[Anesthesia for laparoscopic surgery].

Abstract

A thorough understanding of the physiological repercussions of the pneumoperitoneum is essential in order ot properly grasp the safety rules governing anesthesia for laparoscopic surgery. As a general rule systemic vascular resistance increases as the heart flow rate and venous return circulation decrease. Variations in the ventilation/perfusion ratio explain the origin of hypercapnia observed in patients. There is little reabsorption of CO2 from the peritoneal cavity. However, this increases considerably if CO2 is insufflated outside the peritoneum (for example during pelvic lymph-adenectomy). Anesthesia must therefore limit the intra-abdominal pressure by adequate curarization and adapt the ventilation according to the P and CO2 capnographic readings. When the surgical procedure is protracted, it may be of benefit ot the patient to reduce systemic vascular resistance by using halogenic anesthetics such as isoflurane.