Anesthesiological aspects of laparoscopy in gynecological surgery

Abstract A review of anaesthesia for gynaecologic laparoscopic surgery is given. Special criteria are needed for selection of patients, choice of anaesthesia and intraoperative monitoring. The cardiovascular and respiratory system are affected by tension from the pneumoperitoneum, absorption of CO2 and Trendelenburg position. Gas insufflation can provoke venous gas embolism, pneumothorax, pneumomediastinum, pneumopericardium and subcutaneous emphysema. The introduction of laparoscopic instruments may result in unintentional injuries to intra-abdominal organs. The possibility that the procedure may have to be converted to open laparotomy needs to be considered. Bowel burns may result in perforation, peritonitis and sepsis. Laparoscopy is contraindicated in patients with serious cardiac disease, extensive bowel adhesions or intestinal obstruction. General anaesthesia with muscle paralysis, tracheal intubation and controlled ventilation is the preferred technique in these cases. Short acting anaesthetics are preferred in day case laparoscopy. Central neural blockade or infiltration anaesthesia supplemented with sedation and analgetics can be used for short laparoscopic procedures. The electrocardiogram, noninvasive arterial pressure monitor, airway pressure monitor, intra-abdominal pressure monitor, pulse oximeter and CO2 monitor are used routinely. Antiemetics and analgetics may be needed postoperatively.