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Nur 943 OB > FINAL Robotics > Flashcards

FINAL Robotics Flashcards

1
Q

Advantages of minimally invasive surgery
________ surgical incision and stress response
_________ postop pain and opioid requirements
Preserves __________ function
_______ return of bowel function
______ wound related complications
______ ambulation
______ hospital stays
______ return to normal activities and work
_______ health cost

A

Minimizes surgical incision and stress response
Decreases postop pain and opioid requirements
Preserves diaphragmatic function
Earlier return of bowel function
Fewer wound related complications
Earlier ambulation
Shorter hospital stays
Early return to normal activities and work
Reduces health cost

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2
Q

2 Techniques with laparoscopic surgery

A

Closed and Open techniques

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3
Q

The closed technique uses a spring-loaded needle called the

A

Veress Needle

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4
Q

The open technique is also called the

A

Hasson

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5
Q

Application of Laparoscopy (General Surgery)

A 
Diagnosis
Evaluation of abd trauma
Lysis of adhesions
Cholecystectomy
Appendectomy
Inguinal hernia repair
Bowel resection
Esophageal reflux surgery
Splenectomy
Adrenalectomy
Bariatric Surgery- All types
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6
Q

Application of Laparoscopy (GYN surg)

A 
Diagnosis
Lysis of adhesions
Fallopian- tube surgery (sterilization, ectopic pregnancy)
Fulguration of endometriosis
LAVH
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7
Q

Application of Urologic Surgery

A

Nephrectomy

Variocele

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8
Q

Hemodynamic effects of minimally invasive surgery

______ systemic vascular resistance and mean arterial pressure (MAP) d/t (3 things)

A

Increased
Hypercarbia
Neuroendocrine response (e.g., catecholamines, vasopressin, cortisol)
Mechanical factors (like direct compression of aorta)

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9
Q 
Hemodynamic effects of minimally invasive surgery
Variable change (\_\_\_\_\_ or no change) in cardiac filling volumes d/t (1 thing)
A

increased or no change

compression of intra-abdominal organs (ie. liver and spleen)

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10
Q 
Hemodynamic effects of minimally invasive surgery
Variable change (\_\_\_\_\_\_ or no change) in cardiac index d/t (3 things)
A

decreased or no change
Increased afterload
Decreased Venous return
Cardiac Filling

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11
Q

Hemodynamic effects of minimally invasive surgery
Cardiac Dysrhythmias (_____ or _____ cardia)
D/t (5 things)

A 
Brady or Tachycardia
Peritoneal stretch
Hypercarbia
Hypoxia
Capnothorax
Pulmonary Embolism
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12
Q

Limit IAP to _____mmHg to minimize CV effects

A

12-15

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13
Q

MAP, SVR and HR will ____ during insufflation

A

Increase

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14
Q

Insufflation: CO _______ due to ___HR and ___ venous return with T-Burg positioning

A

CO maintained
Increased
Increased

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15
Q

Insufflation can cause PR ______

A

prolongation

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16
Q

Regional circulatory changes during laparoscopy
________ cerebral perfusion and intracranial pressure
_______splanchnic blood flow
________ or no change in bowel perfusion
_________ hepatic blood flow
_________ renal perfusion and urine output
__________femoral vein flow

A

Increased cerebral perfusion and intracranial pressure
Decreased splanchnic blood flow
Decreased or no change in bowel perfusion
Decreased hepatic blood flow
Reduced renal perfusion and urine output
Decreased femoral vein flow

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17
Q

Renal Function during Laparoscopy

Urine output is ______ d/t

A

reduced
Decreased renal blood flow
Compression of renal parenchyma
Neuroendocrine

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18
Q

Factors that influence urine output (3)

A

Pre-existing renal compromise
Longer insufflation times
High intra-abdominal pressures

