Laparoscopic Flashcards
How long do lap pt stay in PACU and why?
at least 4 hr – to check CBC to ensure no bleeding
What is most precarious time in lap procedures?
when trocars enter
Who is at increased risk of lap adverse outcomes?
thin/obese, abdominal adhesions
What happens if pt bradys?
if manipulating machines, tell them to pull out/stop. If they’re already in place, you will have to medically manage
When does CO2 level off during lap procedure?
around 40 min into procedure
What is the max pneumoperitoneum pressure?
16-20 mmHg
What are some hemodynamic changes that occur as result of pneumoperitoneum?
INCREASED MAP, HR, QT. DECREASED SV (d/t low venous return
What are some respiratory changes that occur as a result of pneumoperitoneum?
DECREASED FRC, VC, compliance. INCREASED PIPs.
Who is at risk of SQ CO2 and what happens?
BMI < 25, long surgery. Will get increased ETCO2 which increased CBF and causes periph vasodilation, pulm vasoconstriction. Increases risk of arrythmia
What should you manipulate respiratory wise to maintain normocapnia?
MV – increase by 20-30%
What are some GU changes d/t pneumoperitoneum?
increased CrCl, transient decrease in UOP. Can lead to oliguria if high pressures are sustained
What is the mortality rate of lap procedures?
3-5%. 30-50% of injuries are undx. 30% are bowel, vascular
What is trajectory of gas embolism?
gas –> IV –> R heart –> lungs –> increased PAP –> RV failure –> decreased pulm venous return –> decreased LV preload –> decreased CO –> arrest
What are some s/sx of gas embolism?
low ETCO2, low BP, low oxygen, millwheel murmur, EKG changes indicating R heart strain
What is the tx of gas embolism?
flood field with NS, DC insufflation, 100% FiO2, place pt in L lateral decub, aspirate through CVL
