Anaesthesia and emergency laparoscopy

This book provides up-to-date evidence on laparoscopic emergency surgery and supplies concrete advice on when and how to approach patients laparoscopically in an emergency setting. All the diseases elegible for emergency laparoscopy are addressed, and for each disease recommendations, levels of evidence, and technical key points are discussed and analyzed. Diagnostic flow charts are included for cases in which laparoscopy turns out to be the final diagnostic step and the first therapeutic one. Furthermore, problematic and positive aspects of the laparoscopic approach from the anesthesiologic point of view are fully explored. Finally, a useful overview of current practice in hospitals across the world is provided, highlighting the varying applications in relation to different medical “cultures”, skills, resources, and healthcare systems.

It is already recognised that laparoscopic surgery produces less postoperative inflammation than open surgery, reducing surgical stress. There is less postoperative pain and respiratory compromise. Anaesthetists and surgeons are treating patients who are increasingly elderly, with complex surgical histories, multiple comorbidities, undergoing combination therapy, or at a ‘high risk’ in emergency situations. These patients, above all, would benefit from a less invasive technique that involves fewer complications and shorter recovery times. It is also clear that as a result of surgical techniques adopted and monitoring systems available, the real contraindications of laparoscopic surgery are increasingly less stringent and absolute. Given the advantages that this type of surgery offers in terms of patient benefits, managing to offer it for urgent and emergency operations, in ‘high-risk’ patients or critical patients, is a challenge that must be faced. This requires a process of learning, training, and shared experience that must involve the anaesthetist as much as the surgeon. This is the only way to safely offer the advantages of laparoscopic procedures to complex patients too.