PROLONGED LAPAROSCOPIES - THE ANESTHETISTS POINT-OF-VIEW

The development of laparoscopic gynaecological surgery has led to a prolonged duration of laparoscopy. On the basis of pathophysiological considerations and the clinical experience acquired, the authors try to define the optimal conditions to ensure patient safety. The essential condition is respect of the limits of intra-abdominal pressure (< 10 mm Hg), which is the only measure capable of preventing complications. The Trendelenburg position only very partially corrects the haemodynamic modifications related to insufflation. The anaesthetist must also possess the necessary monitoring equipment, including capnograph and pulse oxymeter, allowing adaptation to physiological changes related to the surgical procedure and to detect but not prevent any complications.