Laparoscopic Flashcards
Anesthesia will increase or decrease the metabolic rate of the brain?
Decrease
what is the body’s neurohumoral response to lap. surgery?
Same as any other type of stress
Increased catacolamine, increased cortisol, increased antidiuretic hormone (ADH)
How does the body’s PRELOAD respond to lap. surgery?
decreased
The pressure in the abd. makes it hard for the blood to return
How does the body’s AFTERLOAD respond to lap. surgery?
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
How does the body’s Heart Rate respond to lap. surgery?
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
How does the body’s blood pressure respond to lap. surgery?
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*
How does the Cardiac Output respond to Lap. Surgery?
CO will increase in a heathy heart due to the catacholamine release.
CO will decrease in a compensated heart due to the afterload
Summarize the cardiovascular changes that occur during lap. surgery.
- 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
What happens to intracranial pressure during lap. surgery?
ICP will increase because the blood pools in the head and extremities due to the increased abdominal pressures
neuro contraindication to lap. surgery
high ICP
cardiovascular contraindication to lap. surgery
low EF
How does the CO2 adsorption in the reap. system increase or decrease during lap. surgery?
increase
Generally you will see a 3-7 increase in ETCO2 after approximately 5 min. after inflation of abd.
What changes happen to the pul. compliance during lap. surgery?
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
What changes will happen to the Intrathoracic compliance during lap. surgery?
it will decrease due to abd. pressures increasing
What changes will happen to the peak pressures during lap. surgery?
increased
What changes will happen to the FRC during lap. surgery?
decrease
What changes will happen to the possibility of atelectasis during lap. surgery?
increased
*anesthesia is already a risk, but this increases it
What changes will happen to the ventilation/perfusion mismatch during lap. surgery?
increased
What is one technique we can use to decrease the resistance during lap. surgery?
Use a larder ET Tube
What are the CV and Resp. Effects of the Trendelenburg position?
- Increased venus return
- decreased lung compactly
- increase peak pressures
What are the CV and Resp. Effects of the Reverse Trendelenburg position?
- decreased Venus Return
- Monitor their Cerebral BP because it will be lower than arm BP
- decrease Peak Pressures
- decreased WOB
What are the three major signs that some this wrong with your lap. surgery?
- Decreased Sat
- Hyptotension
- Loss of ETCO2
What effect does lap. surgery have on Renal Blood Flow?
- SNS will decrease by vasoconstriction
* Pt is already in a hypovolemic state
What effect does lap. surgery have on Glomerual Filtration Rate?
decreased
What effect does lap. surgery have on Renal plasma flow?
Decreased
What effect does lap. surgery have on Antidiuretic hormone release?
increased
Ultimately what effect with lap surgery have on urine output
decreased
What is normal Torr pressure?
10-15
What effects will having the abd. pressure above 20 cm have?
- hemodynamically compromising
- hypotension
- difficulty breathing
What techniques can be used to decreases post op pain?
- 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
Pathology of a CO2 embolus
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.
Diagnosis of a CO2 embolus
the three main s/s
a Mill Wheel Murmur* this is detected @ the 2nd ICS on the Left sternal border
Treatment for a CO2 embolus
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
Pathology of a pneumothorax
Co2 gas migrates into the intrathorasic space either through the diaphragm or trauma caused by barrowtrauma (resulting from increased PP or disease)
Diagnosis of pneumothorax
the three main s/s NO breath sounds on effected side Wheezing increased PP Early HTN Late hypotension due to hypoxema and acidotic
Treatment for a pneumothorax
Extaflate give 100% O2 turn off the anesthesia *** CT **** support with fluid and pressers if needed
