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54 Cards in this Set
- Front
- Back
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normal profile for GB patient
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female
fair fat fourty fertile |
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if female dont fit profile - do what
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get PG test
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what cardiovascular changes are seen with lap surgery
(SVR, MAP, Preload, CI, HR) |
increase SVR, MAP, filling pressure
decrease Preload, CI no change in HR |
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5 major complications of lap surgery
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CO2 absorption
Sub q emphysema Endobronchial intubation Pneumo Gas embolus |
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3 minor complications of lap surgery
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smaller field of vision
blind approach trocar damage |
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resp changes seen in lap surgery
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decrease lung volume and compliance
Increased peak airway pressures increased CO2 absorption |
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when do cardiovascular changes return to normal
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30 min
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when do resp changes plateau
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15-30 minutes
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can you use LMA in lap procedures
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no- causes LES to relax d/t increase intra abdominal pressure and presence of LMA
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what is standard insufflation pressure
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12-15 mmHg
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good induction drug for lap surgery
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Propofol
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dont forget to empty what for lap surgery
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fluid filled containers
stomach, bladder |
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what to do to MV during lap sugery
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12-25% increase
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can pt breath spontaneously during lap sugery
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no - need to control ventilations
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what rare thing can opiods cause that is problem with GB surgery
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sphincter of oddi spasm
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how to treat sphincter of oddi spasm
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atropine
robinol glucagon |
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problems with nitrous with lap surgery
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increasing nausea
not problem with expansion because not a closed space |
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what do you do to ventilations to maintain EtCO2
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must increase ventilation to blow off CO2
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one of the most common vessel injuries in lap surgery that the surgeon is not aware of when it happens
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retroperitoneal vessels
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gas of choice for insufflation
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CO2
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what do lap surgeries do to renal system
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decrease GFR, U/O (50%), plasma flow
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what does lap surgery do to ICP
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should not change if you keep PaCO2 in normal range
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what does lap surgery do to splachnic circulation
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no change
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why use CO2
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it is not flammable
it can be breathed off |
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what will happen if intra-abdominal pressure exceeds 20 mmHg
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sign. decrease in cardiac output
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what will the CRNA notice if the intra-abdominal pressure is getting too high
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bradycardia and hypotension
from stretch of the vagus nerve |
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how to treat brady and hypotension from increase in intraabdominal pressure
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Robinol (0.1 mg) - HR
deepen anesthetic |
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what happens if CO2 escapes the abdomen through hernia or defect in diaphragm
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pneumothorax
pneumomediastinum |
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what is the most common cause of dysrhythmia under anesthesia until proven otherwise
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hypercarbia
acidosis |
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what position is pt in for GB surgery
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reverse trendelenburg
tilted to left heart higher than wound |
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what position is worse for CO2 embolus- why
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trendelenburg (Gyn)
because wound is higher than heart causing a sucking vessel |
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3 signs of CO2 embolus
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decreased EtCO2 (interrupts circulation to lungs)
Decreased SaO2 Decreased Bp |
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what do you do if pt gets CO2 embolus- 6 things
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turn off insufflation
100% O2 Support Circulation CVP to pull out air CPR - possible durants position may have surgeon flood the field |
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what happens if there is gastrointestinal perforation
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usually requires a conversion to open procedure
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when does cautery become a problem with with Lap surgery
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if gut is perforated- the methane gas from gut will combust
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what happens with position for GB surgery
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ventilation to get easier
VR to get harder- make sure tank is full |
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position for GYN surgery
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marked trendelenburg
no problem with VR, marked increase in inspiratory pressures |
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what are signs that tube is right mainstem after trendelenburg position
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decrease sat
slow increase in CO2 increase PIP |
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why are NMB needed for GYN lap surgery
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dont want tight abdomen to breath against with pneumoperitoneum
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position for lap nissan
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almost seated
make sure pt is strapped to table well |
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problems with position for lap nissan
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decrease venous return
could alter position of ETT |
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make sure you cover what when emerging from lap procedures
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pain and nausea
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good drug for pain from lap surgery
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toradol
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what lap surgery is reglan good for
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ok for GYN, not gut or bowel
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polypharmacy for nausea control??
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Ondansetron
H2 blockers droperidol steroids reglan |
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polypharmacy for pain control??
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NSAIDS
Local to incision Opiods warm CO2 for insufflation will also decrease pain |
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why lap better than open
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less depressed diaphragm function
less venous stasis risk |
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why open better than lap
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less chance bile injury
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initial suggestions for LMA usage by its maker
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<15 minutes
<15 degree trendelenburg <15 cm H20 pressure |
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what some common causes increased Et CO2
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hypoventilation
Exogenous CO2 source Increased metabolism MH |
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formula for CO2 production
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8 x kg to 3/4power
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formula for O2 consumption
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10 x kg to the 3/4power
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increase dead space how much for lap surgery
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25%
physiologic + 25% |
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how do we prevent problems with hypoventilation from lap procedures
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check breath sounds
draw abg increase TV Consider pressure control tidal volume maneuvers(40 psi for 8 seconds 4x per hour |
