Shoulder pain results from peritoneal insufflation
especially when an exaggerated Trendelenburg position is used17.
We know that our patients generally are more inconvenienced by the referred shoulder pain created by the peritoneal insufflation
than by the pain secondary to each and single incisions.
This may be exacerbated by peritoneal insufflation of carbon dioxide, which shifts the mediastinal structures further cephalad.
The treatment involves interruption of peritoneal insufflation and reduction of intraabdominal pressure, administration of atropine and deepening of anaesthesia (36).
The treatment is to stop the peritoneal insufflation and to deflate the abdomen (42).
NEW YORK -- Warm and moist is a whole lot nicer than cold and dry when it comes to laparoscopic peritoneal insufflation
The procedure presents all the difficulties inherent in patients having prolonged surgery in the Trendelenburg position with lower limbs in lithotomy (Figure 5) and where peritoneal insufflation is an ongoing requirement for surgical visualization of the operative site (Table 3).
A further demonstrated side-effect of the prolonged peritoneal insufflation was a universally high fluid volume requirement.
The surgery was temporarily ceased, the operating table was restored from head-up tilt to the horizontal position and peritoneal insufflation of carbon dioxide was discontinued.
Peritoneal insufflation and surgery were commenced and noradrenaline was titrated to maintain the systolic blood pressure above 90 mmHg.