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19
Q

Intraoperative oliguria is reversible within ___hours postoperatively

A

2 hours

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20
Q

IAP

A

<15

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21
Q 
Pulmonary changes during laproscopy
Diaphragm \_\_\_\_\_\_\_
\_\_\_\_\_\_\_ lung volumes
\_\_\_\_\_\_\_\_\_\_ventilation/perfusion mismatch
\_\_\_\_\_\_\_\_\_ alveolar-arterial oxygen gradient
\_\_\_\_\_\_\_ lung compliance and \_\_\_\_\_\_\_ resistance
\_\_\_\_\_\_\_ pleural pressures
\_\_\_\_\_\_\_\_ airway pressures
\_\_\_\_\_\_\_ gas distribution
\_\_\_\_\_\_\_ displacement of carina
\_\_\_\_\_\_\_\_\_\_ intubation
A 
Diaphragm elevated
Decreased lung volumes
Increased ventilation/perfusion mismatch
Increased alveolar-arterial oxygen gradient
Decreased lung compliance and increased resistance
Increased pleural pressures
Increased airway pressures
Uneven gas distribution
Cephalad displacement of carina
Endobronchial intubation
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22
Q

Creation of pneumoperitoneum ( carbon dioxide insufflation and intra-abd pressure) can cause (three areas for problems)

A

Hemodynamic
Pulmonary
Neurohumoral Resonse

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23
Q

Signs and Sx of Gas Embolism

A 
Decreased ETCO2
Increased ETN2
Increased PAP
Hypotension
Dysrhythmias
Cyanosis
Hypoxia
Pulmonary Edema
"Mill Wheel" murmur
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24
Q

Tx for Gas Embolism

A 
D/C gas insufflation
D/C N20
Administer 100% O2
Release pneumoperitoneum
Flood surgical field with NS
Position Pt in Left Lateral decubitus position
Attempt to aspirate gas via CVP
Supportive measures to maintain hemodynamics
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25
Q

Laparoscopic Surgery
_____ is the drug of choice
____ ETT to facilitate ventilation and prevent aspiration
_____ MV by _______% to offset Co2 absorption and maintain ETCO2 at _______mmHg

A

Propofol
Cuffed
15-35%
35-45mmHg

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26
Q

What vent mode is best for laparoscopic surgery

A

PCV

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27
Q

What is the “15” rule with laparoscopic surgeries

A

Keep surgery under 15 mins
Keep bed tilt under 15 decrees
Keep IAP under 15mmHg

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28
Q

Can you use N2O with laparoscopic surgery?

A

Sure- Barash found no convincing reason to eliminate it and Naglenuts says the jury is still out.

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29
Q

Intra op opioids can cause opioid induced ____ of sphincter of Oddi. Antagonize with _____

A

spasm

Glucagon

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30
Q

Muscle relaxants ____ IAP needed for same degree of abdominal distention.

A

decrease

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31
Q 
Laparoscopic positioning
Upper abd procedures (gallbladder)-
Lower abd procedures (appendix)-
Pelvic surgery- 
Urologic (renal) -
A

Upper abd procedures (gallbladder)- Reverse Tburg
Lower abd procedures (appendix)- Tburg
Pelvic surgery- Lithotomy
Urologic (renal) - lateral or semilateral with flexion

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32
Q

Benefits of robotic surgery

A

Less pain and trauma
Shorter Hospital Stay
Quicker Recovery
Better cosmetic result

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33
Q

1st surgical robot defice used in _____ on _____ _____ surgery.

A

1980s

Stereotactic Brain Surgery

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34
Q

1st type of robotic surgical system, capable of highly precise ______ tasks. (autonomous or not?) Used for orthopedic and neurosurgery.

A

repetitive

yes- autonomous

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35
Q

2nd type of robotic surgical system and example.
Used to Control instrument location and guidance
Autonomous or not?

