Brainscape's Knowledge GenomeTM

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


See full index

AP 1 > Test 2: Laparoscopic & Robotics (3/3) > Flashcards

Test 2: Laparoscopic & Robotics (3/3) Flashcards

1
Q

What are the anesthetic techniques associated with Cholecystectomy?

A

-GETA (inhalation or TIVA) with NMB
-Reverse Trendelenburg with L tilt
-Traditional or Robotic assisted
-Has a larger peri-umbilical port for camera and gallbladder removal
-3-4 smaller ports for instruments

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

What are the anesthetic techniques associated with Appendectomy?

A

-GETA with NMB
-Trendelenburg with L tilt and L arm tucked at side
-Traditional or Robotic-Assisted
-Hemodynamic instability if appendix has ruptured (fever, tachycardia, pain)

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

What are the anesthetic techniques associated with Nissen Fundoplication?

A

-Indication: GERD, Hiatal Hernia, Barrett’s Esophagus.
-Fundus is wrapped around the lower esophagus
-Placement of an esophageal dilator/bougie at surgeon’s request and note depth. Notify if any resistance met
-NOTHING IN THE ESOPHAGUS (No OG tube, esophageal stethoscope or temp probe)
-GETA with NMB - possible RSI with full GI prophylaxis (risk for aspiration).
-PONV prophylaxis!!!
-High risk of pneumothorax with esophageal surgery
-Supine
-Traditional or Robotic assisted

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

What are the anesthetic techniques associated with Adrenalectomy?

A

-Indication: Adrenal Tumor (Pheo)
-Alpha blockade, then Beta Blockade. Anticipate hemodynamic swings - arterial line
-IV access
-Vasoactive meds
-GETA with NMB: Multimodal pain mgmt and possible Erector Spinae block
-Lateral position
-Traditional or robotic assisted

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

A catecholamine-secreting tumor that originates from the chromaffin cells of the adrenal medulla.

A

Pheochromocytoma

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

What is the classic triad of symptoms of a Pheo?

A

Headache, diaphoresis, and tachycardia
Additionally, paroxysmal HTN

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

How do you diagnose a Pheo?

A

-Plasma free metanephrines
-Urinary fractionated metanephrines
-CT scan of the Abd

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

What is the anesthetic management of a Pheochromocytoma?

A

-Outpatient alpha blocked (Phenoxybenzamine) 10-14 days prior to surgery
-Then, BB instituted
-On DOS, take all BP meds
-Aggressive hydration for euvolemia
-Major hemodynamic changes: Need IV access, invasive monitoring (Art line), vasoactive meds (uppers and downers), plan for post op care
-Can be laparoscopic or robotic assisted which is preferable to open.

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

What are the anesthetic techniques associated with Hysterectomy?

A

-GETA with NMB
-Steep T burg, Low Lithotomy, arms tucked at side
-Ensure good IV access with this position (multiple PIVs)
-Cystoscopy and dye
-Multimodal pain mgmt - TAP blocks
-Can be traditional, robotic assisted, or combo with vaginal/open procedure

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

What are the anesthetic techniques associated with Gastric Bypass?

A

-GETA with NMB (possible RSI due to aspiration, but also may be difficult airway)
-Thorough airway exam needed
-PONV prophylaxis!!!
-High risk of Pneumothorax
-Steep Reverse T Burg - hypotension
-Placement of esophageal dilator/bougie per surgeon request
-NOTHING IN ESOPHAGUS (no temp probe or stethoscope)
-Complications are r/t being morbidly obese: Airway, pain mgmt, ventilation/oxygenation, positioning
-Utilize ERAS, PONV, and Multimodal pain mgmt

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

What are the benefits of Minimally invasive robotic surgery?

A

-improved patient outcomes
-including greater surgical precision
-reduced perioperative blood loss
-reduced postoperative pain
-decreased hospital length of stay
-faster surgical recovery

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

-A surgeon using robotic-assisted technology controls surgical instruments from a control console that may be immediately adjacent to the patient, within the operative suite, or at a site hundreds of miles away from the operating room.
-An important advantage of robotic technology is the incorporation of three-dimensional (stereoptic) imaging, which permits superior depth perception.
-Robotic-assisted surgery offers the surgeon improved ergonomics, superior dexterity, and the ability to use traditional open surgical skills for laparoscopic operations.
-Robotic-assisted surgical techniques have been used in all types of procedures—cardiac, general, gynecologic, and urologic surgical specialties.

A

Robotic Surgery Fun Facts

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

When was the first Da Vinci robotic surgical procedure performed?

A

April 1997 in Brussels, Belgium

Approved in US in 2000

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

What are the 3 components of the Da Vinci System?

A

1) The Vision System
2) The Surgeon Console
3) The Patient-Side Cart

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

What are the anesthetic implications for robotic-assisted surgery?

A

-prolonged surgical times
-spatial restrictions associated with use of the robot
-inability to alter patient position after docking of the robot
-physiologic changes associated with extreme positioning
-risk of postoperative visual loss (POVL)
-physiologic consequences associated with the creation of pneumoperitoneum
-implementation of Enhanced Recovery after Surgery (ERAS) protocols

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

Why is it imperative the patient be adequately prepared for surgery with robotic procedures?

