Management of mechanical ventilation during laparoscopic surgery

Franco Valenza, Giorgio Chevallard, Tommaso Fossali, Valentina Salice, Marta Pizzocri, Luciano Gattinoni

Research output: Contribution to journalArticlepeer-review

Abstract

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-CO 2 monitoring are emphasised. Ventilatory and non-ventilatory strategies to protect the lung are discussed.

Original languageEnglish
Pages (from-to)227-241
Number of pages15
JournalBest Practice and Research: Clinical Anaesthesiology
Volume24
Issue number2
DOIs
Publication statusPublished - Jun 2010

Keywords

  • abdominal hypertension
  • anaesthesia
  • laparoscopy
  • mechanical ventilation
  • monitoring
  • pneumoperitoneum
  • respiratory mechanics
  • ventilator-induced lung injury

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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