A 
Assist Device (AESOP)
Not autonomous- needs ques from an operator
36
Q

3rd Type of robotic surgical system
Mimics operator’s hand motions in exact or scaled motion.
Examples-

A

Telemanipulator

Da Vinci and ZEUS

37
Q

Components of the Da Vinci System

A

Surgeon Console
Patient-side cart
EndoWrist instuments
Optical vision tower

38
Q

Each Da Vinci system has __ monitors, each displaying ___ channel of stereo endoscope creating a ____ image

A

2
1
3D

39
Q

Da Vinci has ____ arms, manipulated by the surgeon
1st 2 arms are ________ and holds ________
3rd arm positions _______
4th is option and allows surgeon to _______

A 
4
the surgeons R and L arm
instruments
endoscope
perform additional tasks
40
Q

Once instruments are engaged to robot arms and inside patient, body cannot ______ until_______

A

be moved

instruments are disengaged and removed from body cavity

41
Q

EndoWrist instruments have ___ degrees of motion

describe these

A

7
3 arm movements (in/out, up/down, side to side)
3 wrist movements (yaw side to side and L to R, Pitch up/down, Roll)
7th is grasping or cutting

42
Q

Complications with robotic surgery
Most are similar to ________ procedures
Exception- Steep _______position (30-45deg like with robotic-assisted prostatectomy)
Risk for tracheal _______
Facial, pharyngeal and laryngeal ______ leading to upper airway obstruction
Combat this with ____ fluid administration to minimize edema

A 
laparoscopic
Head-Down
displacement
edema
decreasing
43
Q

Prolonged head down and increased IAP with large amount of crystalloid leads to (r/t eyes)

A

increased venous congestion in optic canal and decreased optic nerve perfusion.

44
Q

Prolonged caudad displacement of shoulders leads to

A

brachial plexus injury

45
Q

Branch of medicine concerned with the correction or prevention of deformities, disorders, or injuries of the skeleton and associated structures (tendons and ligaments)

A

Orthopedic Surgery

46
Q

Anesthetic plan for orthopedic surgeries should be based on these factors (6)

A 
Type of surgery
How Long
Patient preference
Airway challenges 
Position of patient
Comorbidities
47
Q 
Advantages of RA over GA with Orthopedic Surgery
\_\_\_\_\_\_\_\_\_\_Rehab
More Rapid hospital \_\_\_\_\_\_\_\_ 
Improved postop \_\_\_\_\_\_\_\_\_\_
Decreased incidence of \_\_\_\_\_\_\_
Less Respiratory and Cardiac \_\_\_\_\_\_\_\_\_
Improved \_\_\_\_\_\_\_ via sympathetic block
\_\_\_\_\_\_\_ blood loss
\_\_\_\_\_\_\_\_\_\_\_\_ risk of thromboembolism
A 
Enhanced Rehab
More Rapid hospital dismissal 
Improved postop analgesia
Decreased incidence of N+V
Less Respiratory and Cardiac Depression
Improved Perfusion via sympathetic block
Reduced blood loss
Decreased risk of thromboembolism
48
Q

Spinal Surgery
_____ cervical segment is the most important for evaluating cervical spine injury
Controls motor function of which 4 muscles

A 
5th
Deltoid
Biceps
Brachialis
Brachioradialis
49
Q

If D_______, B______, B_______, B_______. muscles are flaccid then the ________ nerve is involved with ________ _________ paralysis.

A

Deltoid, Biceps, Brachialis, Brachioradialis (DBBB)
5th Cervical Nerve
Partial Diaphragmatic Paralysis

50
Q

Complete lesion at _________ is incompatible with survival.

A

Cervical 4th segment

51
Q

Sux is safe for ____hours after spinal cord injury (paralysis) so avoid it after this time.
D/t?

A

48hrs

Risk for Hyperkalemia

52
Q

Transections above T5 can cause

A

Autonomic Hyperreflexia

53
Q

Sx of Autonomic Hyperreflexia

A 
Paroxymal hypertension
Bradycardia
Dysrhythmias
Cutaneous Vasoconstriction below Injury
Vasodilation above injuy
54
Q

Tx for Autonomic hyperreflexia

A

Remove Stimulus
Deepen Anesthesia
Direct-Acting Vasodilator

55
Q 
These are complex or noncomplex procedures?
Vertebroplasty
Kyphoplasty
Cervical Discectomy
Foraminectomy
A

Noncomplex

56
Q

Wilson Frame
Jackson Table
Chest Rolls
are use to provide what during spinal surgeries?

