Laparoscopic cholecystectomy is the standard surgical treatment for gallbladder disease, including symptomatic cholelithiasis, acute or chronic cholecystitis, biliary dyskinesia, and gallstone-related complications such as pancreatitis. The procedure involves removal of the gallbladder using small abdominal incisions through which a camera and specialized instruments are introduced. Compared with open surgery, the laparoscopic approach offers reduced postoperative pain, shorter hospital stay, faster recovery, and lower overall morbidity, making it the preferred technique in most patients. Anesthesia management of laparoscopic cholecystectomy requires a clear understanding of both the surgical procedure and the physiological changes associated with minimally invasive abdominal surgery.
The preoperative anesthetic assessment is essential to identify patient-specific risks and optimize perioperative care. Many patients undergoing laparoscopic cholecystectomy have comorbidities such as obesity, hypertension, diabetes mellitus, or obstructive sleep apnea, all of which may influence anesthetic planning. A focused evaluation of cardiovascular and pulmonary function is important, as the physiological effects of pneumoperitoneum (introducing gas into the abdominal space to assist with visualization and access during the surgery) may exacerbate underlying disease. Airway assessment deserves particular attention because obesity and gastroesophageal reflux disease are common and increase the risk of difficult airway management and aspiration. Appropriate fasting, aspiration prophylaxis in selected patients, and optimization of comorbid conditions help reduce perioperative complications.
General anesthesia with endotracheal intubation is the preferred anesthetic technique for laparoscopic cholecystectomy. Secure airway control and controlled ventilation are required to manage the respiratory effects of carbon dioxide insufflation. Induction agents are selected to provide rapid onset and hemodynamic stability, while neuromuscular blocking agents facilitate tracheal intubation and provide optimal surgical conditions. Maintenance of anesthesia may be achieved with volatile anesthetics or total intravenous anesthesia, with adequate depth necessary to suppress sympathetic responses to pneumoperitoneum and surgical stimulation.
The establishment of pneumoperitoneum and patient positioning, typically reverse Trendelenburg with left tilt, produce predictable cardiovascular and respiratory changes. Increased intra-abdominal pressure can reduce venous return, increase systemic vascular resistance, and elevate arterial blood pressure, while lung compliance and functional residual capacity are decreased. Carbon dioxide absorption may lead to hypercapnia, necessitating adjustments in minute ventilation. Ventilatory strategies should focus on maintaining normocapnia and adequate oxygenation. The use of positive end-expiratory pressure can improve oxygenation but must be balanced against potential hemodynamic effects.
Standard intraoperative monitoring is usually sufficient for healthy patients, while invasive monitoring may be indicated in those with significant cardiovascular disease. Hemodynamic changes during insufflation and desufflation should be anticipated and managed with anesthetic depth adjustment, fluid therapy, or vasoactive medications as needed. Analgesia is best provided using a multimodal approach to minimize opioid-related adverse effects. Nonopioid analgesics and local anesthetic infiltration at trocar sites contribute to effective pain control and support early recovery.
Emergence from anesthesia should ensure a full reversal of neuromuscular blockade and a return to adequate spontaneous ventilation, as residual respiratory compromise can be poorly tolerated after pneumoperitoneum. With appropriate anesthetic management, patients typically experience rapid recovery, early ambulation, and timely discharge.
Anesthesia management of laparoscopic cholecystectomy requires knowledge of gallbladder pathology, minimally invasive surgical techniques, and the physiological effects of pneumoperitoneum. Careful assessment, vigilant monitoring, and a tailored anesthetic strategy are key to ensuring patient safety and optimal outcomes in this procedure.