FINAL Robotics Flashcards by Timothy Harris

Advantages of minimally invasive surgery
________ surgical incision and stress response
_________ postop pain and opioid requirements
Preserves __________ function
_______ return of bowel function
______ wound related complications
______ ambulation
______ hospital stays
______ return to normal activities and work
_______ health cost

Minimizes surgical incision and stress response
Decreases postop pain and opioid requirements
Preserves diaphragmatic function
Earlier return of bowel function
Fewer wound related complications
Earlier ambulation
Shorter hospital stays
Early return to normal activities and work
Reduces health cost

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2 Techniques with laparoscopic surgery

Closed and Open techniques

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The closed technique uses a spring-loaded needle called the

Veress Needle

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The open technique is also called the

Hasson

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Application of Laparoscopy (General Surgery)

Diagnosis
Evaluation of abd trauma
Lysis of adhesions
Cholecystectomy
Appendectomy
Inguinal hernia repair
Bowel resection
Esophageal reflux surgery
Splenectomy
Adrenalectomy
Bariatric Surgery- All types

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Application of Laparoscopy (GYN surg)

Diagnosis
Lysis of adhesions
Fallopian- tube surgery (sterilization, ectopic pregnancy)
Fulguration of endometriosis
LAVH

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Application of Urologic Surgery

Nephrectomy

Variocele

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Hemodynamic effects of minimally invasive surgery

______ systemic vascular resistance and mean arterial pressure (MAP) d/t (3 things)

Increased
Hypercarbia
Neuroendocrine response (e.g., catecholamines, vasopressin, cortisol)
Mechanical factors (like direct compression of aorta)

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Hemodynamic effects of minimally invasive surgery
Variable change (\_\_\_\_\_ or no change) in cardiac filling volumes d/t (1 thing)

increased or no change

compression of intra-abdominal organs (ie. liver and spleen)

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Hemodynamic effects of minimally invasive surgery
Variable change (\_\_\_\_\_\_ or no change) in cardiac index d/t (3 things)

decreased or no change
Increased afterload
Decreased Venous return
Cardiac Filling

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Hemodynamic effects of minimally invasive surgery
Cardiac Dysrhythmias (_____ or _____ cardia)
D/t (5 things)

Brady or Tachycardia
Peritoneal stretch
Hypercarbia
Hypoxia
Capnothorax
Pulmonary Embolism

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Limit IAP to _____mmHg to minimize CV effects

12-15

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MAP, SVR and HR will ____ during insufflation

Increase

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Insufflation: CO _______ due to ___HR and ___ venous return with T-Burg positioning

CO maintained
Increased
Increased

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Insufflation can cause PR ______

prolongation

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Regional circulatory changes during laparoscopy
________ cerebral perfusion and intracranial pressure
_______splanchnic blood flow
________ or no change in bowel perfusion
_________ hepatic blood flow
_________ renal perfusion and urine output
__________femoral vein flow

Increased cerebral perfusion and intracranial pressure
Decreased splanchnic blood flow
Decreased or no change in bowel perfusion
Decreased hepatic blood flow
Reduced renal perfusion and urine output
Decreased femoral vein flow

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Renal Function during Laparoscopy

Urine output is ______ d/t

reduced
Decreased renal blood flow
Compression of renal parenchyma
Neuroendocrine

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Factors that influence urine output (3)

Pre-existing renal compromise
Longer insufflation times
High intra-abdominal pressures

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Intraoperative oliguria is reversible within ___hours postoperatively

2 hours

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IAP

<15

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Pulmonary changes during laproscopy
Diaphragm \_\_\_\_\_\_\_
\_\_\_\_\_\_\_ lung volumes
\_\_\_\_\_\_\_\_\_\_ventilation/perfusion mismatch
\_\_\_\_\_\_\_\_\_ alveolar-arterial oxygen gradient
\_\_\_\_\_\_\_ lung compliance and \_\_\_\_\_\_\_ resistance
\_\_\_\_\_\_\_ pleural pressures
\_\_\_\_\_\_\_\_ airway pressures
\_\_\_\_\_\_\_ gas distribution
\_\_\_\_\_\_\_ displacement of carina
\_\_\_\_\_\_\_\_\_\_ intubation

Diaphragm elevated
Decreased lung volumes
Increased ventilation/perfusion mismatch
Increased alveolar-arterial oxygen gradient
Decreased lung compliance and increased resistance
Increased pleural pressures
Increased airway pressures
Uneven gas distribution
Cephalad displacement of carina
Endobronchial intubation

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Creation of pneumoperitoneum ( carbon dioxide insufflation and intra-abd pressure) can cause (three areas for problems)

Hemodynamic
Pulmonary
Neurohumoral Resonse

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Signs and Sx of Gas Embolism

