Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

931: Advanced Principles of Anesthesia I > Laprascopic and robotic assisted surgery- part II > Flashcards

Laprascopic and robotic assisted surgery- part II Flashcards

1
Q

The following types of surgeries can be performed laprascopically

A

gastric, colonic, splenic, hepatic, gallbladder, gynecologic, and urologic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Relative contraindications to laparoscopic surgery includes:

A 
increased ICP
hypovolemia
Severe CV disease
Severe respiratory disease
dense adhesions
V/P shunt or peritoneal jugular shunt (LaVeen)- found in abdomen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Advantages to laparoscopic surgery includes

A

lower pain scores and opioid requirement, earlier ambulation and return to normal activities, lower incidence of post-operative ileus, faster recovery, shorter LOS, lower cost, decreased stress response, reduced postoperative pulmonary dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Disadvantages to laparoscopic surgery include

A

impaired visualization, expensive equipment, requires specific surgical skill, limited range of motion, altered depth perception, no tactile sensation, increased PONV, referred pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Laparoscopic surgery can be used for

A

diagnostic and surgical intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Laparoscopic surgery uses

A

insufflation of the abdomen (carbon dioxide), views of abdominal contents through small incisions, use of small instruments through trocars, camera projects images on monitor screen, minimally invasive surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A pneumoperitoneum can be created using

A

carbon dioxide (most common)
inert gases
or gasless laparoscopy (better for hemodynamically unstable patients but not commonly used)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

As compared to air, helium, oxygen, or nitrous oxide,

A

CO2 is more soluble in blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CO2 pneumoperitoneum is

A

non-combustible
colorless, odorless, inexpensive
eliminated via respiration
easily absorbed by the tissue (high blood solubility) with rapid elimination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The most important aspect regarding insufflation is

A

the need to communicate with the surgeon if the patient cannot tolerate due to pulm or CV issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the respiratory effects of pneumoperitoneum?

A

reduced FRC, reduced compliance, increased ventilatory pressures, barotrauma, atelectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the CV effects of pneumoperitoneum?

A

sympathetic stimulation= HTN, tachycardia
impaired venous return= hypotension
vagal stimulation= arrhythmias, bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the renal effects of pneumoperitoneum?

A

reduced renal perfusion, activation of RAAS, increased ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the gastric effects of pneumoperitoneum?

A

increased intra-abdominal pressure, risk of gastric regurgitation, splanchnic ischemia, embolus, extra-peritoneal spread of CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The physiologic effects of pneumoperitoneum include decreased

A

Cardiopulmonary function, cardiac output, venous return, FRC, VC, and renal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The physiologic effects of pneumoperitoneum include increased

A

PaCO2, EtCO2, PAP, MAP, SVR, HR, CVP, IAP, ICP, Vd (dead space), regurgitation/aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

To manage the pulmonary changes with pneumoperitoneum, we can

A

degree degree of trendelenburg, modify ventilatory settings (pressure control), use PEEP with caution, consider increasing volatile, consider bronchodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

To manage the CV changes of pneumoperitoneum, we can

A

do slow, gradual abdominal insufflations, vent abdomen if IAP >20 mmHg, evaluate intravascular volume, consider treatment for preexisting cardiac dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

To manage the renal changes of pneumoperitoneum, we can

A

closely monitor UOP, administer IVF boluses, consider diuretics, maintain IAP <15 mmHg

20
Q

To manage the cerebral changes of pneumoperitoneum, we can

A

decrease degree of trendelenburg (adjust head up), vent abdomen if IAP >20 mmHg

21
Q

The best way to avoid CV compromise with laparoscopic surgery is

A

IAP <15 mmHg

22
Q

Invasive arterial lines should be used for patients undergoing laparoscopic surgery with

A

ASA III-IV, or abnormal PaCO2/EtCO2 gradient, for BP/serial ABGs

23
Q

The typical surgical type for laparoscopic surgery is

A

GA with cuffed ETT

RA has been used- need high block T4-5 (SNS denervation) more difficult to compensate for CV/resp changes

24
Q

The type of ventilation used for laparoscopic surgery is

A

controlled ventilation
increased MV and PIP often required
adjust RR, Vt 6-8 mL/kg, PEEP 5-10 cmH20
Goals: EtCO2= 35 mmHg, PIP, low 30s cm H20

