ANESTHETIC MANAGEMENT IN LAPAROSCOPIC ABDOMINAL SURGERY: HEMODYNAMIC REPERCUSSIONS OF INDUCED PNEUMOPERITONEUM

Abstract

Introduction: Laparoscopic abdominal surgery has become the standard approach for many procedures due to its minimally invasive nature, yet the pneumoperitoneum required for visualization introduces significant hemodynamic changes. These alterations, including increased intra-abdominal pressure and CO₂ insufflation effects, can challenge anesthetic management in vulnerable patients. Objective: The primary objective of this systematic review was to evaluate the hemodynamic repercussions of induced pneumoperitoneum in patients undergoing laparoscopic abdominal surgery. Secondary objectives included assessing anesthetic strategies to mitigate these effects, exploring differences across patient populations, and identifying gaps in the current evidence. Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Eligible studies published in the last 5 years were included, with an extension up to 10 years if fewer than 10 studies were available. Human studies were prioritized, with animal or in vitro evidence analyzed separately. Risk of bias was assessed using RoB 2, ROBINS-I, or QUADAS-2, and certainty of evidence was graded using GRADE methodology. Results and Discussion: Out of 742 records screened, 18 studies met the inclusion criteria. Most studies confirmed that pneumoperitoneum induces increases in systemic vascular resistance and decreases in venous return, often leading to reduced cardiac output. Evidence suggested that individualized ventilation strategies, intra-abdominal pressure optimization, and the choice of anesthetic agents significantly influence hemodynamic stability. However, study heterogeneity limited pooled analyses. Conclusion: Hemodynamic changes during laparoscopic abdominal surgery are clinically significant and demand tailored anesthetic approaches. Evidence supports the importance of optimizing intra-abdominal pressure, close cardiovascular monitoring, and patient-specific anesthetic strategies. Further randomized controlled trials with standardized outcomes are needed to strengthen evidence-based guidelines. Descriptors: Laparoscopy, Pneumoperitoneum, Hemodynamics, Anesthesia