CHAPTER 44 | Anesthesia for LAPAROSCOPIC SURGERY

Question 1

What is the physiologic effect of INSUFFLATION?

Answer 1

Initial insufflation at an IAP of 5 mmHg in
normovolemic patients leads to an increase in venous return due to displacement of blood from the splanchnic vasculature, a rise in cardiac
output, and hypertension.

Question 2

Which of the following is NOT a risk factor in development of subcutaneous emphysema in laparoscopic procedures?

A. lower BMI

B. young age

C. ETCO2 >50

D. IAP > 15mmHg

E. Duration

Answer 2

Development of subcutaneous emphysema include:

1. Operative times greater than 3.5 hours
2. IAP >15 mmHg
3. Higher insufflation flow rates
4. Greater number of surgical ports
5. Placement of cannulas outside the peritoneal cavity
6. ETCO2 >50 mmHg
7. Lower BMI
8. Older patient age
9. Nissen fundoplication surgery

Question 3

Recommended IAP during intraperitoneal insufflation:

A. 12 - 15 mmHg

B. 5 - 10 mmHg

C. 2 - 5 mmHg

D. 15 - 20 mmHg

Answer 3

A. 12 - 15 mmHg

Initiating insufflation while supine
and maintaining IAP within the recommended range (12 to 15 mmHg) can minimize any reduction in preload.19 Nonetheless, extremely high IAP,
especially in the setting of hypovolemia, can result in severe compression of the venous system as well as a perilous reduction in venous return and
cardiac filling.

Question 4

Which of the following is INACCURATE regarding the cardiovascular effect of laparoscopic surgery?

A. increase in mean arterial pressure (MAP)

B. increase myocardial oxygen demand

C. decrease pulmonary vascular resistance (PVR)

D. increase systemic vascular resistance (SVR)

Answer 4

C. decrease pulmonary vascular resistance (PVR)

The cardiovascular system is exquisitely challenged during laparoscopy by multiple stressors on preload, inotropy, rhythm, and afterload.

The cumulative effect is an increase in mean arterial pressure (MAP), myocardial oxygen demand, pulmonary vascular resistance (PVR), and
systemic vascular resistance (SVR).