ABSTRACT: In Laparoscopic surgery, pneumoperitoneum created has major effects on the respiratory function intraoperatively and post operatively .Careful monitoring of the patients and prompt treatment is necessary to avoid catastrophic events.

METHODS : ;62 year old obese man, known diabetic on insulin ,hypertensive with ischemic heart disease,chronic obstructive pulmonary disease underwent laparoscopic cholecystectomy under general anesthesia. Induction was with thiopentone 250 mg. Muscle relaxation was achieved with vecuronium. Intraopertively ,afterpnemoperitoneum there was no desaturation and peak air way pressure was within normal limits. Extubation was uneventful. On the first post operative day peripheral oxygen saturation was around 95% to 96% with supplemental oxygen 4liters /min through venti mask. On the 2ndPOD, patient complained of breathlessness and there was a further deterioration in peripheral oxygen saturation.

RESULTS : A differential diagnosis of ?Negative pressure pulmonary edema ? pulmonary embolism was made and the patient was shifted to intensive care unit. Low molecular weight heparin and Inj.Lasix was started.Elevation of D dimers was present. Doppler of both lower limbs showed no deep vein thrombosis. Cardiologists opinion was sought and patient was treated with low molecular weight heparin. Patient became well and was discharged on the8 thpost operative day.

CONCLUSIONS : Careful monitoring of patients for respiratory compromise after laparoscopic cholecystectomy and prompt treatment is a must to prevent devastating complications