Summary

■ The primary determinants of the physiologic effects of laparoscopy are the intra-abdominal pressure, the type of gas insufflated, and the position of the patient.

■ Table 3 lists physiologic recommendations grounded in scientific evidence and good practice, which should be considered by every surgeon performing laparoscopy.

■ Important physiologic issues for the surgeon are the cardiopulmonary health of the patient, preoperative volume status, and careful intraoperative monitoring.

■ Surgeons need to be aware of the prevention, recognition, and treatment of physiologic complications during laparoscopy (Table 4). Intraoperative cardiovascular collapse can occur from the physiologic complications of tension pneumoperitoneum, venous gas embolism, hypercapnia, cardiac dysrhythmias, extraperitoneal gas collections, and intra-abdominal explosion.

■ Other physiologic complications include venous thrombosis, elevated intracranial pressure/cerebral ischemia, fluid overload, acute renal failure, hypertension, hypoxemia, and hypothermia.

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