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
What injuries are associated/increased with robotic procedures?
eye
What are some negative outcomes from trendelenburg positioning?
increased diaph pressure which decreases lung expansion, decreased venous drainage which leads to increased ICP, increased IOP in glaucoma pt, baroreceptor activation, shoulder pain
