The Bair Hugger has been very effective in restoring normothermia. Choice of agents to treat postoperative pain and nausea should be made with outpatient discharge in mind. Anesthetic techniques which minimize opiate consumption may reduce these symptoms. Transdermal scopolamine reduces nausea and vomiting after outpatient laparoscopy, but recently has been unavailable. Headache, sore throat and shoulder pain are self limiting.
Several mechanisms can result in the movement of gas from the pneumoperitoneum.
Pneumothorax may result from pleural tears at the level of the gastroesophageal junction during fundoplication for hiatal hernia. Defects in the diaphragm or weak points in the esophageal or aortic hiatus may allow gas to diffuse into the thorax. The rupture of pre-existing pulmonary bullae may also lead to pneumothorax. Cyanosis, decreased oxygen saturation, subcutaneous emphysema and loss of breath sounds should promote a high suspicion of pneumothorax. When a pneumothorax develops during laparoscopy, immediate attention must be given to correction of hypoxemia by adjusting inspired oxygen concentration and ventilation.