#1 Lap CHOLE Flashcards
What is a lap Chole
A minimally invasive laparoscopic colon surgery allows surgeons to perform many common colon procedures through small incisions.
The colont.
is the large intestine; it is the lower part of your digestive tract
The intestine is a
long, tubular organ consisting of the small intestine, the colon (large intestine) and the rectum, which is the last part of the colon.
After food is swallowed, it begins to be
digested in the stomach and then empties into the small intestine, where the nutritional part of the food is absorbed.
After food empty in the stomach, The remaining waste
moves through the colon to the rectum and is expelled from the body. The colon and rectum absorb water and hold the waste until you are ready to expel it.
Patients undergo colon surgery forconditions such as:
Colorectal cancer Polyps Inflammatory bowel disease (Crohn’s and ulcerative colitis) Stricture of the colon Diverticulitis Necrotizing enterocolitis (NEC)
What is NEC?
Necrotizing enterocolitis (NEC) is characterized by varying degrees of mucosal or transmural necrosis of the intestine, most frequently involving the terminal ileum and proximal colon
WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC COLON RESECTION?
Results may vary depending upon the type of procedure and patient’s overall condition
Common advantages are:
Less postoperative pain
May shorten hospital stay
May result in a faster return to solid-food diet
May result in a quicker return of bowel function
Quicker return to normal activity
Improved cosmetic results
Anesthesia techniques for Lap Chole
General Anesthesia
TAP Block
TransthoracicEpidural
Positions for lap chole
Supine/Trendelenburg
INcrease VR, CBV, CO, MAP, Paw (atelectasis)
Decrease VC, FRC, COMPLIANCE
Positioning with supine position
Patient is usually in the supine position; sometimes lithotomy for left sided-procedures. Under general anesthesia with endotracheal intubation, the patient is laid supine on the table with both arms tucked at the sides to allow more room for the surgeon and assistant to move. Patient’s legs are laid flat and separated to facilitate trans-anal passage of the circular staplers for colorectal anastomosis at a later stage of the procedure (Hines & Marschall, 2018, pg. 218).
DURING THEPERIOPERATIVEPERIOD, COLONBLOODFLOW (CBF) ISAFFECTED BY :
BLOOD GAS COMPOSITION
VOLUME STATUS
INTRA-ABDOMINAL PRESSURE
INTRALUMINALPRESSURE
TYPE AND VOLUME OF FLUIDTHERAPY
ANESTHETIC AGENTS ANDANESTHETIC TECHNIQUES
CRITICALCONDITIONS SUCH AS HEMORRHAGE AND SEPSIS.
Blood transfusion
It has been suggested that blood transfusion during surgical resection of colorectal cancers is associated with a decrease in the length of patient survival. This could reflectimmunosuppression produced by transfused blood. For this reason, careful review of the risks and benefits of blood transfusion in these patients is prudent (Hines & Marschall, 2018, pg 598-599).
INCREASED INTRA-ABDOMINAL PRESSUES (IAP)
effects
POOLING OF BLOOD IN THE LEGS
CAVAL COMPRESSION
INCREASED VENOUS RESISITANCE
ALL LEADING TO DECREASED CO
Increase IAB Increase SVR
INCREASED INTRATHORACIC PRESSURE
LEADING TO DECRASED CO