Decreased ETCO2
Increased ETN2
Increased PAP
Hypotension
Dysrhythmias
Cyanosis
Hypoxia
Pulmonary Edema
"Mill Wheel" murmur

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Tx for Gas Embolism

D/C gas insufflation
D/C N20
Administer 100% O2
Release pneumoperitoneum
Flood surgical field with NS
Position Pt in Left Lateral decubitus position
Attempt to aspirate gas via CVP
Supportive measures to maintain hemodynamics

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Laparoscopic Surgery _____ is the drug of choice ____ ETT to facilitate ventilation and prevent aspiration _____ MV by _______% to offset Co2 absorption and maintain ETCO2 at _______mmHg

Propofol Cuffed 15-35% 35-45mmHg

What vent mode is best for laparoscopic surgery

PCV

What is the "15" rule with laparoscopic surgeries

Keep surgery under 15 mins Keep bed tilt under 15 decrees Keep IAP under 15mmHg

Can you use N2O with laparoscopic surgery?

Sure- Barash found no convincing reason to eliminate it and Naglenuts says the jury is still out.

Intra op opioids can cause opioid induced ____ of sphincter of Oddi. Antagonize with _____

spasm | Glucagon

Muscle relaxants ____ IAP needed for same degree of abdominal distention.

decrease

``` Laparoscopic positioning Upper abd procedures (gallbladder)- Lower abd procedures (appendix)- Pelvic surgery- Urologic (renal) - ```

Upper abd procedures (gallbladder)- Reverse Tburg Lower abd procedures (appendix)- Tburg Pelvic surgery- Lithotomy Urologic (renal) - lateral or semilateral with flexion

Benefits of robotic surgery

Less pain and trauma Shorter Hospital Stay Quicker Recovery Better cosmetic result

1st surgical robot defice used in _____ on _____ _____ surgery.

1980s | Stereotactic Brain Surgery

1st type of robotic surgical system, capable of highly precise ______ tasks. (autonomous or not?) Used for orthopedic and neurosurgery.

repetitive | yes- autonomous

2nd type of robotic surgical system and example. Used to Control instrument location and guidance Autonomous or not?

``` Assist Device (AESOP) Not autonomous- needs ques from an operator ```

3rd Type of robotic surgical system Mimics operator's hand motions in exact or scaled motion. Examples-

Telemanipulator | Da Vinci and ZEUS

Components of the Da Vinci System

Surgeon Console Patient-side cart EndoWrist instuments Optical vision tower

Each Da Vinci system has __ monitors, each displaying ___ channel of stereo endoscope creating a ____ image

2 1 3D

Da Vinci has ____ arms, manipulated by the surgeon 1st 2 arms are ________ and holds ________ 3rd arm positions _______ 4th is option and allows surgeon to _______

``` 4 the surgeons R and L arm instruments endoscope perform additional tasks ```

Once instruments are engaged to robot arms and inside patient, body cannot ______ until_______

be moved | instruments are disengaged and removed from body cavity

EndoWrist instruments have ___ degrees of motion | describe these

7 3 arm movements (in/out, up/down, side to side) 3 wrist movements (yaw side to side and L to R, Pitch up/down, Roll) 7th is grasping or cutting

Complications with robotic surgery Most are similar to ________ procedures Exception- Steep _______position (30-45deg like with robotic-assisted prostatectomy) Risk for tracheal _______ Facial, pharyngeal and laryngeal ______ leading to upper airway obstruction Combat this with ____ fluid administration to minimize edema

``` laparoscopic Head-Down displacement edema decreasing ```

Prolonged head down and increased IAP with large amount of crystalloid leads to (r/t eyes)

increased venous congestion in optic canal and decreased optic nerve perfusion.

Prolonged caudad displacement of shoulders leads to

brachial plexus injury

Branch of medicine concerned with the correction or prevention of deformities, disorders, or injuries of the skeleton and associated structures (tendons and ligaments)

Orthopedic Surgery

Anesthetic plan for orthopedic surgeries should be based on these factors (6)

``` Type of surgery How Long Patient preference Airway challenges Position of patient Comorbidities ```

``` Advantages of RA over GA with Orthopedic Surgery __________Rehab More Rapid hospital ________ Improved postop __________ Decreased incidence of _______ Less Respiratory and Cardiac _________ Improved _______ via sympathetic block _______ blood loss ____________ risk of thromboembolism ```

``` Enhanced Rehab More Rapid hospital dismissal Improved postop analgesia Decreased incidence of N+V Less Respiratory and Cardiac Depression Improved Perfusion via sympathetic block Reduced blood loss Decreased risk of thromboembolism ```

Spinal Surgery _____ cervical segment is the most important for evaluating cervical spine injury Controls motor function of which 4 muscles

``` 5th Deltoid Biceps Brachialis Brachioradialis ```

If D_______, B______, B_______, B_______. muscles are flaccid then the ________ nerve is involved with ________ _________ paralysis.

