Exam 2 Laparoscopy

Question 1

Difference between Laparoscopy and Laparotomy

Answer 1

Laparotomy - OPEN procedure
(surgical procedure involving large incision thru abdominal wall to gain access into the abd cavity)

Laparoscopy - operation performed in abdomen/pelvis using small incisions with aid of camera

Question 2

Insufflation

Answer 2

CO2 injected into abd. cavity to create free work space for procedure

Question 3

Major disadvantage of laparoscopic procedures

Answer 3

longer

Question 4

Major advantages of laparoscopic procedures

Answer 4

• minimizes stress response, length of stay, cost

- fewer wound related complications (dehiscence)

Question 5

C/I for laparoscopy

Answer 5

• diaphragmatic hernia
• acute/recent MI (3 months)
• VP shunt

Question 6

insufflation allows for ______ via ________

Answer 6

allows for visualization
via
pneumoperitoneum

Question 7

Characteristics of CO2

Answer 7

• non-combustible
• soluble in blood (increases safety margin)
• decreases risk of gas embolism

Question 8

insufflation is done via

Answer 8

• Veress needle (blind approach)

- Trocar (direct vision)

Question 9

How to monitor insufflation

Answer 9

IAP - Intra Abdominal Pressure

Question 10

What should be monitored during insufflation?

Answer 10

IAP: Less than 15 mmHg

Question 11

What may cause HD instability during insufflation?

Answer 11

Too much gas flow - IAP 25, bp drops – tell surgeon to stop

Question 12

How to determine PaCO2

Answer 12

EtCO2 + 3-5

Question 13

If EtCO2 = 30, should you be concerned?

Answer 13

No

Means PaCO2 = 35

Question 14

If EtCO2 = 45, what is PaCO2?

Answer 14

PaCO2 = 50

Question 15

Effect of insufflation

Answer 15

Increased PaCO2

Question 16

Causes of increased PaCO2 during laparoscopy

Answer 16

• absorp. of CO2 from peritoneal cavity
• V/Q mismatch (increased phys. deadspace)
• CO2 emphysema

Question 17

CO2 emphysema is evidenced by

Answer 17

subQ crackles upon palpation - tell surgeon subQ emphysema/check insufflation ports

Question 18

HD effects – BP/MAP

Answer 18

increased SVR + MAP

Question 19

HD effects – cardiac filling pressures

Answer 19

increased/no change

Question 20

HD effects – cardiac index

Answer 20

decreased/no change

Question 21

HD effects: afterload

Answer 21

increased

Question 22

HD effects: venous return

Answer 22

decreased

Question 23

HD effects: cardiac filling

Answer 23

decreased

-decreased preload esp in hypovolemic patients

Question 24

Cardiac index

Answer 24

cardiodynamic measure based on CO; amount of blood LV ejects into systemic circulation in 1 minute (measured in L/min)