[Pathophysiologic effects of CO2-pneumoperitoneum in laparoscopic surgery].

Today, laparoscopic surgery is one of the most important diagnostic and therapeutic tools in general surgery. This minimally invasive procedure requires pneumoperitoneum for adequate visualization and operative manipulation. Carbon dioxide is the most commonly used gas for creating pneumoperitoneum, because of its high diffusibility and rapid rate of absorption and excretion. Certain specific operations that in the past required long hospitalization and were associated with severe postoperative pain and frequent complications are today performed laparoscopically. This minimally invasive technique potentially offers reduced operative time and morbidity, decreased hospital stay and earlier return to normal activities, less pain and less postoperative ileus compared with the traditional open surgical procedures. Because the postoperative benefits are superior to open surgical procedures, laparoscopy is today also used in many high risk patients in advanced age and pre-existent cardiopulmonary and respiratory diseases. However, insufflations of carbon dioxide into the peritoneum may lead to alteration in the acid-base balance, cardiovascular and pulmonary physiology. Although these changes may be well tolerated in healthy patients, in high risk patients they may increase the rate of perioperative complications. Therefore, it is very important that the anesthesiologist thoroughly understands the pathophysiology of carbon dioxide-pneumoperitoneum and treatment of potential complications. In this article, the acid-base balance, cardiovascular and pulmonary changes associated with laparoscopic surgery, and their potential complications and management are discussed based on our experience and literature data.