title: Laparoscopic surgery: pitfalls due to anesthesia, positioning, and pneumoperitoneum.
abstract: BACKGROUND
  Laparoscopic procedures are increasing in number and extensiveness. Many patients undergoing laparoscopic surgery have coexisting disease. Especially in patients with cardiopulmonary comorbidity, pneumoperitoneum and positioning can be deleterious. This article reviews possible pitfalls related to the combination of anesthesia, positioning of the patient, and the influence of pneumoperitoneum in the course of laparoscopic interventions.
  
  
  METHODS
  A literature search using Medline's MESH terms was used to identify recent key articles. Cross-references from these articles were used as well.
  
  
  RESULTS
  Patient positioning and pneumoperitoneum can induce hemodynamic, pulmonary, renal, splanchnic, and endocrine pathophysiological changes, which will affect the entire perioperative period of patients undergoing laparoscopic procedures.
  
  
  CONCLUSIONS
  Perioperative management for the estimation and reduction of risk of morbidity and mortality due to surgery and anesthesia in laparoscopic procedures must be based on knowledge of the pathophysiological disturbances induced by the combination of general anesthesia, pneumoperitoneum, and positioning of the patient.
authors.affiliation: Department of Anaesthesiology, room H1-228, Academic Medical Centre/University of Amsterdam, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands. C.P.Henny@amc.uva.nl
authors.forename: C P
authors.initials: CP
authors.lastname: Henny
authors.forename: J
authors.initials: J
authors.lastname: Hofland
mesh_terms: D000758:Anesthesia; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D011028:Pneumoperitoneum, Artificial; D011187:Posture