Laparoscopy Lecture A+ Grade Review 2023

Laparoscopy Lecture A+ Grade Review 2023 Advantages of laparoscopy? - Answer-can get back to daily activities sooner, less hospital time, decreased ileus, less pain, smaller incision Disadvantages of laparoscopy? - Answer-DVT, neurohumoral response (increase HR/BP), decreased preload, increased afterload, bleeding risk, increased ICP due to head down, regurg risk with pressure/positioning Vital signs in the first 15-20 mins after insufflation? - Answer-increased HR and BP--- narcotics/agent to offset CV effects of pneumoperitoneum? - Answer-decreased venous return, increased SVR, decreased CO, Pulmonary effects of pneumoperitoneum? - Answer-increase in ETCO2, increased intrathoracic pressure, decreased pulmonary compliance (30-50%), increased peak pressures, atelectasis, increased dead space, decreased capacities (FRC) Method to offset peak pressure increases? - Answer-put them on pressure support versus volume control How to offset increased ETCO2? - Answer-increase the RR (might decrease TV) What can happen in steep trendelenburg or with increased intrathroacic pressure? - Answer-ETT into right main bronchus or even out of trachea Renal effects of pneumoperitoneum? - Answer-decreased UOP and decreased GFR Nerve implications in lap surgery? - Answer-ulnar nerve pressure---use foam padding Temperature regulation in lap surgery? - Answer-use an upper body bair hugger, warm blankets, make sure they stay warm Benefits of CO2 for insufflation? - Answer-non-combustible, easily eliminated through lungs, rapidly abosrbed into blood stream (highly soluble) CO2 embolsim tx? - Answer-stop insufflation, flood area with saline, left lateral with right side up, place CVP to aspirate bubble, supportive interventions, 100% O2, stop surgery Might do what for a lap chole due to regurgitation risk? - Answer-RSI Continues...