Abstract
With a CO2 pneumoperitoneum (which is favored over N2O which supports combustion) virtually all patients exhibit a significant increase in arterial PaCO2 and develop hypercarbia during laparoscopy. The clinical effect of this is tachycardia hypertension and increased incidence of cardiac arrhythmias. The clinical problems can be minimized by controlled hyperventilation and muscle relaxants. Premedication should be narcotic to reduce anxiety and to avoid augmentation of sympathoadrenal response. Hypoxia can be avoided by intubation with controlled ventilation. The patient should be monitored for mill-wheel murmer to avoid CO2 embolus. Percussion of the stomach prior to pneumoperitoneum can avoid gastric perforation due to overdistension. Intubation can be voluntary in short procedures. N2O is the preferred inhalation anesthetic.
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