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Ch 1-21 > 16 > Flashcards

16 Flashcards

1
Q

electrosurgery vs electrocautery

A

electrocautery: uses electrical current to heat an instrument which is then used to cauterize tissueelectrosurgery: form of energy transfer via electrons from the instrument to the tissues

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2
Q

relationship btwn current, resistance of conductor and voltage

A

current is directly proportional to voltagecurrent is indirectly proportional to resistance of the conductor

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3
Q

describe monopolar vs bipolar flow

A

monopolar: Electrosurgical unit or generator sends alternating current flow from generator to hand piece or active electrode–>through patient–>travels back to generator via inactive electrode (grounding or dispersive plate)bipolar:Electrosurgical unit or generator sends alternating current flow from generator to hand piece or active electrode (one prong)–>through patient–>travels back to generator via inactive electrode (inactive prong–dispersive electrode)NO GROUNDING PLATE NEEDED

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4
Q

benefits to bipolar over monopolar

A

no ground dispersive inactive electrode platemore preciseless lateral thermal damageworks in wet environmentsafer

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5
Q

main causes of electrosurgical injury during laparoscopy

A

inadvertent touching or grasping of tissuedirect coupling current traveling

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6
Q

T/Fthe larger the contact area of the dispersive grounding plate, the less is the chance of thermal injury

A

TRUE

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7
Q

what is the degree of tissue injury dependent on when using electrosurgery

A
  1. output mode2. power setting3. contact area time4. tissue resistance
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8
Q

at what temperature do proteins begin to denature irreversibly

A

45 C

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9
Q

electrothermal bipolar sealing devices

A

LigasureSurgRx Ensealelectrothermal energyprovide hemostasis by denaturing collagen and elastin from the vessel wall and surrounding connective tissue

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10
Q

Ligasure device is approved for use of what size blood vessels

A

7 mm or smaller in diameter (veins 7 mm, arteries 5 mm)

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11
Q

benefits of bipolar sealing device SurgRx Enseal vs Ligasure

A

< 7 mm diameter blood vessels (like Ligasure)1 mm limited thermal spreadhot and cold scissorssignificantly higher bursting pressure

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12
Q

comparison of SurgRx Enseal, Ligasure, and Harmonic ACE

A

Enseal = highest bursting pressures, less thermal damage to adventHarmonic ACE (5 mm vessels, ultrasonic E) = shorter sealing processLigasure = significantly longer sealing process, less thermal damage media

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13
Q

ultrasonic energy systems

A

harmonic systems HARMONIC ACEuse waves at 55,000 vibration/s to create an oscillating effect vibration induced heat and coagulation cut (center), coat (outer) part of bladeuse lower temps than electrotherm units and use coaptive coagulation (vessels tamponades then sealed with coagulum)

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14
Q

difference in temp btwn electrosurgery/laser units vs harmonic ultrasonic units

A

electrosurgery/lasers: obliterate coagulation (150-400C)harmonic ultrasound: coaptive coagulation (50-100C)

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15
Q

benefits of harmonic ultrasound over electrocautery

A

simultaneous cuts and sealslower tempsminimal thermal spreadno charring/dissecation/tissue stickingreduced smoke/improved visualization

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16
Q

3 categories of laser -tissue interactions

A
  1. photochemical: chemical reaction induced by light2. photothermal: heat related interactions (ablation/coag)3. photomechanical/ionizing: direct tissue destruction (cell membrane, protein, DNA destruction)
17
Q

T/Fphoto ablation = tissue ablation

A

FALSE in lasers, photoablation = breakage of molecular bondsin radiofrequency, tissue ablation = tissue destruction through direct heating/protein denaturation

18
Q

types of surgical lasers

A
  1. argon 2. co23. Nd:YAG4. Ho:YAG5. Excimer laser
19
Q

depth of penetration by major lasers

A

excimer < CO2 < argon < diode < NG:YAG

20
Q

characteristics of argon lasers

A

488-514 nm wavelength (blue-grn visible light)energy is absorbed by hemoglobin and transformed to heat

21
Q

Characteristics of CO2 lasers

A

instantaneously heat intracellular water causing cells to explode10600 nm (infrared)most comparative studies have shown that CO2 laser is NOT superior to electrosurgery

22
Q

characteristics of Nd:YAG lasers

A

neodymium: yttrium-aluminum-garnet1064 nm (infrared)deepest penetrationused in most endoscopic procedures

23
Q

characteristics of Ho:YAG lasers

A

holmium: yttrium-aluminum-garnet2.1 μm wavelength (TJ says 2.1 nm)Highly absorbed by watervaporize, cut, coagulate and smooth tissue

24
Q

characteristics of excimer laser

A

UV laser used in ophtho sx (LASIKS)

25
Q

safety considerations with lasers

A
  1. ocular hazard2. toxic smoke production3. fire hazard4. energy dissipation to adjacent tissues5. mutagenesis6. tissue emphysema/gas emboli

Ch 1-21 (19 decks)

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