Anesthetic Management for Laparoscopic Cholecystectomy

  • Gabriele ArmellinEmail author
  • Massimo Micaglio


Pneumoperitoneum used for laparoscopic cholecystectomy (LC) causes important pathophysiologic alterations that every anesthetist must know. First of all cardiovascular changes are amplified when the patient assumes the reverse Trendelenburg position. In healthy patients these alterations are usually well tolerated. However, patients with cardiovascular disease or hypovolemia may be at increased risk. The increased intra-abdominal pressure also affects the respiratory system: thoraco-pulmonary compliance and functional residual capacity are reduced, while peak respiratory pressures are increased. These changes may lead to hypoxia. Mechanical ventilation with increased tidal volumes and the addition of positive end-expiratory pressure may counteract this problem. General anesthesia with tracheal intubation is the most commonly used, but in the last years supraglottic airway devices (SADs) have been investigated. The second-generation SADs improve pharyngeal seal and allow the passage of a gastric tube to deflate the stomach. SADs do not need neuromuscular blocking agents, but the use of these drugs for LC is still controversial. Spinal or epidural anesthesia may be safely used for LC. Recovery after this operation is usually rapid, and postoperative pain may be treated with the infiltration at all the trocar sites with local anesthetics, with the intraperitoneal nebulization of local anesthetics, and with a multimodal analgesia started before the induction of anesthesia. To prevent postoperative nausea and vomiting, prophylactic dexamethasone and droperidol or 5-HT3 antagonists may be used.


Laparoscopic Cholecystectomy Spinal Anesthesia Trocar Site Transversus Abdominis Plane Transversus Abdominis Plane Block 
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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.UOC Anestesia e Rianimazione ULSS 19 Adria (RO)AdriaItaly
  2. 2.Dipartimento Assistenziale Integrato Materno InfantileAOU CareggiFirenzeItaly

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