1. Radical surgical intervention, unlike traditional open surgery, is performed without a wide dissection of the integument, under video monitor control through pinpoint tissue punctures. The main advantage of endoscopic surgery is the reduced trauma of the procedure. 2. Surgical interventions are performed under pneumoperitoneum (PP), which is achieved by insufflating 3-4 liters of gas into the abdominal cavity. PP creates the space necessary for performing surgical manipulations in the cavity. 3. Change in body position. Surgeries on the pelvic organs and appendix are performed in the Trendelenburg position. Surgeries on the upper abdominal cavity (biliary tract, pancreas, stomach) are performed in the reverse Trendelenburg position, i.e. with an elevated head end. In this case, the internal organs are displaced by gravity, freeing the surgical field. 4. Absorption of the insufflated gas by the peritoneum during surgery. Carbon dioxide, nitrous oxide, air, argon, and other gases are used for insufflation. Each is absorbed by the peritoneum differently and has a different effect on vital functions. Effects of Pneumoperitoneum: One of the features of laparoscopic surgery is the creation of artificial pneumoperitoneum. The consequences of increased intra-abdominal pressure are of fundamental importance: - compression of the inferior vena cava with impaired venous circulation in its basin; - impaired blood flow in the abdominal arteries; - impaired cardiac function in the form of decreased cardiac output and cardiac index; - compression of the lungs when the diaphragm is raised, reducing residual capacity and increasing dead space, resulting in hypercapnia. Increased intra-abdominal pressure (IAP) is important for the function of the respiratory and cardiovascular systems. Numerous experimental studies on animals have established threshold values ??for IAP. Thus, Yoichi Ishizaki (1992) established that the introduction of CO2 into the abdominal cavity can cause cardiovascular collapse. The effect of increased IAP on systemic hemodynamics was studied in anesthetized dogs. At an IAP of 16 mm Hg, cardiac output (CO) was significantly reduced, and systemic vascular resistance (SVR) increased depending on the cardiac output. At an IAP of 8-12 mm Hg, deviations were insignificant. A decrease in central venous return and, as a consequence, cardiac output at IAP above 16 mm Hg is constantly observed. Maintaining IAP below this level can significantly increase venous age due to the influx of blood from the abdominal organs and the inferior vena cava into the thoracic cavity. David Shafran (1993) studied these changes in detail during laparoscopic surgeries (LO), using precise invasive measurement methods in cardiac patients. Fifteen patients with high anesthetic risk were examined. It was found that PP led to an increase in mean arterial pressure and cardiovascular survivability. This resulted in a significant decrease in CO in patients with inadequate cardiac reserve. Patients with atherosclerosis and coronary artery disease are at risk of heart failure due to the simultaneous increase in circulating blood volume as a result of infusion, on the one hand, and a rapid increase in IAP, on the other. Patients with aortic valve pathology and left ventricular hypertrophy are even more sensitive to anesthesia during PP. Due to an increased heart rate, left ventricular filling decreases, leading to cerebral and myocardial ischemia. Therefore, hemodynamic stress must be prevented in patients with heart failure and early correction must be performed. With uneventful pulmonary insufficiency, an increase in venous oxygenation (VO) is usually observed. A decrease in VO should alert the surgeon and anesthesiologist. Appropriate preoperative preparation can reduce the risk of surgery. Positive end-expiratory pressure (PEEP) can be used to detect cardiac abnormalities. Increased intra-abdominal pressure causes changes in external respiration function and cardiac rotation due to diaphragm displacement. This increases total pulmonary resistance and decreases functional lung capacity. Decreased pulmonary excursion causes respiratory dysfunction due to an increase in ventilation-perfusion inequality fields. These fields increase in the Trendelenburg position. The use of positive end-expiratory pressure (PEEP) during mechanical ventilation can overcome many respiratory disorders caused by an increase in IAP below 14 mmHg and reduces ventilation complications. Our observations show that with sufficient experience, most PEEPs can be performed at a pressure of 9-10 mmHg. One of the common complications