title: Cardiovascular and Ventilatory Consequences of Laparoscopic Surgery.
abstract: Although laparoscopic surgery accounts for >2 million surgical procedures every year, the current preoperative risk scores and guidelines do not adequately assess the risks of laparoscopy. In general, laparoscopic procedures have a lower risk of morbidity and mortality compared with operations requiring a midline laparotomy. During laparoscopic surgery, carbon dioxide insufflation may produce significant hemodynamic and ventilatory consequences such as increased intraabdominal pressure and hypercarbia. Hemodynamic insults secondary to increased intraabdominal pressure include increased afterload and preload and decreased cardiac output, whereas ventilatory consequences include increased airway pressures, hypercarbia, and decreased pulmonary compliance. Hemodynamic effects are accentuated in patients with cardiovascular disease such as congestive heart failure, ischemic heart disease, valvular heart disease, pulmonary hypertension, and congenital heart disease. Prevention of cardiovascular complications may be accomplished through a sound understanding of the hemodynamic and physiological consequences of laparoscopic surgery as well as a defined operative plan generated by a multidisciplinary team involving the preoperative consultant, anesthesiologist, and surgeon.
authors.affiliation: From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.).
authors.forename: Tamara M
authors.initials: TM
authors.lastname: Atkinson
authors.affiliation: From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.).
authors.forename: George D
authors.initials: GD
authors.lastname: Giraud
authors.affiliation: From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.).
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Togioka
authors.affiliation: From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.).
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
authors.affiliation: From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.). Cigarroa@ohsu.edu.
authors.forename: Joaquin E
authors.initials: JE
authors.lastname: Cigarroa
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D023421:Models, Animal
keywords: cardiovascular complications; surgery