Should we be aware of autonomic nervous system control before performing head-down laparoscopy?

laparoscopic surgery accounts for millionsof surgical procedures per year, and it has become the most-used elective procedure among radical prostatectomy surgeries.2, 3 De- spite the fact that the overall mortality from laparoscopic surgery is low 4 and that cardiac and cerebral complications related to laparoscopic prostatectomy are rare,5 head-down positioning and pneumoperitoneum exert their effects on the cardiovascular and respiratory systems. laparoscopic procedures generate hydrostatic and abdominal pressures,6 and in- volve the action of anesthetic drugs. the degree of cardiovascular involvement depends on a complex interaction of all mechanisms in volved in the control of arterial pressure such as the intrinsic myogenic response of vessels and the neuroendocrine and autonomic nervous systems.