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Anesthesia Principles 1 > Anesthesia for Laparoscopic and Robotic Surgery (Part 2) > Flashcards

Anesthesia for Laparoscopic and Robotic Surgery (Part 2) Flashcards

1
Q

Cholecystectomy Anesthesia, Positioning, Surgery

A

Anesthesia: GETA with NMB
Positioning: Reverse Trendelenburg, L-tilt
Procedure: can be done traditionally or robotic-assisted

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2
Q

Appendectomy Anesthesia, Positioning, Surgery

A

Anesthesia: GETA with NMB
Positioning: Trendelenbrug, L-tilt, L arm tucked at side
Procedure: Traditional or robotic-assisted

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3
Q

Nissen Fundoplication Anesthesia, Positioning, Surgery

A

Anesthesia: GETA with NMB RSI
Positioning: Supine
Procedure: Traditional or robotic-assisted

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4
Q

Nissen Fundoplication Special Considerations

A

-High aspiration risk
-RSI + PONV prophylaxis!
-NOTHING IN ESOPHAGUS!

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5
Q

Adrenalectomy Anesthesia, Positioning, Surgery

A

-Usually done for pheochromocytoma
Anesthesia: GETA with NMB
Positioning: Lateral position
Procedure: Traditional or robotic-assisted

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6
Q

Adrenalectomy Special Considerations

A

-Remember alpha before beta blockade (alpha block 10-14 days preoperatively)
-Major hemodynamic changes expected –> large bore IVs, adequate hydration, ABP monitoring, take BP meds DOS
-Use of multimodal pain management and erector spinae block

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7
Q

Pheochromocytoma Classic Triad

A

-Headache
-Diaphoresis
-Tachycardia
think too much coffee even though we never have enough

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8
Q

Diagnosis testing for pheo:

A

-Plasma free and urinary fractionated metanephrines
-CT abdomen

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9
Q

Hysterectomy Anesthesia, Positioning, Surgery

A

Anesthesia: GETA with NMB
TAP block for pain management
Positioning: Steep trendelenburg, low lithotomy, arms tucked to side
Procedure: Traditional, Robotic-assisted, or Mix
Use of dye

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10
Q

Gastric Bypass Anesthesia, Positioning, Surgery

A

Anesthesia: GETA with NMB
Positioning: Steep reverse trendelenburg
Procedure: Traditional or robotic-assisted
Nothing in esophagus

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11
Q

Adjustable Gastric Band
Purpose and benefits?

A

-Reduces/limits food intake
-Avoids permanent alteration of anatomy and has low mortality + low re-operation rates
*Done laparoscopically to reduce morbidity, mortality, and hospital costs

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12
Q

Sleeve Gastrectomy
Purpose and risks

A

-Permenantly removes portion of stomach
-Risks of infection, leak at staple line, malnutrition
-Can be negated by overeating

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13
Q

Roux-en-Y Gastric Bypass
Purpose and risks

A

-Small gastric pouch connects to jejunum to change GI hormones
-Risk of vitamin deficiency, malnutrition, perforation, staple line failure, dumping syndrome

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14
Q

We don’t feel great about our patients breathing, they are still super somnolent after the procedure. What do we do?
Obesity Review

A

Leave em intubated

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15
Q

Benefits of minimally invasive robotic surgery

A

-Improved patient outcomes
-Greater precision
-Reduced blood loss and postoperative pain
-Shorter LOS
-Faster recovery

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16
Q

An important advantage of robotic technology is the incorporation of ___-____ imaging giving better depth perception.

A

Three-dimensional
-Improves ergonomics, dexterity

17
Q

Anesthesia Implications for robotic-assisted surgeries

A

-Longer operation times
-Harder to access pt
-Physiological changes due to positioning for robot
-Physiological changes due to pneumoperitoneum use
-Risk of POVL
-New ERAS protocols

18
Q

Why is adequate preparation of the pt for robotic surgery so essential?

A

We often cannot access the pt as we could normally due to the robot.
-Secured airway, good IVs, monitoring devices secured

19
Q

____ ____ is a commonly used position for robotic procedures.

A

Steep trendelenburg
-This places our pt at higher risks of certain cardiac, respiratory, neurophysiological changes.

20
Q

Goal of robotic-assisted surgery

A

The goal of minimally invasive robotic procedures is to improve surgical outcomes and allow patients to return to normal activity as quickly as possible

21
Q

What 2 specific things about robotic surgeries caused increased risk of injury?

A
  1. Extreme surgical positions necessary for robot
  2. Prolonged surgery durations
22
Q

We should assess our surgical positioning during robotic surgeries how often?

A

q15 mins or whenever the patient, robot, or table are moved around

23
Q

What is mentioned as being one of the most common robotic surgeries worldwide?

A

The robotic-assisted laparoscopic prostatectomy (RALP)
-Less blood loss, shorter LOS, however more expensive

24
Q

RALP Anesthesia, Positioning, Surgery

A

Anesthesia: GETA with NMB
Positioning: Steep trendelenburg and lithotomy
peroneal nerve damage risk in lithotomy
Surgery: Most common robotic

25
Q

Trendelenburg considerations:

A

-Increases VR, CVP, ICP, IOP, PIP
-Decreases lung compliance, tidal volumes, oxygen sats

26
Q

Lithotomy considerations:

A

-May see falsely high BP and hypovolemia can be masked
-Increased PIP, dead space
-Decreased pulmonary compliance, tidal volumes

27
Q

Most important risk (for us) with positioning changes?

A

Maintain that patent airway and ETT placement

28
Q

____ ____ ____ accounts for 89% of post op vision loss due to hypotension.

A

Ischemic optic neuropathy (ION)

29
Q

___ ___ ___ ___ causes post op vision loss from decreased blood supply to the entire retina. Most often due to improper positioning of the head.

A

Central retinal artery occlusion (CRAO)

30
Q

Repeat card on purpose
Signs and symptoms of CO2 embolism

A

-Decreased EtCO2, oxygen saturation
-Increased EtN2
-Tachycardia, hypotension, dysrhythmias, CV collapse

31
Q

Repeat card on purpose
Most CO2 embolisms will resolve how?

A

Spontaneously with no treatment

32
Q

Repeat card on purpose
Treatment of CO2 embolus that will not resolve on its own

A
  1. D/c insufflation, Stop N2O if using, give 100% O2
  2. Deflate abdomen
  3. Flood the field with saline
  4. Place in left lateral position (durant maneuver)
  5. Aspirate out of central line if present
  6. Hemodynamically support the patient
33
Q

What is the purpose of enhanced recovery after surgery (ERAS) protocols?

A

To enhance recovery management pathways and allow return to normal activity as soon as possible

34
Q

Robotic cardiothoracic surgery Anesthesia and Positioning

A

Anesthesia: GETA with NMB
Positioning: Modified left or right lateral position

35
Q

Robotic cardiothoracic surgery Considerations

A

-May use prolonged one-lung ventilation
-Continuous TEE and invasive monitoring may be in place

Anesthesia Principles 1 (7 decks)

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