Because cold CO2 is cycled through the pneumoperitoneum, heat may be absorbed from the patient, resulting in hypothermia (180,181). Studies have shown that heating

TABLE3 ■ Physiologic Recommendations for Laparoscopy

TABLE4 ■ Physiologic Complications of Laparoscopy

Cardiovascular collapse

Tension pneumoperitoneum Venous gas embolism Hypercapnia Cardiac dysrhythmias Extraperitoneal gas collections Intra-abdominal explosion Others

Venous thrombosis

Elevated intracranial pressure and cerebral ischemia

Fluid overload

Acute renal failure




Cardiac and pulmonary status should be assessed preoperatively Adequate circulating blood volume should be attained preoperatively, but once this is achieved,mainten-ance level of fluids should be administered intraoperatively Verify insufflator settings before and during initiation of pneumoperitoneum Intraoperative monitoring must include end-tidal carbon dioxide Use the lowest intra-abdominal pressure that will allow adequate exposure of the field Low-pressure pneumoperitoneum, abdominal wall-lifting devices, or helium for insufflation may be beneficial in some very high-risk patients Apply sequential compression devices for venous thrombosis prophylaxis and humidifying the insufflant prevents a decrease in core temperature (182,183), while others have found that there is no effect from this intervention (184-186). With the use of other modalities such as simple heating blankets, core temperatures may actually increase rather than decrease during laparoscopy, even without heating the insufflant (186,187).

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