of PEEP is CARDIAC ARRHYTHMIAS. According to the literature, they are observed in 6-17% of cases. Most arrhythmias are ventricular extrasystoles. Respiratory acidosis and sympathetic stimulation can cause these arrhythmias. Vagus nerve irritation due to peritoneal overdistension can lead to bradycardia and even asystole. The incidence of arrhythmias can be reduced by maintaining normal PCO2 levels, limiting CO2 intake into the abdominal cavity to 1 L/min during primary insufflation, and maintaining intra-abdominal pressure no higher than 14 mmHg. Despite this, the use of LO in patients with severe cardiovascular pathology is considered justified. To ensure complete safety in such patients, appropriate preparation and an intraoperative hemodynamic and blood gas monitoring system are necessary. Performing LO in this category of patients is also justified because it reduces the likelihood of postoperative complications caused by severe pain, prolonged immobilization, and the risk of pulmonary disorders typical of open surgery. In these cases, a gasless LO technique is more appropriate. Changes in body position can also provoke cardiovascular disorders. In the Trendelenburg position, with an increase in IAP of more than 20 mmHg, CVS increases, while venous return and cardiac output decrease in response to the increase in CVS. In the reverse position, the load on the diaphragm increases. In young patients without comorbidities, cardiovascular disorders resulting from changes in body position or IAP are quickly corrected by compensatory mechanisms. In the elderly, adequate compensation is difficult, leading to the development of hemodynamic changes. Carbon dioxide adsorption: When carbon dioxide is insufflated into the abdominal cavity, some of it is rapidly absorbed through the peritoneum into the body's tissues and then enters the bloodstream, where carbon dioxide is formed. This has a direct effect on the respiratory center and, to a lesser extent, on the chemoreceptors of the carotid sinus. An increase in the partial pressure of carbon dioxide to 45-50 mmHg. A decrease in PCO2 to 30 mmHg requires a 1.5-fold increase in ventilation, while a decrease in PCO2 to 30 mmHg requires a 1.5-fold decrease. Absorption of insufflated carbon dioxide causes mild respiratory acidosis. Minor changes in metabolic acidosis or alkalosis may also be observed, but in most cases they are clinically insignificant. During LO, pH changes are generally well tolerated unless excessive carbon dioxide is absorbed. Impaired oxygenation during surgery is apparently associated with limited lung expansion, but this is compensated for by an increase in inspired oxygen concentration. In conditions of severe hypercapnia, the negative effects of high carbon dioxide concentrations reduce myocardial contractility, worsen atrioventricular conduction, decrease blood pressure, increase vagal tone, and, consequently, decrease heart rate. Furthermore, carbon dioxide promotes increased dissociation of oxyhemoglobin, increases the permeability of cell membranes to oxygen, and enhances its affinity for tissues. However, extreme hypercapnia leads to rapid depletion of the body's energy potential, as carbon dioxide reduces metabolic processes and O2 consumption. This leads to depression of the central nervous system, suppression of respiratory activity, and impaired nerve conduction, meaning high carbon dioxide concentrations act like a narcotic. The pathogenesis of this phenomenon is rooted in excessive concentrations of gamma-aminobutyric acid and sodium ions in neurons. High CO2 concentrations in the body cause bronchospasm and renal vasoconstriction, leading to decreased urinary function and disruption of fluid, electrolyte, and acid-base balance. Therefore, during laparoscopic surgery, increasing hypercapnia requires immediate removal of carbon dioxide from the body. This is achieved by adjusting the parameters of artificial ventilation toward hyperventilation. However, it is important to remember that marked hyperventilation with a 50% reduction in PCO2 reduces blood pressure and systemic vascular resistance. This increases cerebral and cardiac vascular tone, dilates peripheral vessels, and inhibits myocardial contractility. Vascular collapse, impairing cerebral blood flow, occurs. Respiratory alkalosis increases the binding strength of oxygen to hemoglobin, impeding oxygen delivery to tissues. An extreme reduction in carbon dioxide partial pressure causes prolonged postanesthesia depression due to the suppression of the ascending activating influences of the brainstem reticular formation on the cerebral cortex.