25
Q

The benefit of doing a general with ETT for laparoscopic surgery is

A

secure airway

control of ventilation

26
Q

The benefit of using an LMA for laparoscopic surgery is

A

spontaneous ventilation, lower incidence of sore throat, lower pain scores, less analgesics, less PONV
-unable to secure airway (aspiration risk), control ventilation, administer muscle relaxation

27
Q

When positioning for laparoscopic surgery, it is important to

A

prevent nerve injury- common peroneal nerve (lithotomy), & brachial plexus (shoulder braces, arm position)
tilt not to exceed 15-20 degrees
make changes slowly
recheck ETT position after every position change
fluid replacement in Trendeleburg (edema)

28
Q

Conversion to an open procedure consists of

A

supine position
new fluid plan due to increased 3rd space losses
new pain management plan
new ventilator settings- reduce rate, increase Vt

29
Q

For the maintenance of anesthesia for laparoscopic surgery, it is important to

A

avoid nitrous oxide (could expand bowel lumen)
consider propofol-based TIVA if PONV, balance techniques with volatile agent, opioids, TIVA; muscle relaxation?, careful monitoring of pulmonary and hemodynamic status, watch for ETT during position changes

30
Q

Describe the pathophysiology of a gas embolism.

A

depends on size of bubbles & rate of entrainment
vapor lock in vena cava & RA, obstruction to venous return, acute RV hypertension=paradoxical embolism-> circulatory collapse

31
Q

Intraoperative complications of laparoscopic surgery includes

A

vascular injury, GI injury, cardiac, SQ emphysema, CO2 embolism

32
Q

GI injuries present during laparoscopic surgery include

A

bowel, liver, spleen, mesenteric

33
Q

Vascular injury during laparoscopic surgery is a result of

A

trocar insertion and can result in injury to the aorta, IVC, iliac vessels, cystic/hepatic arteries, retroperitoneal hematoma

34
Q

Cardiac issues that present during laparoscopic surgery include

A

dysrhythmias, increased vagal tone, BP changes

35
Q

CO2 embolism can be a result of

A

direct needle placement in vessel, gas insufflation into abdominal organ

36
Q

SQ emphysema is a result of

A

extra-peritoneal insufflation

37
Q

Capnothorax, capnomediastinum, and capnopericardium can be a result of

A

diaphragm defect, plural tear, bullae rupture

38
Q

Diagnosis of a gas embolism is via:

A

ideal world: TEE, Swan Ganz catheter, precordial doppler
Real world: pulse oximetry (hypoxemia), esophageal stethoscope-Millwheel sound, sudden EtCO2 decrease, aspiration of gas from CVP, hypotension, bronchospasm, increased PIP

39
Q

Treatment of a gas embolism is:

A 
stop insufflation and desufflate
steep Trendelenburg and left lateral decubitus
D/C nitrous oxide and give 100% FiO2
Hyperventilate
Place CVP
CPR
Consider CPB
40
Q

Subcutaneous emphysema is a result of ____ & can be identified by

A

accidental insufflation of extraperitoneum

be aware of increases in PaCO2 after plateau has been reached

41
Q

Subcutaneous emphysema is NOT

A

a contraindication for extubation

it can track to thorax & mediastinum and result in capnothorax or capnomediastinum

42
Q

Emergence and postop considerations for laparoscopic surgery is (regrading pain)

A

intra-abdominal incisions and should pain result due to irritation of diaphragm and/or visceral pain from biliary spasm
Opioids + NSAID+ Tylenol + dexamethasone + local infiltration (incisional & intraperitoneal)

43
Q

______ occurs in 40-75% of laparoscopic surgeries

A

PONV

44
Q

Robotic assisted surgery is

A

a minimally invasive surgery using “robotics”

control console, patient side cart (robotic arms), and equipment tower with screens

45
Q

Advantages to robotic assisted laparoscopy include

A

3-D view, improved depth perception & intuitive movements, increased precision 10-15x, magnification, free movement

46
Q

Disadvantages to robotic assisted laparoscopy include

A

massive system, limited working space, limited patient access, limited instrument availability, expensive, maintenance costs, longer setup

47
Q

Preparation for robotic surgery includes

A

2 peripheral IVs
consider arterial line
limit IVF initially (d/t Trendelenburg position)
Positioning- Trendelenburg, lateral, flexion
Limited access to the patient
Padding- robotic can lay arms on patient
concern for sliding

931: Advanced Principles of Anesthesia I (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions