Читать книгу Small Animal Laparoscopy and Thoracoscopy - Группа авторов - Страница 157

Laparoscopic interventions are well established in veterinary medicine and offer several benefits when compared to standard laparotomy [1–6]. Reduced tissue trauma, with minimized incision size, and decreased manipulation of the gastro‐intestinal tract leading to improved comfort and faster recovery times are some of its major advantages [3, 5,7–12]. A decrease in inflammatory mediators (e.g., C‐reactive protein, interleukin‐6) and cells (e.g., WBC's) and a decrease in metabolic responses suggestive of stress (e.g., hyperglycemia) in patients undergoing laparoscopic versus open surgical intervention are taken as support of this [9,13–15]. In addition, direct and indirect evidence from animal studies [3, 13, 16] supports that as for human patients there is less pain associated with a laparoscopic versus traditional surgical approaches for the same procedure. The consequent reduced need for analgesic drugs and shortened hospital stays are well established in human patients and seem to be also true in animals [12]. Additional advantages include reduced adhesion formation [17], lower infection rates [5, 18, 19], a shorter healing time, improved cosmetic results, and quicker return to function [3,20–22]. Because of these benefits, laparoscopy is being used both as a diagnostic [23, 24] and surgical tool [25–27] with increasing frequency, as well as complexity, in veterinary medicine.

Despite the many advantages associated with laparoscopic versus traditional approaches, laparoscopic procedures have their own specific risks and potential complications. In additions to effects related to the disease state of the animal, the positioning for surgery, and the surgical procedure itself, the anesthetist must consider the physiological changes associated with insufflating gas into the abdomen and the consequences to various organ systems, specially the cardiovascular and respiratory systems. These considerations will be the focus of this chapter and are discussed in more detail in the subsequent text.