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Abstract
The development of minimally invasive surgery has revolutionized surgical procedures and in the process has influenced the practice of anesthesiology. The advantages of laparoscopic surgery include reduced overall adverse events, shorter hospital stay, and rapid return to normal activities. (1)
Despite the potential advantages, laparoscopic procedures are associated with physiological changes, which present the anesthesia practitioner with many challenges. (2) Thus, there is a need to modify the anesthetic technique to allow these novel surgical procedures to be performed safely. The increased intra-abdominal pressure (IAP) from pneumoperitoneum displaces the diaphragm upward and decreases functional residual capacity and total lung compliance, resulting in basal atelectasis and increased airway pressures. (2) The increase in minute ventilation required to maintain normocarbia further increases peak airway pressures. These pulmonary changes are compounded with those caused by changes in position. Furthermore, these changes may be exaggerated in obese patients and in those with respiratory dysfunction. (1) In addition, these procedures are associated with potential life-threatening complications that are usually not encountered with the traditional open procedure. (3)
The initial access into the peritoneal cavity can be achieved using the Veress needle that is placed through a subumbilical incision. Because the Veress needle is placed blindly, there is a potential for its misplacement in the subcutaneous space, vascular space, viscus, omentum, mesentery, or retro