Anesthesia and management of anesthetic complications of laparoscopic urological surgery

Patients undergoing laparoscopic urological surgery are subjected by definition to non-physiological trespass that threatens to destabilize their homeostasis. Consequently, the anesthesiologist needs to take an active role in the process from the outset and must work closely with the surgical team in order to bring the patient through the operation without adverse outcome. This coordinated effort involves preoperative patient evaluation, optimization of the patient's composite organ function or dysfunction, provision of an appropriate anesthetic with appropriate physiological monitoring, careful patient positioning, preservation of cardiovascular stability, maintenance of oxygenation and ventilation, protection of renal function, and smooth emergence from the anesthetized state to the recovering state. This chapter will consider this process in three parts: preoperative evaluation and preparation; maintenance of cardiovascular, including renal, function during the procedure; and management of oxygenation and ventilation in the context of laparoscopy and non-supine positioning.