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Anästhesie bei laparoskopischen Eingriffen

Anesthesia for laparoscopic interventions

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Zusammenfassung

Laparoskopische Operationstechniken werden in vielen Bereichen der Chirurgie angewendet und sind teilweise zu Standardverfahren geworden. Die Cholezystektomie wird in ca. 90% der Fälle laparoskopisch durchgeführt. Im Rahmen des Pneumoperitoneums finden Veränderungen statt, die z. T. ausgeprägte Auswirkungen auf die physiologische Homöostase haben. Darüber hinaus kann es bei einer Laparoskopie zu spezifischen Komplikationen mit weitreichenden Folgen kommen. Beides muss dem Anästhesisten bekannt sein, um entsprechend reagieren zu können.

Abstract

Laparoscopic techniques are used in many surgical disciplines and have partially become a standard procedure. Cholecystectomy is performed laparoscopically in 90% of cases. During a pneumoperitoneum changes occur which have a large influence on physiological homeostasis. Furthermore there are specific complications of laparoscopy which can have severe consequences. For adequate management the anesthetist has to be aware of both in order to react in the correct way.

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Literatur

  1. Jin C, Hu Y, Chen XC et al (2009) Laparoscopic versus open myomectomy – a meta analysis of randomized controlled clinical trials. Eur J Obstet Gynecol Reprod Biol 145:14–21

    Article  PubMed  Google Scholar 

  2. Damiani G, Pinnarelli L, Sammarco A et al (2008) Postoperative pulmonary function in open versus laparoscopic cholecystectomy: a meta-analysis of the Tiffenau index. Dig Surg 25:1–7

    Article  PubMed  Google Scholar 

  3. Gurusamy KS, Samraj K, Davidson BR et al (2008) Abdominal lift for laparoscopic cholecystectomy. Cochrane Database Syst Rev 16:CD006574

    Google Scholar 

  4. Hirvonen EA, Poikolainen EO, Pääkkönen ME, Nuutinen LS (2000) The adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy. Surg Endosc 14:272–277

    Article  CAS  PubMed  Google Scholar 

  5. Jee D, Lee D, Yun S, Lee C (2009) Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy. Br J Anaesth 103:484–489

    Article  CAS  PubMed  Google Scholar 

  6. Cadi P, Guenoun T, Journois D et al (2008) Pressure-controlled ventilation improves oxygenation during laparoscopic obesity surgery compared with volume-controlled ventilation. Br J Anaesth 100:709–716

    Article  CAS  PubMed  Google Scholar 

  7. Kim JY, Shin CS, Kim HS et al (2010) Positive end-expiratory pressure in pressure-controlled ventilation improves ventilatory and oxygen parameters during laparoscopic cholecystectomy. Surg Endosc 24:1099–1103

    Article  PubMed  Google Scholar 

  8. Abassi Z, Bishara B, Karram T et al (2007) Adverse effects of pneumoperitoneum on renal function: involvement of the endothelin and nitric oxide systems. Am J Physiol Regul Integr Comp Physiol 294:R842–R850

    PubMed  Google Scholar 

  9. Atila K, Terzi C, Ozkardesler S et al (2009) What is the role of the abdominal perfusion pressure for subclinical hepatic dysfunction in laparoscopic cholecystectomy? J Laparoendosc Adv Surg Tech A 19:39–44

    Article  PubMed  Google Scholar 

  10. Meininger D, Byhahn C, Wolfram M et al (2004) Prolonged intraperitoneal versus extraperitoneal insufflation of carbon dioxide in patients undergoing totally endoscopic robot-assisted radical prostatectomy. Surg Endosc 18:829–833

    Article  CAS  PubMed  Google Scholar 

  11. Maharjan SK, Shrestha BR (2007) Do we have to hyperventilate during laparoscopic surgery? Kathmandu Univ Med J (KUMJ) 5:307–311

