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10 Cards in this Set
- Front
- Back
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What are main factors for assessing gas used for insufflation?
How would you describe ideal gas? |
1)Combustibility
2) blood and tissue solubility 3) Expense 4) potential for side effects Inert, Colorless, and excreted via lungs |
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What are advantages of C02?
What are the disadvantages? |
-Colorless, Odorless
-Cheaper - Doesnt combust - has high solubility = less risk of emboli vs other gases - HYPERCARBIA --> Resp ACIDOSIS - More post op neck and shoulder pain due to diaphramatic irritation (vs other gasses - Cardiac dysarryhtmias |
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what are advantages of No2?
What are disadvantages? |
-decreased peritioneal irritation
-supports combustion and may lead to EXPLOSIONS within abdomen when HYDROGEN OR METHANE present - decreased heart dyarrythmias (vs c02) bigger DECLINE in CARDIAC INDEX and BLOOD PRESSURE (vs C02) |
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Air only has disavantages for insufflation. What are they?
Oxygen only has disadvantages. Name them. |
- COMBUSTION
- higher risk of emboli COM?BUSTION |
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Helium as insufflator gas - what are advantages and disadvantages?
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- INERT
- Not absorbable in abdomen -BIGGEST RISK FOR EMBOLI |
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What does C02 insufflation do to PaC02?
What factors determine the extent of this effect? |
Increases PaC02.
- intra-abdominal pressure - age - underlying medical problems - patient position - mode of ventilation Healthy patient: absorb in peritoneum |
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What are effects of increaseed intra-abdominal pressure on lungs?
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-diaphragm dysfunction
- increased alveolar deadspace |
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What are timings of PaC02 increase after insufflation?
How about gradient of PaC02 and end-tidal? |
Start after 5-10 mins; plateau about 20-25 mins
- doesnt change during insufflation but INCREASES during MAINTENANCE (especially in compromised patients) |
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What are the effects of Trendelenberg on hemodynamics and pulmonary function?
What are the effects of reverse? |
-INCREASED Cardiac output and CVP (increased preload) - will lead to DECREASED HR and Vasodilation
- organs shift up onto lungs - decreasing FRC, TLC, compliance --> predisposes to ATELECTASIS - decreased PRELOAD - decreased CO + Mean Arterial Pressure (MAP) - blood pooling - statis --> thromobosis/pe - compression stockings - increased respiratory function |
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What are limits of insufflation pressure?
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16 - get physiologic changes
- decreased CO - increased SVR - decreased compliance >20 - more damange - decrease in RENAL BLOOD FLOW, GFR, and Urine output |