A

Support

57
Q 
Spinal Stenosis
Spondylosis
Spondyloisthesis
Intervertebral disc herniation 
are all what types of disease?
A

Degenerative Vertebral Column Disease

58
Q

Cervical Laminectomy anterior approach will be ____ position

A

Supine

59
Q

Cervical laminectomy posterior approach will be _____ or _____ position.

A

Sitting or Prone

60
Q

Thoracolumbar laminectomy will be _____ position

A

prone

61
Q

Advantages of Pneumatic Tourniquet

A

Minimize Blood Loss
Identify Structures
Expedite Case
Bloodless Field

62
Q

______ and ______ influenced by duration of pneumatic tourniquet insufflation

A

Tissue hypoxia and acidosis

63
Q

TQ insufflation: Maximum of ____ hours is considered safe

A

2

64
Q

Deflation of TQ results in release of _______ and can cause (5 things)

A 
METABOLIC WASTE
Metabolic acidosis
Hyperkalemia
Myoglobinemia
Myoglobinuria
Renal Failure
65
Q

TQ, use pressure _____x ______BP to reduce nerve pain. Or just use _______mmHg above BP

A

2x Systolic BP

100mmHg

66
Q

TQ: ________ mins to see ischemic pain with is resistant to ______/_______

A

45-60mins

analgesia/anesthesia

67
Q

minimally invasive procedure to examine or repair damage to a joint through an arthroscope

A

Arthroscopy

68
Q

Anesthetic technique with arthroscopy

Consider—

A

Peripheral Nerve blocks
Periarticular injections
NA
GA

69
Q

Shoulder scope- has greater risk of

A

subcut emphysema
tension pneumothorax
pneumomediastium

70
Q

Surgical replacement of all (total) or part (hemi) of a jont with goal of restoring natural motion and function

A

Arthoplasty

71
Q

Bone Cement also known as

A

Methyl methacrylate (MMA)

72
Q

Bone Cement Implantation Syndrome presents as

A 
Hypoxia
Hypotension
Cardiac Arrhythmias
Increased pulmonary vascular resistance
Unexpected LOC during regional
Cardiac Arrest
Drop in ETCO2 during GA
73
Q

Etiology of Bone Cement Implantation Syndrome

A

Histamine Release
Complement Activation
Endogenous Cannabinoid-mediated vasodilation

74
Q

Bone Cement Implantation Syndrome is most common in ____ arthroplasty

A

Hip

75
Q

Hip Arthroplasty

_____ position requires large incision through large muscle groups

A

Lateral

76
Q

Hip Arthroplasty
_______ approach requires special bed, smaller incision but has greater blood loss
Will be in _____ position

A

Anterior

Supine

77
Q

Hip Arthroplasty

Avoid _____ due to risk for air entrapment

A

N20

78
Q

Hip Arthroplasty

Preferred anesthetic

A

Regional

79
Q

Hip Arthroplasty

Avg blood loss

A

500-1000ml

80
Q

Hip Arthroplasty

Average blood loss

A

500-1000ml

81
Q

Hip Arthroplasty

Revisions are associated with _______ blood loss

A

much greater

82
Q

Indications for shoulder arthroplasty

A 
posttraumatic brachial plexus injuries
paralysis of deltoid muscle
rotator cuff injury
chronic infection
failed revision
severe refractory instability 
bone deficiency
83
Q

Shoulder Arthroplasty will be done in ______ or ______ position

A

Beach Chair

Lateral

84
Q

Beach chair is associated with _____in cerebral perfusion which can lead to (3 things)

A

decrease

blindness, stroke, and brain death

85
Q

Present within 72 hours of long bone or pelvic fractures

A

Fat embolism syndrome

86
Q

Diagnosis of Fat Embolism Syndrome

A

Petechiae on chest, upper extremities, axilla and conjunctiva
Decreased ETCO2 and arterial 02 sat
Increased PAP
ST changes on ECG

87
Q

Management of Fat Embolism Syndrome

A

Preventive and supportive

Oxygen with CPAP ventilation

Nur 943 OB (11 decks)

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