Laparoscopic Cholecystectomy
Updated On: July 23, 2026
Anesthetic Approaches
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. 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.
Reverse Trendelenburg Position (general considerations): Improves access to the organs of the upper abdomen. To avoid patient slipping, use a foot board if an extreme angle is used. This position results in blood pooling in the abdomen and lower extremities. Reductions will be seen in stroke volume, cardiac filling, and cardiac output. The greater the angle, the greater these affects. Increases will be seen in FRC and compliance, which will be especially the case with obese patients. Ulnar nerve injuries can result if pressure is placed on the ulnar groove at the elbow. Any bump, rise, or IV pole along on the arm board between the elbow and the shoulder can result in radial nerve injury. Pad all pressure points (emphasis on head, sacrum, elbows, and heels) and ensure any straps used to secure limbs are loose enough to allow normal blood flow. Ensure the patient is not lying on IV tubing, monitor lines, or knots.
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.