Abstract

Laparoscopic surgery is widely used for a range of elective and emergency procedures but presents significant challenges to the anaesthetist managing the airway. Compared to laparotomy, laparoscopic surgery reduces wound size, postoperative pain and ileus while improving postoperative respiratory function, allowing earlier mobilization and shorter hospital stays. However, the creation of a pneumoperitoneum has a number of disadvantageous effects on ventilation. Peritoneal insufflation increases airway pressures and ventilation/perfusion mismatch while reducing functional residual capacity and pulmonary compliance. The risk of regurgitation and gastric aspiration is also increased. These effects can be compounded by head-down patient positioning for lower abdominal procedures.

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