Management of mechanical ventilation during laparoscopic surgery.
Laparoscopy is widely used in the surgical treatment of a number of diseases. Its advantages are generally believed to lie on its minimal invasiveness, better cosmetic outcome and shorter length of hospital stay based on surgical expertise and state-of-the-art equipment. Thousands of laparoscopic surgical procedures performed safely prove that mechanical ventilation during anaesthesia for laparoscopy is well tolerated by a vast majority of patients. However, the effects of pneumoperitoneum are particularly relevant to patients with underlying lung disease as well as to the increasing number of patients with higher-than-normal body mass index. Moreover, many surgical procedures are significantly longer in duration when performed with laparoscopic techniques. Taken together, these factors impose special care for the management of mechanical ventilation during laparoscopic surgery. The purpose of the review is to summarise the consequences of pneumoperitoneum on the standard monitoring of mechanical ventilation during anaesthesia and to discuss the rationale of using a protective ventilation strategy during laparoscopic surgery. The consequences of chest wall derangement occurring during pneumoperitoneum on airway pressure and central venous pressure, together with the role of end-tidal-CO2 monitoring are emphasised. Ventilatory and non-ventilatory strategies to protect the lung are discussed.
Valenza
Franco
F
Università degli Studi di Milano, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Via Festa del Perdono n.7, Milano, Italy. franco.valenza@unimi.it
Chevallard
Giorgio
G
Fossali
Tommaso
T
Salice
Valentina
V
Pizzocri
Marta
M
Gattinoni
Luciano
L
D000758:Anesthesia / Q000379:methods*; D015992:Body Mass Index; D002245:Carbon Dioxide / Q000378:metabolism; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D016343:Monitoring, Intraoperative / Q000379:methods; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods*; D015656:Respiratory Mechanics; D013997:Time Factors
D002245:Carbon Dioxide