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Anesthetic Management for Laparoscopic Cholecystectomy

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Laparoscopic Cholecystectomy

Abstract

Pneumoperitoneum used for laparoscopic cholecystectomy (LC) causes important pathophysiologic alterations that every anesthetist must know. First of all cardiovascular changes are amplified when the patient assumes the reverse Trendelenburg position. In healthy patients these alterations are usually well tolerated. However, patients with cardiovascular disease or hypovolemia may be at increased risk. The increased intra-abdominal pressure also affects the respiratory system: thoraco-pulmonary compliance and functional residual capacity are reduced, while peak respiratory pressures are increased. These changes may lead to hypoxia. Mechanical ventilation with increased tidal volumes and the addition of positive end-expiratory pressure may counteract this problem. General anesthesia with tracheal intubation is the most commonly used, but in the last years supraglottic airway devices (SADs) have been investigated. The second-generation SADs improve pharyngeal seal and allow the passage of a gastric tube to deflate the stomach. SADs do not need neuromuscular blocking agents, but the use of these drugs for LC is still controversial. Spinal or epidural anesthesia may be safely used for LC. Recovery after this operation is usually rapid, and postoperative pain may be treated with the infiltration at all the trocar sites with local anesthetics, with the intraperitoneal nebulization of local anesthetics, and with a multimodal analgesia started before the induction of anesthesia. To prevent postoperative nausea and vomiting, prophylactic dexamethasone and droperidol or 5-HT3 antagonists may be used.

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Bibliography

  1. Johnson A (1997) Laparoscopic surgery. Lancet 349:631–635

    Article  CAS  PubMed  Google Scholar 

  2. Gonzales R, Smith CD, Mc Cluski DA III et al (2004) Laparoscopic approach reduces likelihood of perioperative complications in patients undergoing adrenalectomy. Am Surg 70(8):668–674

    Google Scholar 

  3. Sanchez NC, Tenofsky PL, Dort JM et al (2001) What is normal intra-abdominal pressure? Am Surg 67:243–248

    CAS  PubMed  Google Scholar 

  4. O’Malley C, Cunningham A (2001) Physiologic changes during laparoscopy. Anesthesiol Clin North America 19:1–19

    Article  PubMed  Google Scholar 

  5. O’Leary E, Hubbard K, Tormey W et al (1996) Laparoscopic cholecystectomy: haemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position. Br J Anaesth 76:640–644

    Article  PubMed  Google Scholar 

  6. Mac Mahon AJ, Fischbacher CM, Frame SH et al (2000) Impact of laparoscopic cholecystectomy: a population-based study. Lancet 356(11):1632–1637

    Article  Google Scholar 

  7. Gerges FJ, Kanazi G, Jabbour-Khoury S (2006) Anesthesia for laparoscopy: a review. J Clin Anesth 18:67–78

    Article  CAS  PubMed  Google Scholar 

  8. Gutt CN, Oniu T, Mehrabi A et al (2004) Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg 21(2):95–105

    Article  CAS  PubMed  Google Scholar 

  9. Odeberg S, Ljungqvist O, Svenberg T et al (1994) Hemodynamic effects of pneumoperitoneum and the influence of posture during anesthesia for laparoscopic surgery. Acta Anaesthesiol Scand 38(3):276–283

    Article  CAS  PubMed  Google Scholar 

  10. Sprung J, Abdelmalak B, Schoenwald PK (1998) Recurrent complete heart block in a healthy patient during laparoscopic electrocauterization of the fallopian tube. Anesthesiology 88(5):1401–1403

    Article  CAS  PubMed  Google Scholar 

  11. Nguyen NT, Anderson JT, Budd M et al (2004) Effects of pneumoperitoneum on intraoperative pulmonary mechanics and gas Exchange during laparoscopic gastric bypass. Surg Endosc 18:64–71

    Article  CAS  PubMed  Google Scholar 

  12. Rauh R, Hemmerling TM, Rist M et al (2001) Influence of pneumoperitoneum and patient positioning on respiratory system compliance. J Clin Anesth 13(5):361–365

