamic changes. Gasless laparoscopy may be more helpful, but unfortunately increases technical difficulty. The incidence of complications has now been reported in several large surveys and compares favorably to that of open surgery. The death rate during operative laparoscopy is approximately 0.1 to 1 per 1000 cases; the incidence of hemorrhagic complications and visceral injury is 2 to 5 per 1000 cases. Whereas no anesthetic technique has proved to be clinically superior to any other, general anesthesia with controlled ventilation seems to be the safest technique for operative laparoscopy. Improved knowledge of the intraoperative repercussions of laparoscopy permits safe management of patients with more and more severe cardiorespiratory disease, who may subsequently benefit from the multiple postoperative advantages offered by this approach.