Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
79 Cards in this Set
- Front
- Back
|
what are the advantages of laproscopic sx
|
*mimimizes surgical trauma
*less post-op pain *improved post-op pulmonary fxn *shorter hospital stays *earlier return to normal activities |
|
|
with a laproscopy there is decreased tissue damage that is evidenced by what
|
*decreases in C-reactive protein
*decreaeses in interleukin-6 |
|
|
what occurs with the hyperglycemic response with laproscopy compared to laparotomy
|
it is decreased
|
|
|
is there a benefit in reduction of adrenocortical response with laproscopy
|
NO
|
|
|
what occurs with excretion of cortisol and catecholamines with a laproscopy compared to a laparotomy
|
they are UNCHANGED
|
|
|
a laparotomy has what type of pain
|
incisional pain
|
|
|
a laproscopy has what type of pain
|
*more visceral (spasm) pain
*shoulder pain from diaphragmatic irritation |
|
|
what are some tech to minimize pain following a laproscopy
|
*pre-op NSAIDs
*intraperiotoneal local anesthetic *more complete evacuation of pneumopertineum |
|
|
pre-op NSAIDs for minimizing pain after a laproscopy are def effective in what procedures
|
*lap chole
*GYN laproscopy except BTL |
|
|
intraperitoneal LA for minimizing pain after a laproscopy is particularly benefical in what procedures
|
GYN
|
|
|
a mesosapinx block is valuable for minimizing pain after a laproscopy in what procedure
|
Lap BTL
|
|
|
when is a mesosapinx block more effective
|
when perfomed at the beginning of the procedure
|
|
|
with a laproscopy greater severity of pulm dysfunction and slower recovery is reported in what pts
|
*elderly
*obesity *COPD *smokers |
|
|
what are the disadvantages of a laproscopy
|
*PONV
*2 dimensional image *diff in maneuvering instruments |
|
|
fredelig
|
peaceful
|
|
|
what are methods to reduce PONV with a laproscopy
|
*propofol anesthetic
*intra-op antiemetics *supplemental analgesia to reduce opioid consumption *empty stomach intra-op |
|
|
what positions are common with pelvic and lower GI sx with a laproscopy
|
trendelburg often accompanied by lithomy
|
|
|
what positions are common with upper GI sx with a laproscopy
|
reverse trendlenburg
|
|
|
with a laproscopy and positioning CV and resp changes are directly related to what
|
steepness of tilt
|
|
|
what resp changes are produced with tredelenburg
|
*decreased FRC
*decreased lung volume *decreased compliance |
|
|
resp effects from trendelenburg are exacerbated when
|
*elderly
*obese *pre-existing pulm compromise |
|
|
what are the CV changes related to trendelenburg in a normal heart
|
no sig compromise
|
|
|
what are the CV changes related to trendelenburg with poor ventricular fxn/CAD
|
increased myocardial o2 demand
|
|
|
what are the CV changes related to reverse trendelenbug
|
decreased CO
|
|
|
what may further decrease CO in reverse trendelenburg
|
increased SVR seen with pneumoperitoneum
|
|
|
venous stasis is exacerbated by what in regards to positioning
|
*reverse trendelenburg
*pneumoperitoneum *lithtomy |
|
|
what nerve injury is the most concern with trendelenburg
|
overextension of the shoulder
|
|
|
what nerves can be damaged in lithotomy position
|
*COMMON PERONEAL
*lateral femoral cutaneous *femoral |
|
|
what ventilatory changes occur with a pneumoperitoneum
|
*decreased compliance
*decreased FRC *potential for VQ mismatch |
|
|
what amt of change occurs with ventilatory compliance as a result of a pneumoperitoneum
|
30-50% reduction
|
|
|
to reduce the potential for a VQ mismatch with a pneumoperitoneum what should be done esp with CV compromise
|
avoid pressure greater than 14 mmHg
|
|
|
what occurs with PaCo2 with a pneumoperitoneum
|
it is INCREASED
|
|
|
what occurs with pH with a pneumoperitoneum
|
it is DECREASED
|
|
|
ETCO2 and PaCo2 plateau when with a pneumoperitoneum
|
about 20 min in
|
|
|
what is PaCo2 like with a local and a pneumoperitoneum and why
|
UNCHANGED d/t compensatory increase in MV
|
|
|
what is PaCo2 like with general anesthesia and spontaneous ventilation with a pneumoperitoneum
|
INCREASED despite increase MV d/t decreased compliance & vent depression from anesthetics
|
|
|
a greater change in PaCo2 with a pneumoperitoneum is seen with what pts
|
sicker one
|
|
|
what are the causes of increased PaCo2 with a pneumoperitoneum
|
*ABSORPTION OF CO2 (#1)
*impaired ventilation and perfusion |
|
|
with a pneumoperitoneum what do you like to keep the IAP at
|
</= 14
|
|
|
what are the resp complications that can occur from a pneumoperitoneum
|
*sub-q emphysema
*pneumothorax *endobronchial intubation *gas embolism |
|
|
sub-q emphysema with a pneumoperitoneum is suggested by what
|
increase in ETCO2 follwing the intial plateau
|
|
|
what are the causes of sub-q emphysema with a pneumoperitoneum
|
*accidental extraperitoneal insufflation
*necessary extraperiotoneal insufflation |
|
|
what is the management of sub-q emphysema with a pneumoperitoneum
|
*hyperventilation
