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30 Cards in this Set
- Front
- Back
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Advantages of laparoscopy |
Decreased pain Decreased length of stay Decreased complications (infection) Improved visualization |
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What are various entry techniques for laparoscopy |
Veress needle Open (Hasson) Direct trocar insertion Shielded disposable trocar Radially expanding trocar Optical trocars |
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Where is palmer’s point |
3cm below left subcostal margin in midclavicular line |
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What should be done before palmer’s point insertion |
Empty stomach with NG |
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When should palmer’s point be used |
Risk of periumbilical adhesions (midline laparotomy) Umbilical hernia Failed 3 attempts at umbilicus Obese or very thin |
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Contraindications to palmer’s point |
Hepatosplenomegaly Gastric or splenic surgery Portal htn Gastropancreatic masses |
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Other possible entry points |
Transuterine Trans cul de sac Ninth or tenth intercostal space - risk of gastric injury and pneumothorax |
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Risk of umbilical adhesions after previous laparoscopy, pfannenstiel or midline |
Laparoscopy 0-15% Pfannenstiel 20-30% Midline 50-60% |
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Preferred angle of veress needle insertion |
45 degrees 90 if obese * as weight goes up, umbilicus moves caudal from aortic bifurcation |
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3 most commonly injured vessels at laparoscopic entry |
Left common iliac vein Abdominal aorta Right common iliac artery |
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What is number 1 safety check for laparoscopy |
Veress intraperitoneal pressure < 10mmHg |
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Complication rates with each entry attempt |
One attempt 0-16% Two 16-37.5% Three 44-64% More than three 85-100% Extraperitoneal insufflation, omental/bowel injuries, failed laparoscopy |
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What are colours during entry with optical trocar |
Yellow fat White fascia Red rectus muscle Clear peritoneum |
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What are adequate pneumo pressures for entry |
20-30mmHg |
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Does high entry pressure impact cardiopulmonary function in healthy women |
No. Transient |
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What is force required with shielded trocar vs reusable trocar |
Half |
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Steps of Hasson entry |
Skin incision Fascial incision Peritoneal incision Insertion of blunt trocar Pursestring suture or suture an angles and attached to trocar Laparoscope introduced and pneumo created |
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Risks and benefits of Hasson entry |
Benefit: decreased vascular injury (retroperitoneal) Risk: increased bowel injury No evidence that it is superior or inferior to veress |
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Benefits and risk of direct trocar entry |
Benefit: faster, less CO2 embolism Risk: need strength to lift abdomen and thrust in trocar, bowel injury |
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What is SOGC recommendation about radially expanding trocars |
Not superior Used blunt trocar - may protect against injury BUT they require much more force |
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What is SOGC recommendation about visual entry trocars |
Not superior Benefits: smaller incision and less force Risk: do not decrease risk of bowel of vascular injury |
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First line surgical approach for benign hyst |
Vaginal Lower morbidity, fewer complications, faster recovery time |
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Risks and benefits of a subtotal hyst |
Benefits: less operating time, less blood loss (not statistically significant) Risks: cyclic bleeding (endocervical canal), need for routine cervical cytology No difference between TAH: sexual function and lower urinary tract symptoms (improved in both) |
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What is SOGC recommendation about subtotal (supracervical) hyst |
Not recommended - no benefit and risk of cyclic bleeding and need for routine cytology Recommend against if history of cervical dysplasia |
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5 parts of Nausea/Vomiting |
Chemoreceptor trigger zone Vagal pathway in GI tract Vestibular system Cerebral cortex Midbrain afferents |
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Risk factors for PONV |
Hx PONV Female Postoperative opioids Hx motion sickness Emetogenic surgery Non smoker |
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Techniques to reduce risk of PONV |
Regional anesthesia Adequate hydration Avoid NO Avoid high dose neostigmine High FiO2 |
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What med can be given before induction to reduce PONV |
Dexamethasone |
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What antiemetics can be used for PONV |
Ondansetron 4-8mg IV Dimenhydrinate 1-2mg/kg IV Metoclopramide 25-50mg IV Prochlorperazine 5-10mg IV * use mulitmodal approach instead of increasing dose |
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What non pharmacologic therapy can be used for PONV |
Acupoint electrical stimulation |
