**5. Anesthesia for urological laparoscopic surgery**

Laparoscopic procedures in urology cover both oncological surgery like nephrectomy, prostatectomy, cystectomy and nononcological surgery like pyeloplasty. Laparoscopic surgery has found wide applications in urological surgery with the developing technol‐ ogy. After laparoscopic surgery, some complications due to pneumoperitoneum began to occur more frequent.

#### **5.1. Preoperative considerations**

An anesthetic plan is developed based not only on the patient's physical status determined by the assessment but on how the patient will tolerate pneumoperitoneum and body posi‐ tion during the surgery. Some factors like obesity and Trendelenburg level may increase the intraabdominal pressure during the laparoscopic operations. These factors should be con‐ sidered, when anesthetic management is planned. Difficult airway, cardiopulmonary status, allergies, medications and comorbid conditions are important issues for patients undergoing laparoscopic surgery. Especially, decision of laparoscopic surgery should be considered care‐ fully in patients with advanced respiratory disorder because of the high risk of anesthesia.

#### **5.2. Intraoperative considerations**

*4.2.1. Preoperative consideration*

62 Current Topics in Anesthesiology

*4.2.2. Intraoperative consideration*

stretch of the spermatic cord.

*4.2.3. Choice of anesthesia*

*4.2.4. Complications*

occur more frequent.

**5.1. Preoperative considerations**

erence, one technique may be more appropriate.

urological procedures. The sensorial block level must be Th10.

**5. Anesthesia for urological laparoscopic surgery**

These procedures generally do not require any particular anesthetic technique, depending upon the procedure, the medical condition of the patient and patient's and/or surgeon's pref‐

Routine monitorization is advised. During the varicocelectomy, bradycardia can occur due to

Many of these procedures are ambulatory, performed in cystoscopy suites with a rapid turn‐ over of patients and the anesthetic choice must also consider these concerns. Evaluation of the lower urinary system tract is often performed by the urologist with a flexible cystoscope. This procedure generally performed by the urologist with local topical anesthesia applied to the inside of the urethra as it does not require full bladder distention. If patient could not tolerate pain, the procedure must be performed under monitored anesthesia care with sedation [53]. Neuraxial anesthesia has been long considered the anesthetic technique of choice for these

During the varicocelectomy, bradycardia can occur due to stretch of the spermatic cord.

Laparoscopic procedures in urology cover both oncological surgery like nephrectomy, prostatectomy, cystectomy and nononcological surgery like pyeloplasty. Laparoscopic surgery has found wide applications in urological surgery with the developing technol‐ ogy. After laparoscopic surgery, some complications due to pneumoperitoneum began to

An anesthetic plan is developed based not only on the patient's physical status determined by the assessment but on how the patient will tolerate pneumoperitoneum and body posi‐ tion during the surgery. Some factors like obesity and Trendelenburg level may increase the intraabdominal pressure during the laparoscopic operations. These factors should be con‐ sidered, when anesthetic management is planned. Difficult airway, cardiopulmonary status, allergies, medications and comorbid conditions are important issues for patients undergoing laparoscopic surgery. Especially, decision of laparoscopic surgery should be considered care‐ fully in patients with advanced respiratory disorder because of the high risk of anesthesia.

Pneumoperitoneum and patient positioning impede normal respiratory mechanics. Placement of an endotracheal tube allows the ventilator to supply the work necessary to breathe. Gastric secretions are commonly seen in the oropharynx or on the face of patients at the end of sur‐ gery. The placement of an arterial line may be indicated if the patient's medical condition war‐ rants closer blood pressure monitoring nasogastric tube decompression of the stomach and Foley catheter drainage of the bladder is the basic procedure for most urologic laparoscopic surgeries. Hypothermia is common beginning with the disruption of thermal regulation due to anesthesia.

#### **5.3. Choice of anesthesia**

Most common anesthetic plan is general anesthesia. General endotracheal anesthesia is cho‐ sen to counter the adverse conditions created by the pneumoperitoneum, patient positioning and surgical time. If general anesthesia is contraindicated, high level sensorial block (Th4) can be performed.

#### **5.4. Complications**

Anesthetic complications are addressed through that prism: anesthetic strategies to mini‐ mize hemodynamic changes due to pneumoperitoneum and patient position. Increasing the intrathoracic blood volume improved hemodynamic function in all body positions with pneumoperitoneum. Fluid management is the most important element for minimizing pneu‐ moperitoneum side effects [54].

Most common observed complications of laparoscopic surgeries are swelling of the face, eye‐ lids, conjunctivae and tongue along with a plethoric color of venous stasis in the head and neck. Although facial edema is common, but laryngeal edema may prevent the extubation of patient and can cause delay extubation in 5% of patients [55, 56].
