Anaesthesia and minimally invasive surgery

Minimally invasive surgery is commonly performed because of various advantages such as reduced postoperative pain, faster recovery, and reduced postoperative pulmonary complications. However, anaesthesia for laparoscopy can be difficult and potentially hazardous in long, complex surgical procedures and in sick patients. Establishment of CO₂ pneumoperitoneum produces adverse pathophysiological changes due to increased intra-abdominal pressure and hypercapnia, and these are further altered by postural changes. Laparoscopy is also associated with potential complications such as extraperitoneal gas insufflation and pneumothorax. It is important for the anaesthetist to understand the advantages and potential risks. General anaesthesia with endotracheal intubation is the most common anaesthetic technique, but supraglottic airway devices can sometimes be used. Neuroaxial anaesthesia has been used in some laparoscopic procedures as the sole anaesthetic technique. This article will focus on the pathophysiological changes caused by CO₂ pneumoperitoneum, the anaesthetic management for patients undergoing laparoscopy, and potential complications.