    Google Scholar 

  12. Menes T, Spivak H (2000) Laparoscopy: searching for the proper insufflation gas. Surg Endosc 14:1050–1056

    Article  CAS  PubMed  Google Scholar 

  13. Grabowski JE, Talamini MA (2009) Physiological effects of pneumoperitoneum. J Gastrointest Surg 13:1009–1016

    Article  PubMed  Google Scholar 

  14. Sprung J, Whalley DG, Falcone T et al (2002) The impact of morbid obesity, pneumoperitoneum and posture on respiratory system mechanics and oxygenation during laparoscopy. Anesth Analg 94:1345–1350

    Article  PubMed  Google Scholar 

  15. Hong JY, Lee SJ (2009) Effects of thoracic epidural analgesia combined with general anesthesia on intraoperative ventilation/oxygenation and postoperative pulmonary complications in robot-assisted laparoscopic radical prostatectomy. J Endourol 23(11):1843–1849

    Article  PubMed  Google Scholar 

  16. Maltby JR, Beriault MT, Watson NC et al (2003) LMA-Classic and LMA-ProSeal are effective alternatives to endotracheal intubation for gynecologic laparoscopy. Can J Anaesth 50(1):71–77

    Article  PubMed  Google Scholar 

  17. Abdi W, Amathieu R (2010) Sparing the larynx during gynecological laparoscopy: a randomized trial comparing the LMA Supreme and the ETT. Acta Anaesthesiol Scand 54(2):141–146

    Article  CAS  PubMed  Google Scholar 

  18. Weller WE, Rosati C (2008) Comparing outcomes of laparoscopic versus open bariatric surgery. Ann Surg 248(1):10–15

    Article  PubMed  Google Scholar 

  19. Corneille MG, Gallup TM (2010) The use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy. Am J Surg 200(3):363–367

    Article  PubMed  Google Scholar 

  20. Terrier G (1999) Anaesthesia for laparoscopic procedures in infants and children: indications, intra- and post-operative management, prevention and treatment of complications. Curr Opin Anaesthesiol 12:311–314

    Article  CAS  PubMed  Google Scholar 

  21. Metzelder ML, Ure BM (2010) Minimal-invasive Kinderchirurgie. Chirurg 81:72–82

    Article  Google Scholar 

  22. Whaba WM, Tessler MJ, Kleiman SJ (1996) Acute ventilatory complications during laparoscopic upper abdominal surgery. Can J Anaesth 43:77–83

    Article  Google Scholar 

  23. Soro M, García-Pérez ML (2004) Closed-system anaesthesia for laparoscopic surgery: is there a risk for carbon monoxide intoxication? Eur J Anaesthesiol 21(6):483–488

    CAS  PubMed  Google Scholar 

  24. Gurusamy KS, Samraj K (2009) Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev 15(2):CD006930

    Google Scholar 

  25. Phelps P, Cakmakkaya OS, Apfel CC, Radke OC (2008) A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial. Obstet Gynecol 111(5):1155–1160

    Article  PubMed  Google Scholar 

  26. Apfel CC, Greim CA (1998) The discriminating power of a risk score for postoperative vomiting in adults undergoing various types of surgery. Acta Anaesthesiol Scand 42(5):502–509

    Article  CAS  PubMed  Google Scholar 

  27. Karanicolas PJ, Smith SE (2008) The impact of prophylactic dexamethasone on nausea and vomiting after laparoscopic cholecystectomy – a systematic review and meta-analysis. Ann Surg 248(5):751–762

    Article  PubMed  Google Scholar 

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  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland

    R. Hömme DESA

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  1. R. Hömme DESA
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Correspondence to R. Hömme DESA.

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Hömme, R. Anästhesie bei laparoskopischen Eingriffen. Anaesthesist 60, 175–188 (2011). https://doi.org/10.1007/s00101-011-1856-5

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  • DOI: https://doi.org/10.1007/s00101-011-1856-5

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