Lap Colon Resection

Question 1

Laparoscopic Colon Resection: Surgical Procedure Description
MUA 3- IOS
May create what? CIA
Anastomosis check for leaks

Answer 1

Minimally invasive surgery
small incisions as opposed to opening the entire abdomen.
near the naval and inserts a laparoscope into the abdomen.
pneumoperitoneum is created by inflating the abdominal cavity with CO2 to provide a working space for the surgeon.
Images from the laparoscope are projected onto videomonitors near the OR table.
3-5 more small incisions are made in the abdomen to allow placement of surgical instruments needed for the procedure.
Incisions may need to be enlarged to allow the colon to be pulled out of abdominal cavity.
Once the colon has been repaired or removed, the surgeon reconnects the digestive system.
Surgeon may create an anastomosis, colostomy, or ileostomy.
Abdominal cavity is rinsed out and anastomosis checked for leaks. Incisions closed with sutures or glue.

Question 2

Position for LAP COLON SURGERY (3 ) STL

Answer 2

Under general anesthesia with endotracheal intubation, the patient is placed
SUPINE on the table with
BOTH ARMS TUCKED at the sides to allow more room for the surgeon and assistant to move.
ALSO MAY be in TRENDELENBURG
LITHOTOMY

Question 3

What are the effects of the SUPINE position during LAP COLON SURGERY

Answer 3

The supine position causes the FRC to decrease

Question 4

COLON SURGERY: Trendelenburg position causes an

Answer 4

increase in VCM
venous return,
cardiac output, and MAP, and

decreases in VFP
vital capacity FRC, and pulmonary compliance.

Question 5

Lithotomy position is used in certain colon procedures and the Physiologic changes from pneumoperitoneum
are other anesthetic concerns that need to be monitored (increased SVR, airway pressure, airway
resistance, decreased CO, venous return, FRC, pulmonary compliance, and renal perfusion)

Answer 5

legs are placed in stirrups.

Question 6

DURIG COLON SURGERY , LITHOTOMY position, patients are at higher risk of (DD-PSSF-P

Answer 6

DVT and need prophylaxis.
Damage to the peroneal, sciatic, saphenous, and femoral nerves is common because leg pressing against the
stirrup.
Pressure points need to be padded accordingly.

Question 7

4 2 1 rule

Answer 7

1st 10kg x4
2nd 10kg x 2
remainin gx1

Question 8

NPO fluid resuscitation

Answer 8

ml/hr x #hr NPO
1/2 during 1st hour
1/4 during 2 hour
1/4 during 3 hr

Question 9

Calculating ABL

Answer 9

EBV x start HCT - Final HCT/ Start HCT

Question 10

Calculating EBV male vs female

Answer 10

Male 65ml/kg

Female 75ml/kg

Question 11

Anesthetics plan for LAP COLON SURGERY and rationales

PPPIED

Answer 11

GETA due to 
potential for RSI for SBO
prolonged operative times, and 
induced cardiopulmonary derangements.
extreme patient positioning,
discomfort from pneumoperitoneum,

Question 12

LAP COLON SURGERY Physiologic changes from pneumoperitoneum

Answer 12

increased SvAPAR
SVR, airway pressure, airway resistance
decreased CVFPR
CO, venous return, FRC, pulmonary compliance, and renal perfusion)

Question 13

PREOP for LAP COLON SURGERY
Labs?
Make sure to have IV , why? and do full
Consider this for fluid management guide?

Answer 13

Review patient labs;
–CBC, renal panel, and T&S on hand prior to surgery.
–Obtain at least 2 large bore IV’s if a central line has not been placed. (make sure because arm will be tucked)
–Head to TOE PE
Consider placement of arterial line, as fluid shifts are
common in this type of surgery.

Question 14

What if the patient has an ACUTE ABDOMEN for LAP COLON SURGERY?

Answer 14

If the patient is an acute abdomen an NG tube will be placed before induction to decompress the stomach, otherwise an NG is placed during surgery with surgeon
assistance.

Question 15

What is the recommended Prophylactic ABT for COLON surgery ?

Answer 15

Ertapenem 1g IV is the recommended pre-op antibiotic.

Question 16

Standard induction for LAP COLON SURGERY

Answer 16

Preoxygenate
Lidocaine  1mg/kg
Propofol 2mg/kg
Fentanyl 1mcg/kg
Assess ability to ventilate
Succinylcholine 1mg/kg -> INTUBATE

Question 17

RSI INDUCTION for COLON SURGERY For distended abdomen patient

Answer 17

150 mg IV Ranitidine OR 20 mg IV Pepcid 30-60 minutes before induction
30 ml PO Sodium citrate immediately before induction, preoxygenate, induction with choice of
etomidate 0.3mg/kg, propofol 1.5mg/kg, or ketamine 1.5mg/kg, give
Succinylcholine 1.5mg/kg or Rocuronium 1.2mg/kg
Sellick maneuver (cricoid pressure), intubation,
DO NOT bag-mask ventilate RSI

Question 18

LAP COLON SURGERY Maintenance:

Answer 18

Volatile anesthetics: Isoflurane or Sevoflurane

NDNMB and TOF monitoring to maintain paralysis,, standard monitors, urinary catheter

Question 19

VENTILATION MODE FOR LAP COLON SURGERY

Answer 19

PRESSURE CONTROL VENTILATION

Question 20

Pain CONTROL during LAP COLON SURGERY

Answer 20

TAP BLOCK or LIDOCAINE GTT

Question 21

Emergence: Analgesia with

Answer 21

(NSAIDS, Ketamine, TAP block, epidural)

Question 22

Emergence : (DEWFA)

Answer 22

D/C volatile agents and administer 100% O2, suction, Extubate when hemodynamically stable,
Warm, alert and cooperative
Fully reversed from any muscle relaxants, and has Adequate return of pulmonary function

Question 23

Indicators of Adequate return of Pulmonary function

Answer 23

spontaneously breathing, coughing, pulling adequate tidal volume)

Question 24

Indicators of Adequate return of Pulmonary function

Answer 24

spontaneously breathing, coughing, pulling adequate tidal volume

Question 25

3 POTENTIAL POST OP ISSUES post LAP COLON SURGERY

Answer 25

Shoulder pain
Paralytic Ileus
Anastomotic Leak

Question 26

POST OP ISSUE: LAP COLON SURGERY SHOULDER PAIN and treatment

Answer 26

• due to insufflation of CO2, Treatment: responds well to Ketorolac

Question 27

POST OP ISSUE: LAP COLON SURGERY PARALYTIC ILEUS and s/s / treatment

Answer 27

due to the decrease in intestinal movement caused by the surgeon handling theintestines, or caused by medications such as opioids that slow intestinal movement,

Question 28

POST OP ISSUE: LAP COLON SURGERY ANASTOMOTIC LEAK

Answer 28

Anastomotic leak: most common cause of death after elective colon resection

Question 29

Ileus s/s: (NAA)

Answer 29

N/V abdominal distention, abdominal cramping

Question 30

S/S of anatomotic leaks

Answer 30

s/s: tachycardia, fever, chills, stomach pain, N/V, fluid leaking from incision site

Question 31

Anatomotic leaks Tx (DAS)

AVOID

Answer 31

antibiotics, drainage, surgery

avoid medications that may contribute,Reglan, NG tube decompression, surgery