[Anesthesia in urologic laparoscopic surgery]

Although minimally invasive, urological laparoscopic surgery is still a major surgery and has special characteristics which should not be ignored. Our protocol includes: premedication with diazepam and atropine, preinduction with fentanyl, induction with propofol, followed by atracurium or succinylcholine for tracheal intubation. Anesthesia is sustained with continuous pump infusion of propofol at gradually lower doses and is discontinued on removing the abdominal trocars. Muscle relaxation throughout the operation is maintained with atracurium in continuous infusion and is discontinued at the same time as propofol. Intraoperative analgesia is achieved with bolus administration of fentanyl. We routinely use vesical and nasogastric catheters; the latter is removed at the end of the operation. Similarly, compressive bandaging is done for the lower limbs in all patients. Intraoperative monitoring includes ECG, heart rate, arterial blood pressure (noninvasive method), end expiratory CO2, O2 saturation, minute/volume, tidal volume and respiratory rate, airway pressures, temperature and diuresis. Pulmonary ventilation is by IPPV with a mixture of oxygen and air, maintaining FiO2 at 0.4. Nitrous oxide is not utilized, therefore the airways were only used for lung ventilation and not for the administration of inhalatory anesthetic agents. The higher increments of end expiratory CO2 of up to 48 mm Hg were observed at the end of the procedure following peritoneal desufflation. In summary, the technique of choice is total i.v. anesthesia with propofol and monitoring as complete as possible (noninvasive). Furthermore, capnographic and capnometric control of end expiratory CO2 is warranted.