Lap & Gyn (Part 1)

Question 1

Laparoscopic surgery, once a groundbreaking innovation, is now the standard of care for what procedures? (4)

Answer 1

• cholecystectomy
• appendectomy
• bariatric surgery
• complex oncological resections

Question 2

what are the benefits to laparoscopic surgery? (4)

Answer 2

• minimally invasive
• reduces postoperative pain
• accelerates recovery
• decreases morbidity

Question 3

what specific physiological stresses can occur with laparoscopic surgery (2)

Answer 3

creation of pneumoperitoneum
extreme patient positioning

Question 4

Robotic-assisted surgery is usually of what nature? (4)

Answer 4

• urology
• gynecology
• colorectal surgery
• thoracic

Question 5

benefits of the Da Vinci (3)

Answer 5

• improved precision
• dexterity
• visualization

Question 6

Robotic systems complicates anesthetic management due to
(3)

Answer 6

• the limited access to the patient once the robotic arms are docked
• the prolonged duration of surgeries
• physiological strain induced by steep Trendelenburg positioning, especially during pelvic surgeries

Question 7

Pneumoperitoneum introduces significant ____________.

Answer 7

cardiovascular changes

Question 8

The insufflation of carbon dioxide (CO2) into the peritoneal cavity raises intra-abdominal pressure (IAP), typically to ____________________

Answer 8

12-15 mmHg.

Question 9

what does an increase in intra-abdominal pressure cause?

Answer 9

Increase in IAP compresses the inferior vena cava (IVC): reducing venous return and, consequently, decreasing preload

*In patients with compromisd cardiac function, compensatory mechanisms may be insufficient. *

Question 10

in a patient with severe aortic stenosis, the patient relies heavily on

Answer 10

a fixed preload to maintain adequate stroke volume

Question 11

Hemodynamic instability can occur rapidly if

Answer 11

preload is not carefully maintained

Question 12

how can preload be maintained? (3)

Answer 12

• appropriate fluid management
• inotropic support
• reducing the pneumoperitoneum pressure temporarily.

Question 13

CO2 insufflation triggers the release of ____________ leading to ____________

Answer 13

catecholamines; vasoconstriction and increased afterload.

Question 14

In patients with left ventricular hypertrophy (LVH) or diastolic dysfunction, an increase in afterload ….

Answer 14

exacerbates the workload on an already stiff left ventricle

Question 15

Patients may struggle to maintain stroke volume, leading to… (3)

Answer 15

• diastolic heart failure
• pulmonary edema
• increased myocardial oxygen consumption.

Question 16

Transesophageal echocardiography (TEE) can be a useful tool to monitor:

Answer 16

• ventricular filling pressures
• wall motion abnormalities
• the adequacy of preload and afterload management in real time.

Question 17

CO2 absorption during pneumoperitoneum can lead to …

Answer 17

hypercarbia, which directly affects the cardiovascular system by increasing sympathetic nervous system activity.

Question 18

what does hypercarbia do to the cardiovascular system?

Answer 18

Hypercarbia induces vasodilation in most vascular beds, but paradoxically, it also increases heart rate and blood pressure due to the stimulatory effect on the sympathetic nervous system.

Question 19

In patients with coronary artery disease, the combination of increased heart rate, increased myocardial oxygen demand, and reduced coronary perfusion (due to higher SVR) can precipitate ____________ during pneumoperitoneum

Answer 19

myocardial ischemia

Question 20

What respiratory changes may develop when PaCO2 rises above 60 mmHg

Answer 20

Where PaCO2 rises above 60 mmHg, we may see a mixed respiratory and metabolic acidosis develop, further complicating the hemodynamic picture.

Question 21

Patients with pre-existing lung disease, such as chronic obstructive pulmonary disease (COPD) or restrictive lung disease, are particularly vulnerable to elevated PaCo2 because ____________

Answer 21

their ability to clear CO2 is already compromised.

Question 22

Patients with pre-existing lung disease may require what ventilatory management if they have an elevated PaCO2?

Answer 22

-increased respiratory rates
- higher tidal volumes
- conversion to pressure-controlled ventilation to prevent barotrauma

Question 23

Consider a patient with a history of a recent myocardial infarction, now presenting for a laparoscopic colon resection.
What might you see?

Answer 23

• CO2 insufflation begins and the patients end-tidal CO2 rises to 50 mmHg
• HR increases from 75 to 100 bpm
• EKG begins to show subtle ST-segment depression

(This is a classic scenario where hypercarbia, combined with increased afterload, is exacerbating myocardial ischemia.)

Question 24

Immediate interventions (3) for myocardial ischemia caused by hypercarbia

Answer 24

• increasing minute ventilation to reduce PaCO2
• administering beta-blockers to slow heart rate and reduce myocardial oxygen demand,
• possibly reducing pneumoperitoneum pressure to alleviate the hemodynamic stress.

Question 25

what does Trendelenburg position do to the cardiovascular system?

Answer 25

Question 26

immediate management for acute pulmonary edema (3)

Answer 26

• placing the patient in reverse Trendelenburg to decrease venous return,
• administering diuretics to reduce preload
• nitroglycerin to reduce afterload.

Question 27

manifestations of acute pulmonary edema (2)

Answer 27

• frothy secretions in the endotracheal tube
• a sudden drop in oxygen saturation.

Question 28

The creation of a pneumoperitoneum leads to significant changes in respiratory mechanics due to ____________

Answer 28

the elevation of the diaphragm.

Question 29

what does elevation of the diaphragm do to FRC

Answer 29

This reduces functional residual capacity (FRC), particularly affecting the dependent lung regions.

Question 30

As the diaphragm is pushed upwards, lung compliance decreases, which … (2)

Answer 30

• increases airway pressures
• reduces tidal volumes.

Question 31

a decreased lung compliance from upward push of diaphragm is pronounced in what patient populations?

Answer 31

• obese patients, where baseline FRC is already reduced,
• patients with restrictive lung diseases, where lung compliance is further impaired.