    Article  CAS  PubMed  Google Scholar 

  13. Leonard IE, Cunningham AJ (2002) Anaesthetic considerations for laparoscopic cholecystectomy. Best Pract Res Clin Anaesthesiol 16(1):1–20

    Article  PubMed  Google Scholar 

  14. Leslie K, Myles PS, Chan MTV et al (2008) Risk factors for severe postoperative nausea and vomiting in a randomized trial of nitrous oxide-based vs nitrous oxide-free anaesthesia. Br J Anaesth 101(4):498–505

    Article  CAS  PubMed  Google Scholar 

  15. Maltby RJ, Beriault MT, Watson NC et al (2002) The LMA-ProSealTM is an effective alternative to tracheal intubation for laparoscopic cholecystectomy. Can J Anaesth 49(8):857–862

    Article  PubMed  Google Scholar 

  16. Beleña JM, Gracia JL, Ayala JL et al (2011) The laryngeal mask airway supreme for positive pressure ventilation during laparoscopic cholecystectomy. J Clin Anesth 23:456–460

    Article  PubMed  Google Scholar 

  17. Beleña JM, Núñez M, Anta D et al (2013) Comparison of Laryngeal Mask Airway Supreme and Laryngeal Mask Airway Proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy: a randomised controlled trial. Eur J Anaesthesiol 30(3):119–123

    Article  PubMed  Google Scholar 

  18. Maharjan SK (2013) I-gel for positive pressure ventilation. JNMA J Nepal Med Assoc 52(189):255–259

    PubMed  Google Scholar 

  19. Sharma B, Sehgal R, Sahai C, Sood J (2010) PLMA vs. I-gel: a comparative evaluation of respiratory mechanics in laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol 26(4):451–457

    PubMed Central  PubMed  Google Scholar 

  20. Jones MJ, Mitchell RW, Hindocha N (1989) Effect of increased intra-abdominal pressure during laparoscopy on the lower esophageal sphincter. Anesth Analg 68:63–65

    Article  CAS  PubMed  Google Scholar 

  21. Miller DM, Camporota L (2006) Advantages of ProSealTM and SLIPATM airways over tracheal tubes for gynecological laparoscopies. Can J Anaesth 53(2):188–193

    Article  PubMed  Google Scholar 

  22. Carron M, Veronese F, Gomiero W et al (2012) Hemodynamic and hormonal stress responses to endotracheal tube and ProSeal Laryngeal Mask AirwayTM for laparoscopic gastric banding. Anesthesiology 117:309–320

    Article  PubMed  Google Scholar 

  23. Gerusamy KS, Samraj K, Davidson BR (2009) Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev (2):CD06930

    Google Scholar 

  24. Salihoglu Z, Demiroluk S, Dikmen Y (2003) Respiratory mechanics in morbid obese patients with chronic obstructive pulmonary disease and hypertension during pneumoperitoneum. Eur J Anaesthesiol 20(8):658–661

    Article  CAS  PubMed  Google Scholar 

  25. Van Zundert AAJ, Stultiens G, Jalimowicz JJ et al (2007) Laparoscopic cholecystectomy under segmental thoracic spinal anaesthesia: a feasibility study. Br J Anaesth 98(5):682–686

    Article  PubMed  Google Scholar 

  26. Tzovaras G, Fafoulakis F, Pratsas K et al (2008) Spinal vs general anesthesia for laparoscopic cholecystectomy: an interim analysis of a controller randomized trial. Arch Surg 143(5):497–501

    Article  PubMed  Google Scholar 

  27. Collins LM, Vaghadia H (2001) Regional anesthesia for laparoscopy. Anesthesiol Clin North America 19(1):43–55

    Article  CAS  PubMed  Google Scholar 

  28. Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362(9399):1921–1928

    Article  PubMed  Google Scholar 

  29. Hasaniya NW, Zayed FF, Faiz H et al (2001) Preinsertion local anesthesia at the trocar site improves perioperative pain and decreases costs of laparoscopic cholecystectomy. Surg Endosc 15(9):962–964

    Article  CAS  PubMed  Google Scholar 

  30. Ahn Y, Woods J, Connor S (2011) A systematic review of interventions to facilitate ambulatory laparoscopic cholecystectomy. HPB (Oxford) 13:677–686

