ABSTRACT
Anesthetic Management Hemodynamic and/or humoral changes are not observed in association with laparoscopic
surgery provided that normovolemia, and adequate depth of general anesthesia are continu ously maintained together with high plasma level opiate administration.8 With this anesthetic regime, only if LAP exceeds 12 mm Hg are hemodynamic changes observed.9’10
In patients with IAH, LAP is per definition higher than 12 mm Hg, comorbidity exists and altered pharmacokinetics make a straightforward anesthetic regime unlikely. Perioperative myocardial ischemia has to be prevented and O 2 consumption of the heart should be low. This means that the heart rate should be kept below 80 beats/min'1, coronary perfusion pressure above 50 mm Hg, Hb above 6 mmol/L'1 and normocarbia should be maintained. Sympathetic stimulation has to be minimal (good sedation and analgesia, and p-blockade if needed). Hypo thermia or hypovolemia, and all medication which induces tachycardia should be avoided. If vasopressors are needed, restoring fluid volume should be considered first.
