The positioning of the patient for laparoscopic surgery, and the positions of the surgeon, assistants and scrub nurses differ in many ways from conventional operations. These differences must be taken into account when preparing the patient for anaesthesia, since they frequently interfere with routine management and impair the anaesthetist's access to the patient's head and extremities. A simple example in point is the positioning for a laparoscopic herniotomy. In the conventional procedure, the surgeon stands at the level of the groin, and the anaesthetist has unimpeded access to the arms and head. For the laparoscopic procedure, on the other hand, the surgeon stands at the patient's head in order to guide the instruments from above, into the hernial orifice. One or even both of the patient's arms are positioned at his side, his head is almost completely covered and the operating table is brought into a steep Trendelenburg position. The result of this is that the anaesthetist has difficulties in accessing the venous cannulae and the endotracheal tube, as well as monitoring the patient's skin colour and pupils. At the same time, there is a higher risk of endotracheal tube movement relative to the carina with endobronchial intubation, without the anaesthetist being unable to confirm or correct it (Figure 3.1).

Preparing the patient

Preparing the patient for anaesthesia – from selecting the venous cannulation site, to the choice of endotracheal tube and the monitoring modes – must take the above-mentioned set of problems and risks as well as the particular routine of the individual hospital into account.