Laparoscopic Surgery (also see
Chapter 57
)
Case series of successful diagnostic and operative laparoscopic
procedures performed during pregnancy have been published.[281]
A retrospective study of laparoscopic procedures versus open procedures during the
first two trimesters of pregnancy demonstrated a significant reduction in opiate
requirements and length of stay.[282]
Certain physiologic
changes of pregnancy may have an impact on anesthetic management during laparoscopic
surgery. Mechanical ventilation of a pregnant patient can be difficult because of
upward displacement of the diaphragm before abdominal insufflation. Capnography
may be used to guide ventilation during CO2
pneumoperitoneum with no increased
risk of respiratory acidosis if the end-tidal CO2
is maintained at 32
mm Hg.[283]
The extent of Trendelenburg positioning
may also be limited. Pneumoperitoneum pressure should be limited to 15 mm Hg.[284]
