Laparoscopia pélvica: considerações clínicas e anestésicas
Palavras-chave:
laparoscopia ginecologica, assistencia perioperatoria, morbidade perioperatoria, anestesiaResumo
As fronteiras da cirurgia laparoscópica estenderam-se de procedimentos ginecológicos para cirurgia geral. Apresenta como vantagens menores incisões, menos dor no pós-operatório, menor trauma cirúrgico, menos complicações pulmonares, recuperação mais rápida e menor tempo de permanência hospitalar. Tais vantagens são sempre enfatizadas e explicam o sucesso crescente da técnica. Devem os anestesiologistas estarem familiarizados com possíveis complicações associadas aos diversos procedimentos laparoscópicos. Portanto, além dos cuidados relacionados à técnica anestésica, o anestesiologista deve garantir que a pressão intra-abdominal mantenha-se abaixo de 1 SmmHg e que a intubação endobrônquica inadvertida, pneumotórax e embolia gasosa não ocorram. Nos casos em que as alterações de sinais vitais não respondam às manobras de uso rotineiro, é imperativo desfazer o pneumoperitônio e colocar o paciente em posição supina. A anestesia geral com intubação traqueal e ventilação controlada é comumente usada, o que resulta em menor desconforto para o paciente e melhor controle da ventilação. Em se tratando, na maioria das vezes, de procedimento ambulatorial, é importante o uso de drogas anestésicas de rápida eliminação, evitar náuseas, vômitos e dor com o uso profilático de antiéméticos e analgésicos.
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