Test 3 Flashcards
Laparoscopy
Effects of pneumoperitoneium
Resp
Cardiac
-Intraperitoneal insufflation of CO2
-Release of catecholamines and vasopressin
-Increased PaCO2
-Decrease compliance/FRC
-Gas embolism, pneumo, endotracheal intub
-Increase BP and SVR
-Decrease CO
**Bradycardia = Glycopyyrolate
*Brady does not correlate with ETCO2
-Gas embolism. L>?? Tx?
-Subqemphysema
-Pneumothorax
-Pneumomediastium
-Endobronchial intubation
Gas embolism
-Tachycardia + Hypo
-Decrease ETCO2
-Millwhell murmur
–> Tx: Tredenlengburg, fluid bolus, O2, aspirate air
Improper placement of trochar but resolves in ~30-60mins
Cephalad movement of carina from tredenlenburg position
Tredenlengburg
(Head down)
Reverse Tredelenburg
(Head up)
T = ^CO, VR, IABP, IOP
Decrease FRC/compliance
Reverse T=
–> Hypotension, decrease CO, **Venous stasis
:) for breathing
Complications of laparoscopy (4)
Contraindications? (4)
Considerations for anesthesia?
-30-50% = performation/CBD injury
-15-30% = Burns
-Retroperitoneal hematomas (often insidious)
-Infection
Contra= Increase ICP, tumor, trauma, hydrocephalus
Anesthesia: OG, T = intubate, light pressure = LMA, NMBD, narcotics
Nissen fundoplication
What is the surgery for? indications?
Pre-op
Intra-op
Positions?
–>To increase lower esophageal sphincter pressure
–>Complications of GERD
-Stricture
-Aspiration pneumonia
-Esophageal ulcerations
-Barrett’s esophagus
-Failure or unwillingness to commit to medication
Pre-op=
PPI, Pro-kinetics, document eso hyperacidity
Intra-op=
-OG decompress,
-Esophageal dilator = lube+ leave til surgeon suture then pull out
-Anti-biotics
Position??
Supine, low lithotomy, reverse Tburg
Cholecystectomy= remove Gallbladder
Indications? 5 Fs
Pre-op
Intra-op
Position?
Symptomatic cholecystitis=
–>5 F’s: female, forty, fair, flatulent, fat
Pre-op:
Full stomach = prokinetics
Bicitra
Position?
Supine, reverse Tburg, left tilt
Glucagon= for sphincter of oddi spasm
SpLLLenectomy
Indications?
***Position?
Pre-op? week before? labs?
Intraop?
Indications: THINK BLEEDING
ITP
Lymphoma
Hemolytic anemia
Trauma
Preoperatively
Should have received pneumococcal, meningococcal, and H influenza vaccinations 1 week preop
Evaluate LLL atelectasis
Intraoperatively
GETA
–>Type and cross
vs type and screen
Xtra venous access
-SCIP antibiotics
Position
45 degree right lateral decubitus=Kidney rest, table flexed
Bowel resection
Indications?
Pre-op
Meds?
Intra-op
Position:
Indications
Ulcerative colitis
Crohn’s disease
Diverticular disease
Cancers
Ischemic bowel
Preoperatively
Bowel prep
Mu-opioid antagonists
Entereg (alvimopan)
ERAS/ (multimodal)
Preop warming
MEDS??
Gabapentin, acetaminophen, scopolamine
Gatorade
Intraoperatively
GETA
OG vs. NGT
SCIP antibiotics
Consider albumin vs crystalloid
Postop pain control
Position
Supine or low lithotomy
Appendectomy
Pre-op? Symptoms to look for?? Labs?
Intra-op?
Position? what armed tucked?
Preoperatively
Consider full stomach
May be dehydrated d/t fever/N&V
-Hemoconcentration
-elev. BUN
Intraoperatively
GETA
Consider full stomach/aspiration risk
OGT
SCIP antibiotics
Position
–>Supine, left arm tucked; trendelenburg
Bariatric Surgery
Obesity + symptoms
Pre-op– prophylaxis
Intra-op
POSITION? Whats good for breathing??
When to remove OG tube?
Preoperatively
-Review medication list- appetite suppressors?
-Assess airway- limit preoperative sedation?
-Commonly have undiagnosed OSA
VTE prophylaxis!!!
POSITION: Reverse Tburg/HOB up 30 degrees…..GOOD pre-oxygenation
Intraoperatively
–>GETA/RSI- supine position=too hard to mask ventilate
–> Induction on ideal body weight
OGT- removed before stomach stapled
Calibration tube/methylene blue
Long term concerns for bariatric surgery
Types:
1.) Lap banding
2.) Sleeve Gastroectomy
3.) Gastric bypass
Long term complications: Diarrhea, dysphagia, protein and vitamin malabsorption
A,D,E,K,B12,calcium
Laparotomy
Indications?
Indications for conversion
Obesity
Adhesions
Bleeding
Unclear anatomy
Staple misfire
Inability to ventilate
Exploratory laparotomy
pre-op?
intra-op?
Indications
-Trauma
-Abdominal catastrophes
-Staging
Intraoperatively
-GETA
-Profound muscle relaxation
-NGT—manipulate the bowel. Will have ileus
-Consider epidural placement
-Consider multi-modal pain control
-Keep warm!!!
Gynecological
D & C (Dilation and Curettage)
Pre-op
Intra-op
Type of anesthesia?
Meds???
Removes excess uterine/endometrial lining
Pregnancy test
Stop breast feed
General anesthesia
L> Bradycardia
Pitocin IV
NOOOO SCIP ANTIBIOTICS
D & E
how many weeks counseling period??
Anesthesia involvement?
Variable by state
-20-24 weeks
-Counseling/Waiting period
-Parental involvement
Anesthesia involvement
–>Pitocin IV
