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Principles of Anesthesia 1 (Summer 2023) > Exam 3 (Gen & Gyn surgery) > Flashcards

Exam 3 (Gen & Gyn surgery) Flashcards

1
Q

What does the body release during the first few minutes of a abdominal insufflation of CO2?

A

Catecholamines & vasopressin

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2
Q

What is the desired IAP in a laparotomy?

A

< 20 mmHg

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3
Q

What are the pulmonary effects of a laparoscopy?

A
  • Increased PaCO2 d/t decreased compliance & FRC,
  • increased PIP
  • atelectasis development
  • SubQ emphysema from improper trocar placement
  • Pneumothorax if diaphragm is punctured
  • Pneumomediastinum
  • Gas embolism
  • Endobronchial intubation
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4
Q

How do you treat the pulmonary side effects of a laparoscopy?

A

Increase Vm (Vt hard d/t PIP; increase RR)

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5
Q
  • What is the best early S/S of a gas embolism during a laparoscopy?
A

Decreased EtCO2

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6
Q

How is a gas embolism treated?

A
  • Cease gas insufflation
  • Trendelenburg
  • 100% O2
  • Aspirate air thru CVL if present
  • Vasopressor support
  • Fluid bolus
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7
Q

At what IAP pressures are hemodynamics affected?

A

> 10 mmHg

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8
Q

What are the CV effects of IAP?

A
  • Decreased CO
  • Increased arterial
  • Increased & SVR/PVR
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9
Q

What meds can be used to treat the CV side effects of IAP?

A

Use short acting meds as effects are temporary (esmolol, propofol, remifentanil, VA, cardene)

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10
Q

What nerve can be affected from stirrups?

A

Peroneal nerve

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11
Q

What is the largest overall complication of laparoscopies?

A

Intestinal injuries

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12
Q

When are laparoscopies contraindicated?

A

Pts with increased ICP, tumors, trauma, hydrocephalus

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13
Q

What position will the Pt be in for Gallbladder removal?

A

Reverse Trendelenburg & left

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14
Q

What are the SCIP Abx of choice for most cases?

A

Cefazolin & Cefoxitin (1-2gm IVPB)

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15
Q

A Pt undergoing a Nissen procedure should do what in the morning of Sx?

A

Take his/her PPI meds

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16
Q

Which esophageal dilator is safer to use?

A

Maloney dilator

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17
Q

What position will the Pt be in for a Nissen procedure?

A

Supine, low lithotomy, reverse trendelenburg

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18
Q

What are the 5 F’s stand for?

A
  • Female
  • Forty
  • Fair skin
  • Flatulent
  • Fat
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19
Q

What is given preop for a cholecystectomy Pt?

A
  • Bicitra
  • Prokynetic
20
Q

What procedure has a chance for Sphincter of Oddi spasms?
How is it treated?

A
  • Cholecystectomy
  • Treated with glucagon
21
Q

What are the indications for a spleenectomy?

A
  • ITP: Immune thrombocytopenic purpura
  • hemolytic anemia
  • trauma
  • Lymphoma
22
Q

What should Pts having a spleenectomy have done preoperatively?

A
  • Receive pneumococcal, meningococcal & H influenza vaccinations
  • 1wk preop
23
Q

What kind of access should be established for a spleenectomy?

A

Large bore IV’s (14ga or 16ga)

24
Q

What is the Pt position for a spleenectomy?

A
  • 45 degree right lateral decubitus
  • Kidney rest & table flexed
25
Q

What medications are often given prior to a bowel resection & why?

A
  • Mu-opioid antagonists
  • To help resolve ileus faster
26
Q

What positions could a Pt going for a bowel resection be in

A

Supine or lithotomy

27
Q

What could be damaged during a appendectomy?

A

Nearby lymphnodes

28
Q

What position will a Pt be in for a appendectomy?

A
  • Supine
  • Left arm tucked
  • Trendelenburg
29
Q

What are the downsides of Lap Banding, Sleeve gastrectomy & gastric bypass?

A
  • Lap Band: Band erosion
  • Gastric Sleeve: suture line & overeating
  • Gastric bypass: suture line & malabsorption
30
Q

What are important intraoperative measures for a Pt undergoing a bariatric surgery?

A
  • Good preoxygenation
  • RSI intubation with ETT
  • Remove OGT before stomach sutures/staples
31
Q

Which bariatric surgery has higher dysphagia concerns?

A

Lap Banding

32
Q

What vitamins are affected due to malabsorption?

A
  • A, D, E, K
  • B12
  • Calcium
33
Q

What is important during an open bowel resection in which the bowel is exumed?

A

Keep Pt hydrated as bowel dries out quickly

34
Q

What are indications for conversion to laparotomy?

A
  • Obesity: instruments not long enough
  • adhesions
  • bleeding
  • unclear anatomy
  • staple misfire
  • inability to ventilate d/t CO2 compression
35
Q

What are intraop considerations for Ex-laps?

A
  • GETA
  • Profound muscle relaxation
  • NGT
  • Consider epidural unless emergent
  • Consider multi-modal pain control
  • Keep Warm!!!!
36
Q

What are PONV risk factors?

A
  • Female
  • Laparoscopy or Laparotomy
  • Opioids
  • Volatile anesthetics
37
Q

Pulling on what vaginal structure can lead to bradycardia? How is it treated?

A

Cervix
- Treat or preemtively with Robinol

38
Q

Which GYN surgery does not necessarily call for SCIP Abx?

A

D&C

39
Q

How can uterine bleeding be stopped? What is the side effect?

A
  • With Pitocin (20 units in 500-1000cc given rapidly)
  • Post op pain due to uterine cramping
40
Q

Where is pitocin secreted from?

A

Posterior pituitary gland(neuro-hypophysis)

41
Q

Sorbitol is not good for which type of Pt undergoing a hysteroscopy?
What about glycine?
What about hypotonic solutions?

A
  • Diabetics
  • Liver Pt’s (d/t ammonia build-up)
  • Anemics (d/t hypotonic solutions can cause RBC rupture)
42
Q

How much post-op pain do hysteroscopy Pts typically have?

A

None to minimal

43
Q

What must you have for a Condyloma surgery?

A

Laser evacuation procedures
- Laser mask
- Smoke evacuation from cautery

44
Q

Which GYN surgeries do not necessarily require ETT and can be done using LMA’s?

A
  • Condyloma
  • Urethral slings
  • Repair procedures (Ex: Bladder prolapse)
45
Q

What is the difference between a Partial, total & BSO?

A
  • Partial: Only uterus is removed
  • Total: uterus & cervix are removed
  • BSO: Total + fallopian tubes & ovaries are removed
46
Q

What are the surgical options for hysterectomies?

A
  • Vaginal
  • Abdominal (Pfannenstiel or vertical)
  • LAVH (Laparoscopic assisted vaginal hysterectomy)

Principles of Anesthesia 1 (Summer 2023) (14 decks)

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