Module 5

Question 1

indications for local anesthesia

Answer 1

diagnostic laparoscopy, tubal ligation, inguinal hernia repairs

Question 2

what are the options for local anesthesia agents?

Answer 2

bupivacaine, ropivicaine, lidocaine

Can be used to prevent parietal pain at trocar sites, no sign it helps with visceral pain of pneumoperitoneum or manipulation/dissection of viscera

Question 3

benefits of regional anesthesia

Answer 3

May be used alone or as adjunct to general anesthesia

Can provide improved muscle relaxation, improved post-op analgesia, and decreased rate of post-op ileus

Question 4

for pt undergoing GETA, what pre meds can help?

Answer 4

• benzos (for anxiety),
• atropine (for bradyarrhythmias
• glycopyrrolate (for bradyarrhythmias)
• H2 blocker or sodium citrate (acid-reducing)

Question 5

anesthetic agents

Answer 5

Anesthetic agents: IV induction and ET intubation for positive pressure ventilation, neuromuscular blockade

Use of laryngeal mask airway is controversial in laparoscopy

Bowel distension with inhaled NO is rarely a problem unless bowel obstruction

Question 6

supine

Answer 6

Pelvis/lower abdomen: tuck one or both arms
If arms tucked, make sure hands are clear when breaking down the bed
Upper abdomen: arms left out to the side with shoulder abducted to 90 degree angle
>90 degrees can cause brachial plexus stretch injury
Arms should be padded to avoid pressure point injury

Question 7

Reverse Trendelenburg

Answer 7

Foot board to help patient from sliding

Place belt across patient’s thighs to prevent knees from buckling during the procedure

Question 8

Lithotomy

Answer 8

SCDs should reduce incidence of position related injuries or DVTs

Allen stirrups are preferable to candy cane stirrups due to less extreme angulation and ability to conform to patient needs
Especially for longer procedures

Procedures that require dissection in the upper abdomen (omentectomy and colon resection):
Keep knees level with torso to avoid interference with handles of laparoscopic instruments

Question 9

Lateral decubitus position

Answer 9

Avoid stretch on brachial plexus on both sides

Roll placed under axilla on dependent side can help protect axilla and brachial plexus

Upper arm must be held in sling or laying on padded surface

Bean bag may help with patient positioning, but edges should not extend past midline: More rigid, Increased risk of pressure injuries for longer surgeries,
**Consider padding bean bag to reduce this risk

Access to adrenal gland and kidney: flex OR table enough to increase distance between costal margin and iliac crest -> provides more space for ports to be placed for optimal access

Question 10

Modified decubitus position

Answer 10

To allow rotation of operating table from full lateral decubitus position to supine position

Patient needs to be adequately secure

Allows exposure benefits of lateral decubitus with ability to convert to supine for open surgery if needed

May avoid use of flank incision or subcostal/midline incision that may not be tolerated

Helps with extraction of larger specimens

Procedures that use this position: Splenectomy, nephrectomy, and adrenalectomy