Background : The tolerance of pa­tients subjected to laparoscopic radi­cal cystectomy to the diffused C02 and Trendelenburg position has not been reported . We studied pulmo­nary and haemodynamic changes in addition to postoperative outcome fol­lowing laparoscopic radical cystecto­my under total intravenous anaesthe­sia. Patients and methods : A prospective cohort study was con­ducted on 21 patients anaesthetized by a combination of epidural and total intravenous anaesthesia . Anaesth­esia was induced by fentanyl (ijag kg "¹) , midazolam ( 0.1 mg kg'¹) and ketamine (2 mg kg ~1) and maintained by intravenous infusion of the three drugs in a decreasing dose regimen. Vecuronium was used for muscle re­laxation . Surgery was done while the
patient in head down position (45°) . Lungs were ventilated using air - oxy­gen ( FiO2 = 0.35 ) with a tidal volume of 10 ml kg "¹ at a rate of 14 min "¹ . Lung mechanics , gasometric and haemodynamic variables were re­corded at different strategic points . Results : Two patients were excluded as they resorted to open surgery . Nine of 19 patients ( 47% ) had pre-operative medical problems and 7 pa­tients ( 37% ) received blood . There were significant changes in both lung mechanics and haemodynamic varia­bles associated with pneumoperiton-eum and Trendelenburg position but without deleterious effects . The used anaesthetic technique yielded accept­ed recovery with satisfactory posto­perative outcome . Conclusion ; lapar­oscopic radical cystectomy can be performed safely under total intrave-