SPECIFIČNOSTI ANESTEZIJE U LAPAROSKOPSKOJ KIRURGIJI

VIŠNJA NESEK-ADAM, VIVIANA MRŠIĆ, ALEKSANDRA SMILJANIĆ

Laparoskopska kirurgija je kirurška tehnika kojom se abdominalni zahvati izvode na minimalno invazivan način. Mnoge operacije koje su nekada zahtijevale dugotrajni ostanak u bolnici danas se izvode laparoskopskom tehnikom. Manja poslijeoperacijska bol, manji broj komplikacija, kraći boravak u bolnici, brži oporavak i povratak svakodnevnim aktivnostima samo su neke od prednosti laparoskopske kirurgije. Prva laparoskopska kolecistektomija u Hrvatskoj učinjena je 14. svibnja 1992. godine u Klinici za kirurgiju Opće bolnice »Sveti Duh« u Zagrebu. Uvođenjem te metode kao »zlatnog standarda« u liječenje kolelitijaze započinje širenje laparoskopske kirurgije, koja je danas, deset godina kasnije, postala priznatom rutinskom kirurškom metodom. Zbog specifičnosti izvođenja laparoskopija zahtijeva i određene anesteziološke prilagodbe. Operacije se izvode obično u općoj endotrahealnoj anesteziji, iako se mogu izvesti i u regionalnoj ili lokalnoj anesteziji. Izbor anesteziološke tehnike i anestetika ovisi o poslijeoperacijskom statusu bolesnika, vrsti kirurškog zahvata, procjeni anesteziologa te o dogovoru i suradnji bolesnika, anesteziologa i kirurga. Osnovni cilj anestezije je respiracijska i hemodinamska stabilnost bolesnika, a izbor anesteziološke tehnike i anestezije treba omogućiti dobru analgeziju, amneziju, mišićnu relaksaciju te brzi oporavak bolesnika i kraći boravak u bolnici.

Summary. Laparoscopic surgery is a technique by which abdominal surgical treatments are performed in minimally invasive way. Many operations that once required long hospitalization are now being performed with laparoscopic technique. It has significantly reduced postoperative pain and the number of complications, shorter hospital stay, with faster recovery, and more rapid return to normal activities. These are only some of the advantages of laparoscopic surgery. The first laparoscopic chole- cystectomy in Croatia was performed on May 14, 1992, at the University Department of Surgery of »Sveti Duh« General Hospital in Zagreb. By the introduction of this method as the »gold standard« in the treatment of cholelithiasis, laparoscopic surgery has been widely accepted, and today, ten years later, has become a recognized and routine surgical method. Because of its particular performance, laparoscopic surgery requires some specific anesthesiologic adjustments. Surgical treatments are usually performed in general endotracheal anesthesia, although regional or local one could be applied too. The choice of anestesiologic technique and anesthetics depends upon preoperative patient’s condition, the kind of surgical treatment, anesthe- siologist’s evaluation, and at last upon the cooperation among patients, anesthesiologist and surgeon. The basic aim of anesthe- sia is respiratory and hemodynamic patient’s stability, and the choice of anesthesiologic technique and anesthesia should enable satisfactory analgesia, amnesia, muscular relaxation, faster recovery and shorter hospital stay.