    Article  Google Scholar 

  31. Boddy AB, Mehta S, Rhodes M (2006) The effect of intraperitoneal local anaesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Anesth Analg 103:682–688

    Article  CAS  PubMed  Google Scholar 

  32. Ingelmo PM, Bucciero M, Somaini M et al (2013) Intraperitoneal nebulization of ropivacaine for pain control after laparoscopic cholecystectomy: a double-blind, randomized, placebo – controlled trial. Br J Anaesth 110(5):788–799

    Article  Google Scholar 

  33. Donatsky AM, Bjerrum F, Gögenur I (2013) Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy: a systematic review. Surg Endosc 27:2283–2292

    Article  PubMed  Google Scholar 

  34. Kehlet H, Gray AW, Bonnet F et al (2005) A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy. Surg Endosc 19:1396–1415

    Article  CAS  PubMed  Google Scholar 

  35. Petersen PL, Stjernholm P, Kristiansen VB et al (2012) The beneficial effect of transversus abdominis plane block after laparoscopic cholecystectomy in day-case surgery: a randomized clinical trial. Anesth Analg 115:527–533

    CAS  PubMed  Google Scholar 

  36. Bisgaard T, Klarskov B, Rosenberg J et al (2001) Characteristics and prediction of early pain after uncomplicated laparoscopic cholecystectomy. Pain 90:261–269

    Article  CAS  PubMed  Google Scholar 

  37. Bisgaard T (2006) Analgesic treatment after laparoscopic cholecystectomy. A critical assessment of the evidence. Anesthesiology 104:835–846

    Article  PubMed  Google Scholar 

  38. Bisgaard T, Klarskov B, Kehlet H et al (2003) Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled trial. Ann Surg 238:651–660

    Article  PubMed Central  PubMed  Google Scholar 

  39. Murphy GS, Szokol JW, Greenberg SB et al (2011) Preoperative dexamethasone enhance quality of recovery after laparoscopic cholecystectomy. Anesthesiology 114:882–890

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  41. Macario A, Weinger M, Carney S et al (1999) Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 89:652–658

    CAS  PubMed  Google Scholar 

  42. Raeder JC, Mjaland O, Aasbo V et al (1998) Desflurane versus propofol maintenance for outpatient laparoscopic cholecystectomy. Acta Anaesthesiol Scand 42(1):106–110

    Article  CAS  PubMed  Google Scholar 

  43. Karanicolas PJ, Smith SE, Kanbur B et al (2008) The impact of prophylactic dexamethasone on nausea and vomiting after laparoscopic cholecystectomy. A systematic review and meta-analysis. Ann Surg 248:751–762

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. UOC Anestesia e Rianimazione ULSS 19 Adria (RO), Piazza degli Etruschi 9, Adria, 45011, Italy

    Gabriele Armellin

  2. Dipartimento Assistenziale Integrato Materno Infantile, AOU Careggi, Largo Brambilla 3, Firenze, 50134, Italy

    Massimo Micaglio

Authors
  1. Gabriele Armellin
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  2. Massimo Micaglio
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Correspondence to Gabriele Armellin .

Editor information

Editors and Affiliations

  1. Department of General Surgery, ULSS19 del Veneto, ADRIA, Rovigo, Italy

    Ferdinando Agresta

  2. Division of General Surgery, Hospital S.Giovanni Decollato Andosilla, Civita Castellana, Viterbo, Italy

    Fabio Cesare Campanile

  3. Unit of Laparoscopic Surgery, Hospital Mellino Mellini, Chiari, Brescia, Italy

    Nereo Vettoretto

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© 2014 Springer International Publishing Switzerland

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Armellin, G., Micaglio, M. (2014). Anesthetic Management for Laparoscopic Cholecystectomy. In: Agresta, F., Campanile, F., Vettoretto, N. (eds) Laparoscopic Cholecystectomy. Springer, Cham. https://doi.org/10.1007/978-3-319-05407-0_14

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  • DOI: https://doi.org/10.1007/978-3-319-05407-0_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-05406-3

  • Online ISBN: 978-3-319-05407-0

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