*suspend insufflation/sx briefly until CO2 blows off *continue mech vent at the end of case until ETCO2 returns to normal |
|
|
what causes a capothorax/pneumothorax with a pneumoperitoneum
|
*passage of gas through weak points in diaphragm or at aortic/esophageal hiatus secondary to increased IAP
*rupture of pre-existing bullae secondary to increased MV |
|
|
what is the dx for a capnothorax/pneumothorax secondary to passage of gas through weak points in diaphragm or at aortic/esophageal hiatus with a pneumoperitoneum
|
*increased airway pressure
*increased ETCO2 *auscultation/CXR |
|
|
what is the dx for capnothrorax/pneumothorax secondary to rupture of pre-existing bullae 2 to increased MV with a pnemoperitoneum
|
*increased airway pressure
*DECREASED etco2 *ausculation/CXR |
|
|
what is the management of a CO2 pneumothorax (capnothorax) with a pneumoperitoneum
|
*stop N2O if using
*adjust vent to correct hypoxemia *PEEP *reduce IAP *resolves spontaneously secondary to CO2 very diffusable |
|
|
what is the management of ruptured bullae (pneumothorax) with a pneumoperitoneum
|
*thoracentesis
*NO peep |
|
|
endobronchial intubation with a pneumoperitoneum caused by
|
cephalad displacement of diaphragm following insufflation
|
|
|
what is the dx for endobronchial intubation with a pneumoperitoneum
|
*decreased o2 sat
*INCREASED airway pressure *auscultation |
|
|
what is the management for a endobronchial intubation with a pneumoperitoneum
|
pull the tube back
|
|
|
when does a gas emobolism with a pneumoperitoneum usually present
|
at the start of insufflation
|
|
|
why does a gas emobolism occur with a pneumoperitoneum
|
d/t placement of insufflating needle into a blood vessel or organ
|
|
|
what is the lethal dose of Co2
|
~5x that of air
|
|
|
a large volume of Co2 in RA or vena cava does what
|
obstructs venous return resulting in decreased CO or circulatory collapse
|
|
|
what is the dx of a gas embolism during laproscopy
|
*decreased ETCO2
*tachycardia *hypotension *millwheel murmur |
|
|
what is the DEFINITIVE dx for a gas embolism during laproscopy
|
aspiration of gas or foamy blood from a central line
|
|
|
what is the management of a gas embolism with a pneumoperitoneum
|
*stop insufflation
*relase pneumopertineum *steep trendelenburg *left lateral decubitis position *stop N2O *100% o2 *central venous line to aspirate *consider hyperbaric o2 tx if gas in cerebral circulation |
|
|
what are the hemodynamic effects of a pneumoperitoneum in a NORMAL pt
|
*decreased CO
*increased BP *min to no change in HR *increased SVR |
|
|
what is the change initially in CO with a normal pt and a pneumoperitoneum
|
10-30% decrease with insufflation
|
|
|
the change in CO initially with insufflation of the abd in a pneumoperitoneum with a NORMAL pt is proportional to what
|
increase in intra-abd pressure
|
|
|
the change in CO initially with insufflation of the abd in a pneumoperitoneum with a NORMAL pt is INDEPENDENT of what
|
pt positioning
|
|
|
the change in CO with insufflation of the abd in a NORMAL pt is related to what
|
*increased SVR
*decreased venous return |
|
|
decreased venous return with a pneumoperitoneum occurs with what IAP
|
>10 mmHg
|
|
|
decreased venous return with a pneumoperitoneum is attenuated by what
|
*fluid preload
*wrapping legs or SCDs |
|
|
increased SVR with a pneumoperitoneum is NOT a result of what
|
decreased CO
|
|
|
increased SVR with a pneumoperitoneum is affected by what factors
|
*pt postion
*volume status *mechanically and neurohumorally mediated |
|
|
what occurs with the renal system with a pneumoperitoneum
|
~50% reduction in UO, GFR and renal blood flow
|
|
|
what occurs with cerebral blood flow with a pneumoperitoneum
|
increased d/t elevated PaCo2
|
|
|
what should be done with pts at risk for changes in cerebral blood flow with a pneumoperitoneum
|
maintain normocarbia
|
|
|
what is the most common cardiac arrythymia in sx with a pneumoperitoneum
|
bradycardia
|
|
|
what is the primary cause of bradycardia in laproscopy with pneumoperitoneum
|
increase of vagal tone from stretch of the peritoneum
|
|
|
what is the tx for bradycardia with a pneumoperitoneum
|
*stop insufflation
*release pneumoperitoneum if needed *atropine |
|
|
when is bradycardia with a pneumoperitoneum less likely to occur
|
with a deeper plane of anesthesia
|
|
|
what are the concerns of sx during pregnancy
|
*premature labor
*damage to uterus *teratogenicity of anesthetic agents |
|
|
what things should be done with sx in the pregnant pt
|
*involve the OB
*minilap for trocar access *fluid load *maintain normal maternal ETCO2 *left uterine displacement |
|
|
what is the safest approach for anesthesia with a laproscopic sx
|
general with ETT
|
|
|
what are the advantages of using inert gases for laproscopy
|
*PaCo2 not elevated
*smaller increase in BP |
|
|
what are the disadvantages of using inert gases for laproscopy
|
*greater decrease in CO
*low blood solubility |
