Laparoscopic cholecystectomy produces significantly less tissue trauma than that with conventional open procedures, with the advantages of reduced postoperative pain, facilitating faster recovery, shorter hospital stays, and more rapid return to normal daily activities. Now, it becomes a routinely performed procedure for symptomatic cholelithiasis. However, anesthetic management for laparoscopic cholecystectomy is not a simple method. The physiologic changes associated with pneumoperitoneum creation and patient positioning reveal decreased cardiac output and increased mean arterial pressure and systemic vascular resistance; especially in older patients with co-existing cardiopulmonary disease, presenting significant challenges in anesthetic management. Intra-operative complications may also arise due to traumatic injuries, CO₂ embolism, surgical emphysema, pnemothorax, pneumomediastinum, and etc. Careful monitoring and appropriate management are needed to modify the hemodynamic changes, and to provide an early detection of complications during pneumoperitoneum creation.