Laparoscopy

Question 1

What are the advantages to performing laparoscopic

surgery over open surgical procedures?

Answer 1

Less conspicuous scars, less postoperative pain, shorter
hospitalization, and decreased cost.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1040.

Question 2

During a laparoscopy, the patient develops
subcutaneous emphysema in the neck and face.
What do you suspect is the cause?

Answer 2

Pneumothorax, which is life-threatening situation during
laparoscopy, may present as subcutaneous emphysema,
hypotension, hypoxia, and cardiovascular collapse. The risk is
higher in lower esophageal procedures.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1041.

Question 3

How does the ETCO2 change during laparoscopy?

Answer 3

The ETCO2 increases. The CO2 used for insufflation of the
abdomen is highly soluble and will dissolve across tissues into
the bloodstream. The ETCO2 can increase as much as 30%,
requiring an increase in ventilation as much as 30% to maintain
normocapnia.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1041.

Question 4

What are two proposed reasons for avoiding nitrous

oxide during laparoscopy?

Answer 4

1. Nitrous oxide diffuses into the abdominal cavity in an amount
   sufficient enough to support combustion. 2. Should a CO2
   embolus occur, the nitrous oxide will diffuse into the CO2
   bubble rapidly, expanding it and worsening the threat to the
   patient.
   Longnecker DE, Newman MF, Brown DL, Zapol WM.
   Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1042.

Question 5

When performing a pneumoperitoneum, the

abdomen is usually inflated to what pressure?

Answer 5

Between 12 and 15 mm Hg (17-22 cm H2O)
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1041.

Question 6

What cardiac effects are seen with insufflation of the

abdomen?

Answer 6

The central venous pressure increases, left ventricular function
and cardiac output decrease, and the systemic vascular
resistance and mean arterial pressure increase with insufflation
of the abdomen. Higher insufflation pressures (>25 cm H2O or
18 mm Hg) can cause severe compression of the major
abdominal veins which reduces venous return, preload, cardiac
output, and blood pressure more significantly.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1041.

Question 7

What two factors are responsible for most of the
hemodynamic changes associated with laparoscopic
surgery?

Answer 7

The instillation of CO2 into the abdomen and the tilting of the
patient to facilitate visualization and instrumentation of the
abdomen
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1041.

Question 8

What are the major respiratory complications that
can occur from placing the patient in Trendelenburg
position to facilitate visualization during laparoscopy?

Answer 8

The head-down position places the weight of the abdominal
contents against the diaphragm and reduces vital capacity.
Right mainstem intubation can occur as the patient is moved
into Trendelenburg position.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1041.

Question 9

What is a pneumoperitoneum?

Answer 9

This is a deliberate condition where CO2 is instilled into the
abdomen to facilitate visualization and manipulation of the
abdominal contents.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1041.