[Is the pneumoperitoneum minimally invasive during laparoscopic colonic surgery?]

The importance of laparoscopic colonic surgery has increased considerably in the past decade. However, a minimally invasive operation with induction of pneumoperitoneum does not imply a minimally invasive anaesthesia. The haemodynamic effects of intraperitoneal carbon dioxide insufflation depend an the extent of intraabdominal pressure elevation, severity of preexisting cardiopulmonary diseases, alterations of arterial PCO (2) and pH, volume state of the patient and co-medications. In addition, positioning of the patient for laparoscopic colonic surgery and endocrinological reactions during and after induction of pneumoperitoneum may significantly affect systemic and pulmonary haemodynamics. Intraabdominal operations may impair respiratory function independent from anaesthesia. Preoperative evaluation of the high risk patient is of utmost importance. Assessment of expiratory PCO (2), extended cardiopulmonary monitoring and maintenance of intraabdominal pressure in the range of 5 - 7 mmHg are recommended during laparoscopic colonic surgery.