A

There is limited access to patients for prolonged periods of time. Ensure adequate airway, IV access, monitoring, etc.

17
Q

Which position is commonly used for robotic?

A

Steep T burg
40-45 deg head down tilt of the OR table for several hours

18
Q

What are the complications associated with Steep Trendelenburg for several hours?

A

-CV, Respiratory, and neurophysical changes

19
Q

Robotic surgical procedures performed in the steep Trendelenburg position put you at risk for what?

A

POVL

20
Q

Robotic surgical procedures performed in the steep Trendelenburg position put you at risk for what?

A

POVL

21
Q

What is the goal of minimally invasive robotic procedures?

A

-Improve surgical outcomes
-Allow patients to return to normal activity as quickly as possible

22
Q

T/F: Extreme surgical positions and prolonged surgical time put the patient at increased risk for injury.

A

True

23
Q

What is the problem associated with the proximity of the fixed robotic arms and attached surgical instruments to the patient?

A

Increased risk for compression of underlying structures.
The anesthetist needs to assure that adequate padding is placed between the robotic arms/instruments and the patient.

24
Q

What should you do to prevent the patient from sliding down the table when in steep tburg?

A

Patients must be appropriately secured on the operating room table to prevent inadvertent movement and the creation of pressure points.

25
Q

How often should the surgical position be assessed?

A

-15 min intervals throughout the procedure
-When changes in position of the patient, robot, or OR table occur

26
Q

What is the most common robotic assisted procedure?

A

Robotic-Assisted Laparoscopic Prostatectomy (RALP)

27
Q

What are the anesthetic implications with the Robotic-Assisted Laparoscopic Prostatectomy (RALP)?

A

-GETA with NMB
-Potential for significant blood loss, use of peritoneum, and hemodynamic/ventilatory changes associated with the use of Steep Trendelenburg.
-Steep Tburg and Lithotomy position (Common peroneal nerve damage is common)
-Increased risk for VAE if insufflation > venous pressures in the presence of active bleeding
-Positioning & Insufflation - increased ICP, so risk for visual defects and POVL

28
Q

What are the benefits of the Robotic-Assisted Laparoscopic Prostatectomy (RALP)? compared to the open?

A

Associated with less blood loss and shorter LOS, but at a higher cost than open procedures

29
Q

What are the physiologic alterations associated with Trendelenburg Position?

A

-Improves surgical exposure (Gyn)
-Increases venous return, CVP, ICP, and IOP (!!!!) risk of edema to face, tongue, airway, and eyes
-Potential for difficult oxygenation/ventilation due to increased PIPs, decreased lung compliance, dec Vt, dec SpO2.
-Caution use of shoulder braces (brachial plexus), ensure arms secured at side, no patient sliding or table tipping

30
Q

What are the physiologic alterations associated with Lithotomy position?

A

-BP may be normal/high due to elevation of legs - autotransfusion (gravity dependent redistribution of blood volume)
-Extreme flexion of thighs in exaggerated compresses abd, shifts abd cephalad, and limits diaphragm mvmt.
-Decreased pulm compliance & Vt
-Increased Airway pressures & Dead space (Vd)
-Effects may be amplified in obese individuals
-Potential for back pain due to loss of lumbar curvature, lumbosacral nerve stretch, and peroneal nerve injury

31
Q

May occur in one or both eyes and refers to a variety of visual defects ranging from decreased visual acuity to total blindness.

A

Postoperative Vision Loss (POVL)

32
Q

Ischemic optic neuropathy (ION) and central retinal artery occlusion (CRAO) accounted for ___% of all cases, with ION accounting for ___% of POVL after prone spinal procedures.

A

81%; 89%

33
Q

What is the most common cause of Central Retinal Artery Occlusion (CRAO)?

A

Improper head positioning that results in external pressure on the eye, decreasing blood supply to the entire retina.

The optic nerves may be susceptible to hypoperfusion.

34
Q

What are risk factors for developing POVL?

A

-undergoing lengthy procedures in the prone or steep Trendelenburg position, especially if surgery is accompanied by hypotension and significant blood loss (Spine).
-hypertension, diabetes, vascular disease, obesity, and smoking have been associated with POVL.

35
Q

A multidisciplinary, evidence-based list of recommendations for the care of patients during the preoperative, intraoperative, and postoperative periods in an attempt to modify the stress response to surgery and improve surgical outcomes for a faster return to function.

A

Enhanced Recovery After Surgery (ERAS)

36
Q

What are the periop guidelines of ERAS?

A

-Prevention of a catabolic state associated with long periods of fasting and fluid restriction
-Fluid mgmt to maintain euvolemia
-Promote early ambulation and feeding following surgery

37
Q

What is the Anesthetic Technique associated with ERAS?

A

Must consider the need to minimize the impact of anesthetics on organ systems and facilitate rapid awakening following surgery to speed recovery of gastrointestinal and motor function.
-Short acting agents
-Opioid sparing
-Aggressive PONV prophylaxis
-TIVA with propofol > inhalation
-Multimodal pain mgmt with NSAIDs and RA

38
Q

What are the challenges associated with Robotic Cardiothoracic Surgery?

A

-Need for anesthesia expertise in cardiac and thoracic anesthesia (one lung ventilation required)
-Advanced monitoring

AP 1 (32 decks)

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