Arrhythmias during laparoscopy

[Use of Diprivan in laparoscopic surgery]

Anaesthesia is induced, as usual, after inhalation of oxygen at 100 vol p. 100, with propofol 2-2.5 mg.kg-1 associated with a muscle relaxant for tracheal intubation. The inhalation of oxygen is maintained as long as the spontaneous ventilation is persisting. The trachea is intubated following the occurrence of apnoea. Anaesthesia is maintained with a continuous infusion of propofol at a low rate of about 4-8 mg.kg-1.h-1. At this rate the arterial pressure remains very stable during the whole course of the procedure. The infusion rate depends also on the dose and the type of the associated analgesic agent. Analgesia can be obtained either with alfentanil 30 micrograms.kg-1.h-1 or with fentanyl 1.5 micrograms.kg-1, administered about every 30 min. Muscle relaxation should remain stable until the end of the main surgical period. Nitrous oxide does not seem to interfere with surgery. Its involvement in the occurrence of postoperative nausea and vomiting has not been proven. Atropine (0.02 mg.kg-1, possibly repeated) should be administered as soon as the heart rate decreases below 50 b.min-1. When a gradual postanaesthetic recovery is desirable, the infusion rate of propofol is progressively decreased (decrease of about 2 mg.kg-1.h-1 every 20-30 min, according to the FETCO2 and the temperature).