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Principles2 > Laparoscopic surgery > Flashcards

Laparoscopic surgery Flashcards

1
Q

what needle is used for closed technique?

A

Verres

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2
Q

what trocar is used for open technique?

A

Hasson

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3
Q

For closed technique intra-abdominal pressure of how many mmHg or less is a reliable indicator of correct needle placement?

A

10 mmHg or less

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4
Q

what is one test that can be performed to confirm correct placement for closed technique? (SDT)

A

saline drop test

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5
Q

many complications with laparoscopic surgery are seen at what 2 times? (IE, PE)

A

initial entry and pneumoperitoneum establishment

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6
Q

Pneumoperitoneum causes what 3 hemodynamic measurements to increase?

A

HR, MAP, SVR

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7
Q

In what 2 ways does the pneumoperitoneum cause the increase of HR, MAP and SVR? (IAVC, NHR)

A
  1. intraabdominal vessels compression

2. neuroendocrine hormones released (vasopressin and renin)

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8
Q

Pneumoperitoneum causes what 2 hormones to be released?

A

Vasopressin, renin

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9
Q

steep trendelenburg increases or decreases CVP?

A

increases

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10
Q

Does pneumoperitoneum increase or decrease stroke volume?

A

decreases stroke volume

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11
Q

What does pneumoperitoneum decrease and thus decreases stroke volume?

A

venous return

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12
Q

Does pneumoperitoneum prolong or shorten the QT dispersion?

A

prolong

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13
Q

Pneumoperitoneum CO2 is absorbed through what? (PS)

A

peritoneal serosa

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14
Q

misplaced trocar and insufflation can result in development of what? (SE)

A

subcutaneous emphysema

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15
Q

pneumoperitoneum causes the diaphragm to displace cephalad causes what 3 pulmonary measurements to decrease?

A
  1. pulmonary compliance
  2. vital capacity
  3. functional residual capacity
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16
Q

max PCO2 increases how many minutes after insufflation begins?

A

40 minutes

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17
Q

during robotic prostatectomy in steep trendelenburg, pulm compliance decrease what % and peak inspiratory pressure increases what %?

A

decreases 50%, increases 50%

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18
Q

oliguria from pneumoperitoneum occurs from sustained periods of intra-abd pressure greater than how many mmHg?

19
Q

decreases in renal BF results in the release of what hormone?

20
Q

in her table, there is marked decrease in GFR and UO when intraabdominal pressure is at what mmHg?

21
Q

> 50% of laparoscopic complications occur during what? (AE/TI)

A

abdominal entry/trocar insertion

22
Q

what is done when there is a risk of urinary structure damage?

A

foley insertion and methylene blue instillation

23
Q

what is the most sensitive test/monitor for a gas embolism?

24
Q

TEE able to identify a gas emboli as small as how many mL/kg?

25
Q

Changes in doppler sounds and increase PA pressure when gas embolism volume is how many mL/kg?

26
Q

what is the name of the murmur that is a temporary loud, machinery-like churning or splashing d/t mixing of air in the right ventricle?

A

mill wheel murmur

27
Q

where is the mill wheel murmur best heard over? (P)

A

pericardium

28
Q

mill wheel murmur occurs when the gas volume is how many mL/kg?

29
Q

is mill wheel murmur a late or early sign?

30
Q

what are 4 s/s of mill wheel murmur? (IP, C, T, S)

A

increased pressure, cyanosis, tachycardia, syncope

31
Q

how should you position pt with a gas embolism?

A

left lateral decubitus

32
Q

what is the maneuver called when you place a pt on their left lateral decubitus? (DM)

A

durant maneuver

33
Q

what are 8 treatments of a gas embolism? (DCGI, DCN, AO, RP, FSFwNS, AGvCVC, SH,PPoLLD)

A
  1. d/c gas insufflation
  2. d/c N2O
  3. administer 100% O2
  4. release pneumoperitoneum
  5. flood surgical field with NS
  6. aspirate gas via CVC
  7. support hemodynamics
  8. position pt on LLD
34
Q

does a low CVP increase or decrease risk of a venous air embolism?

35
Q

what are the 3 body adjacent body cavities gas can migrate? (P,P,P)

A

pneumothorax, pneumopericardium, pneumomediastinum

36
Q

CO2 can be a peritoneal and diaphragmatic irritant which is seen in postop pain where? (S)

37
Q

prolonged CO2 absorption can cause what 2 things? (H, RA)

A

hypercarbia, respiratory acidosis

38
Q

If you are going to use an LMA, which kind are you going to use?

39
Q

why are you going to use a Pro-Seal?

A

ability to decompress the stomach

40
Q

what are the 3 rules of 15 for an LMA during laparoscopy?

A
  1. < 15 degrees tilt
  2. < 15 cmH2O
  3. < 15 minutes
41
Q

majority of postop pain is day of surgery and is what type of pain? (V)

42
Q

shoulder pain is more likely on what postop day number?

43
Q

PONV in laparoscopic pts is up to what %?

Principles2 (21 decks)

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