Laparoscopic Cholecystectomy

Anesthesia Implications

Position: Supine, Reverse Trendelenburg, airplaned left, one arm extended, one arm tucked
Time: 1-2 hours (average)
Blood Loss: Low (10-50 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Yes

OG tube – Insert OG tube shortly after induction to clear stomach contents prior to the procedure.

PONV – Consider giving a full range of antiemetics for PONV prophylaxis.

Quick wakeup – At the end of the case, The physician will close the entry points in the skin, which is completed quickly. Make sure to have your wakeup plan ready.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

Laparoscopic cases (general considerations): The patient’s peritoneum is insufflated (which is called a pneumoperitoneum), and instrumentation will be inserted into the abdomen. General anesthesia, ETT tube, and paralytics are necessary. Some of the procedures are rather short, so make sure the timing is right to reverse the paralytic. The pressure in peritoneum affects the organs of that space. Anything more than 10 mmHg will begin to alter hemodynamics. Cardiac output is decreased and SVR is increased. Peak inspiratory pressures rise. Renal vessels will be compressed, which reduces flow to the kidneys, and activates the renin angiotensin aldosterone system (RAAS). Reduced blood to the kidney means reduced urine output. Peak inspiratory and plateau pressures will also increase. The gas used to insufflate the peritoneum is CO2 – so, as you might guess, hypercarbia can develop – and with it, acidosis. You’ll see this sometimes reflected in the end-tidal CO2. This is all adding to the stress response we try to avoid in anesthesia.

The Gallbladders connection with the liver is clipped and the gallbladder itself is cut away from the liver.  The gallbladder is then removed – generally from one of the laparoscopic entry points.