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Der Anaesthesist

, Volume 58, Issue 5, pp 520–526 | Cite as

Pathophysiologie des Kapnoperitoneums

Implikationen für Beatmung und Hämodynamik
  • A. VogtEmail author
  • B. Eberle
Medizin aktuell

Zusammenfassung

Die laparoskopische Chirurgie wurde Anfang der 50er Jahre für gynäkologische Eingriffe eingeführt. Mit verbesserter Technik erweiterte sich das Spektrum in den letzten Jahrzehnten beträchtlich. Es wurden zunehmend komplexere und länger dauernde Operationen durchgeführt. Als Vorteile gegenüber offener Chirurgie wurden eine Reduktion der postoperativen Schmerzen, bessere kosmetische Ergebnisse, raschere Erholung und die Verkürzung der Krankenhausverweildauer angeführt. Infolgedessen wird die Laparoskopie mittlerweile auch bei immer älteren Patienten mit entsprechenden pulmonalen sowie kardiovaskulären Komorbiditäten und in der Chirurgie für adipöse Patienten eingesetzt. Eine sichere Anästhesieführung setzt detaillierte Kenntnisse der Pathophysiologie des Kapnoperitoneums voraus, insbesondere im Hinblick auf dessen respiratorische und hämodynamische Konsequenzen. Der Übersichtsartikel diskutiert die wichtigsten Effekte des Kapnoperitoneums und stellt aktuelle Forschungsergebnisse sowie deren Umsetzungsmöglichkeiten in der klinischen Praxis dar.

Schlüsselwörter

Kapnoperitoneum Pneumoperitoneum Laparoskopie Hämodynamik Mechanische Beatmung 

Pathophysiology of capnoperitoneum

Implications for ventilation and hemodynamics

Abstract

Laparoscopic surgery was introduced into clinical practice in the early 1950s by gynaecologists. Technical improvements allowed its use for more complex and longer lasting procedures. Reduction of postoperative pain, more favourable cosmetic results, quicker recovery and reduced length of hospital stay proved to be advantageous when compared to open surgery. As a result progressively older patients with corresponding pulmonary and cardiovascular comorbidities and morbidly obese patients are now undergoing advanced laparoscopic surgery. Detailed knowledge of the respiratory and hemodynamic pathophysiology induced by capnoperitoneum is necessary to administer safe anaesthesia to such patients. This review addresses the most important effects of capnoperitoneum and recent research as well as the possible implications for clinical practice.

Keywords

Capnoperitoneum Pneumoperitoneum Laparoscopic surgery Hemodynamics Mechanical ventilation 

Notes

Interessenskonflikt

Der Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Universitätsklinik für Anästhesiologie und SchmerztherapieInselspital, Universitätsspital und Universität BernBernSchweiz

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