Specifičnosti anestezije za laparoskopske zahvate

master's thesis

• Title (english): Specificities of anesthesia for laparoscopic procedures
• Author: Mislav Pečnik
• Mentor: Daniela Bandić Pavlović (mentor)
• Committee member: Vilena Vrbanović Mijatović (predsjednik povjerenstva)
• Committee member: Dinko Tonković (član povjerenstva)
• Committee member: Daniela Bandić Pavlović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Laparoskopska kirurgija pruža brojne prednosti nad klasičnim, otvorenim pristupom, do te mjere da je danas postala zlatnim standardom za izvođenje mnogih kirurških postupaka, posebno u abdominalnoj kirurgiji. Glavne prednosti uključuju manje postoperativne boli, kraći boravak u bolnici, brži oporavak i bolje kozmetičke rezultate. Međutim, provođenje same tehnike nužno uključuje prilagodbu organizma brojnim nefiziološkim promjenama.
Najbitnija među tim promjenama je pneumoperitoneum, nastao insuflacijom abdomena ugljičnim dioksidom (CO2) kako bi se stvorio prostor za rad kirurga. Osim toga, pacijent često mora biti postavljen u položaje koji olakšavaju pristup operateru, što može utjecati na hemodinamičku stabilnost. Veće potrebe za ventilacijom također su karakteristične, prvenstveno zbog absorpcije CO2, a pneumoperitoneum povećava intraabdominalni tlak i može smanjiti funkcionalni rezidualni kapacitet pluća.
Sve ove promjene doprinose jedinstvenoj kliničkoj slici anesteziranog pacijenta na kojemu se provodi laparoskopski zahvat. Takve okolnosti nose veći rizik od razvoja kardijalnih i pulmonalnih komplikacija, te komplikacija vezanih uz insuflaciju CO2, kao što su hiperkapnija i acidoza. Također, može doći do poremećaja regionalne cirkulacije zbog povećanog intraabdominalnog tlaka.
Unatoč tome, imajući na umu sve patofiziološke utjecaje i moguće komplikacije, anestezija se u laparoskopiji ne razlikuje značajno u svojim osnovnim načelima od one kod otvorenog pristupa. Međutim, razlike ipak postoje. Zbog ovih razlika, vještina i iskustvo anesteziologa postaju nezamjenjivi alati koji omogućuju sigurno provođenje laparoskopskih zahvata. Anesteziolog mora biti sposoban brzo prepoznati i sanirati potencijalne komplikacije koje mogu zahtijevati prelazak na otvoreni zahvat. Njihova uloga je ključna za osiguravanje sigurnosti pacijenta tijekom cijelog postupka, od pripreme do postoperativnog oporavka.

Abstract (english)

Laparoscopic surgery offers numerous advantages over traditional open surgery to such an extent that it has become the gold standard for performing many surgical procedures, especially in abdominal surgery. The main benefits include less postoperative pain, shorter hospital stays, faster recovery, and better cosmetic results. However, performing the technique itself necessarily involves adapting the body to several non-physiological changes.
The most important of these changes is pneumoperitoneum, created by insufflating the abdomen with carbon dioxide (CO2) to create space for the surgeon to work. Additionally, the patient often needs to be positioned in ways that facilitate the surgeon's access, which can affect hemodynamic stability. There is also a greater need for ventilation, primarily due to the absorption of CO2, and pneumoperitoneum increases intra-abdominal pressure and can reduce the functional residual capacity of the lungs.
All these changes contribute to the unique clinical picture of an anesthetized patient undergoing a laparoscopic procedure. Such circumstances carry a higher risk of developing cardiac and pulmonary complications, as well as complications related to CO2 insufflation, such as hypercapnia and acidosis. Moreover, there can be disturbances in regional circulation due to increased intra-abdominal pressure.
Despite these issues, considering all the pathophysiological impacts and possible complications, anesthesia in laparoscopy does not significantly differ in its basic principles from that used in open surgery. However, there are differences. Due to these differences, the skill and experience of the anesthesiologist become indispensable tools for safely conducting laparoscopic procedures. The anesthesiologist must be able to quickly recognize and manage potential complications that may require conversion to open surgery. Their role is crucial in ensuring patient safety throughout the entire procedure, from preparation to postoperative recovery.

• Keywords: abdominalna kirurgija; anestezija; laparoskopska kirurgija
• Keywords (english): abdominal surgery; anesthesia; laparoscopic surgery
• Language: croatian
• URN:NBN: urn:nbn:hr:105:542315
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-07-02 12:36:15