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Advanced Anesthesia Test#1 > Laparoscopic > Flashcards

Laparoscopic Flashcards

1
Q

Anesthesia will increase or decrease the metabolic rate of the brain?

A

Decrease

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2
Q

what is the body’s neurohumoral response to lap. surgery?

A

Same as any other type of stress

Increased catacolamine, increased cortisol, increased antidiuretic hormone (ADH)

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3
Q

How does the body’s PRELOAD respond to lap. surgery?

A

decreased

The pressure in the abd. makes it hard for the blood to return

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4
Q

How does the body’s AFTERLOAD respond to lap. surgery?

A

decreased
The pressure in the and. makes it hard for the blood to leave the heart and go to the organs.
Resulting in a higher SBP

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5
Q

How does the body’s Heart Rate respond to lap. surgery?

A

Generally the heart rate will increase due to the release of catacholamines.
BUT it is possible for the heart to have a celiac reflex resulting in bradycardia

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6
Q

How does the body’s blood pressure respond to lap. surgery?

A

the BP is variable

  • in a health heart the BP will increase due to the catacholmine release.
  • In a compensated heart the BP will drop because the heart is unable to overcome the increased afterload.
  • Pts with a decreased EF can not have Laparoscopic surgery*
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7
Q

How does the Cardiac Output respond to Lap. Surgery?

A

CO will increase in a heathy heart due to the catacholamine release.

CO will decrease in a compensated heart due to the afterload

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8
Q

Summarize the cardiovascular changes that occur during lap. surgery.

A
  • decreased venous return (preload)
  • increase systemic vascular resistance (after load)
  • decreased isotropism (due to anesthesia
  • increased intrathoracic pressures resulting in higher peak pressures and increased resistance
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9
Q

What happens to intracranial pressure during lap. surgery?

A

ICP will increase because the blood pools in the head and extremities due to the increased abdominal pressures

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10
Q

neuro contraindication to lap. surgery

A

high ICP

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11
Q

cardiovascular contraindication to lap. surgery

A

low EF

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12
Q

How does the CO2 adsorption in the reap. system increase or decrease during lap. surgery?

A

increase

Generally you will see a 3-7 increase in ETCO2 after approximately 5 min. after inflation of abd.

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13
Q

What changes happen to the pul. compliance during lap. surgery?

A

pul compliance will decrease due to the increased abd. pressure.
You will see increased PP and you may need to decrease you TV to prevent barrowtrauma

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14
Q

What changes will happen to the Intrathoracic compliance during lap. surgery?

A

it will decrease due to abd. pressures increasing

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15
Q

What changes will happen to the peak pressures during lap. surgery?

A

increased

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16
Q

What changes will happen to the FRC during lap. surgery?

A

decrease

17
Q

What changes will happen to the possibility of atelectasis during lap. surgery?

A

increased

*anesthesia is already a risk, but this increases it

18
Q

What changes will happen to the ventilation/perfusion mismatch during lap. surgery?

A

increased

19
Q

What is one technique we can use to decrease the resistance during lap. surgery?

A

Use a larder ET Tube

20
Q

What are the CV and Resp. Effects of the Trendelenburg position?

A
  • Increased venus return
  • decreased lung compactly
  • increase peak pressures
21
Q

What are the CV and Resp. Effects of the Reverse Trendelenburg position?

A
  • decreased Venus Return
  • Monitor their Cerebral BP because it will be lower than arm BP
  • decrease Peak Pressures
  • decreased WOB
22
Q

What are the three major signs that some this wrong with your lap. surgery?

A
  • Decreased Sat
  • Hyptotension
  • Loss of ETCO2
23
Q

What effect does lap. surgery have on Renal Blood Flow?

A
  • SNS will decrease by vasoconstriction

* Pt is already in a hypovolemic state

24
Q

What effect does lap. surgery have on Glomerual Filtration Rate?

A

decreased

25
Q

What effect does lap. surgery have on Renal plasma flow?

A

Decreased

26
Q

What effect does lap. surgery have on Antidiuretic hormone release?

A

increased

27
Q

Ultimately what effect with lap surgery have on urine output

A

decreased

28
Q

What is normal Torr pressure?

A

10-15

29
Q

What effects will having the abd. pressure above 20 cm have?

A
  • hemodynamically compromising
  • hypotension
  • difficulty breathing
30
Q

What techniques can be used to decreases post op pain?

A
  • Pre-emptive Anesthesia by injecting LA before injection
  • More LA @ incision when the surgery is over
  • after extaflation of abd. make the patient take a large breath (like a valsalva) while the surgeon pushes on the abd. to help remove extra CO2
  • . Post-op Medications
31
Q

Pathology of a CO2 embolus

A

Cow gas gets in venus system and moves to the vena cava creating a airlock @ the junction between the bean cava and right atrium.

If the Embolism is large enough, there will be not blood circulating through the heart.

32
Q

Diagnosis of a CO2 embolus

A

the three main s/s

a Mill Wheel Murmur* this is detected @ the 2nd ICS on the Left sternal border

33
Q

Treatment for a CO2 embolus

A

Extaflate
give 100% O2
turn off the anesthesia
Support with Pressers and fluids
position pt in a left lateral decubits position
PLace a central line and ASPIRATE the air

34
Q

Pathology of a pneumothorax

A

Co2 gas migrates into the intrathorasic space either through the diaphragm or trauma caused by barrowtrauma (resulting from increased PP or disease)

35
Q

Diagnosis of pneumothorax

A 
the three main s/s
NO breath sounds on effected side
Wheezing
increased PP
Early HTN
Late hypotension due to hypoxema and acidotic
36
Q

Treatment for a pneumothorax

A 
Extaflate
give 100% O2
turn off the anesthesia
*** CT ****
support with fluid and pressers if needed

Advanced Anesthesia Test#1 (4 decks)

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