Deltoid, Biceps, Brachialis, Brachioradialis (DBBB) 5th Cervical Nerve Partial Diaphragmatic Paralysis

Complete lesion at _________ is incompatible with survival.

Cervical 4th segment

Sux is safe for ____hours after spinal cord injury (paralysis) so avoid it after this time. D/t?

48hrs | Risk for Hyperkalemia

Transections above T5 can cause

Autonomic Hyperreflexia

Sx of Autonomic Hyperreflexia

``` Paroxymal hypertension Bradycardia Dysrhythmias Cutaneous Vasoconstriction below Injury Vasodilation above injuy ```

Tx for Autonomic hyperreflexia

Remove Stimulus Deepen Anesthesia Direct-Acting Vasodilator

``` These are complex or noncomplex procedures? Vertebroplasty Kyphoplasty Cervical Discectomy Foraminectomy ```

Noncomplex

Wilson Frame Jackson Table Chest Rolls are use to provide what during spinal surgeries?

Support

``` Spinal Stenosis Spondylosis Spondyloisthesis Intervertebral disc herniation are all what types of disease? ```

Degenerative Vertebral Column Disease

Cervical Laminectomy anterior approach will be ____ position

Supine

Cervical laminectomy posterior approach will be _____ or _____ position.

Sitting or Prone

Thoracolumbar laminectomy will be _____ position

prone

Advantages of Pneumatic Tourniquet

Minimize Blood Loss Identify Structures Expedite Case Bloodless Field

______ and ______ influenced by duration of pneumatic tourniquet insufflation

Tissue hypoxia and acidosis

TQ insufflation: Maximum of ____ hours is considered safe

Deflation of TQ results in release of _______ and can cause (5 things)

``` METABOLIC WASTE Metabolic acidosis Hyperkalemia Myoglobinemia Myoglobinuria Renal Failure ```

TQ, use pressure _____x ______BP to reduce nerve pain. Or just use _______mmHg above BP

2x Systolic BP | 100mmHg

TQ: ________ mins to see ischemic pain with is resistant to ______/_______

45-60mins | analgesia/anesthesia

minimally invasive procedure to examine or repair damage to a joint through an arthroscope

Arthroscopy

Anesthetic technique with arthroscopy | Consider---

Peripheral Nerve blocks Periarticular injections NA GA

Shoulder scope- has greater risk of

subcut emphysema tension pneumothorax pneumomediastium

Surgical replacement of all (total) or part (hemi) of a jont with goal of restoring natural motion and function

Arthoplasty

Bone Cement also known as

Methyl methacrylate (MMA)

Bone Cement Implantation Syndrome presents as

``` Hypoxia Hypotension Cardiac Arrhythmias Increased pulmonary vascular resistance Unexpected LOC during regional Cardiac Arrest Drop in ETCO2 during GA ```

Etiology of Bone Cement Implantation Syndrome

Histamine Release Complement Activation Endogenous Cannabinoid-mediated vasodilation

Bone Cement Implantation Syndrome is most common in ____ arthroplasty

Hip

Hip Arthroplasty | _____ position requires large incision through large muscle groups

Lateral

Hip Arthroplasty _______ approach requires special bed, smaller incision but has greater blood loss Will be in _____ position

Anterior | Supine

Hip Arthroplasty | Avoid _____ due to risk for air entrapment

N20

Hip Arthroplasty | Preferred anesthetic

Regional

Hip Arthroplasty | Avg blood loss

500-1000ml

Hip Arthroplasty | Average blood loss

500-1000ml

Hip Arthroplasty | Revisions are associated with _______ blood loss

much greater

Indications for shoulder arthroplasty

``` posttraumatic brachial plexus injuries paralysis of deltoid muscle rotator cuff injury chronic infection failed revision severe refractory instability bone deficiency ```

Shoulder Arthroplasty will be done in ______ or ______ position

Beach Chair | Lateral

Beach chair is associated with _____in cerebral perfusion which can lead to (3 things)

decrease | blindness, stroke, and brain death

Present within 72 hours of long bone or pelvic fractures

Fat embolism syndrome

Diagnosis of Fat Embolism Syndrome

Petechiae on chest, upper extremities, axilla and conjunctiva Decreased ETCO2 and arterial 02 sat Increased PAP ST changes on ECG

Management of Fat Embolism Syndrome

Preventive and supportive | Oxygen with CPAP ventilation

FINAL Robotics Flashcards

(87 cards)