Laparoscopic surgery

Question 1

what needle is used for closed technique?

Answer 1

Verres

Question 2

what trocar is used for open technique?

Answer 2

Hasson

Question 3

For closed technique intra-abdominal pressure of how many mmHg or less is a reliable indicator of correct needle placement?

Answer 3

10 mmHg or less

Question 4

what is one test that can be performed to confirm correct placement for closed technique? (SDT)

Answer 4

saline drop test

Question 5

many complications with laparoscopic surgery are seen at what 2 times? (IE, PE)

Answer 5

initial entry and pneumoperitoneum establishment

Question 6

Pneumoperitoneum causes what 3 hemodynamic measurements to increase?

Answer 6

HR, MAP, SVR

Question 7

In what 2 ways does the pneumoperitoneum cause the increase of HR, MAP and SVR? (IAVC, NHR)

Answer 7

1. intraabdominal vessels compression

2. neuroendocrine hormones released (vasopressin and renin)

Question 8

Pneumoperitoneum causes what 2 hormones to be released?

Answer 8

Vasopressin, renin

Question 9

steep trendelenburg increases or decreases CVP?

Answer 9

increases

Question 10

Does pneumoperitoneum increase or decrease stroke volume?

Answer 10

decreases stroke volume

Question 11

What does pneumoperitoneum decrease and thus decreases stroke volume?

Answer 11

venous return

Question 12

Does pneumoperitoneum prolong or shorten the QT dispersion?

Answer 12

prolong

Question 13

Pneumoperitoneum CO2 is absorbed through what? (PS)

Answer 13

peritoneal serosa

Question 14

misplaced trocar and insufflation can result in development of what? (SE)

Answer 14

subcutaneous emphysema

Question 15

pneumoperitoneum causes the diaphragm to displace cephalad causes what 3 pulmonary measurements to decrease?

Answer 15

1. pulmonary compliance
2. vital capacity
3. functional residual capacity

Question 16

max PCO2 increases how many minutes after insufflation begins?

Answer 16

40 minutes

Question 17

during robotic prostatectomy in steep trendelenburg, pulm compliance decrease what % and peak inspiratory pressure increases what %?

Answer 17

decreases 50%, increases 50%

Question 18

oliguria from pneumoperitoneum occurs from sustained periods of intra-abd pressure greater than how many mmHg?

Answer 18

15 mmHg

Question 19

decreases in renal BF results in the release of what hormone?

Answer 19

ADH

Question 20

in her table, there is marked decrease in GFR and UO when intraabdominal pressure is at what mmHg?

Answer 20

20 mmHg

Question 21

> 50% of laparoscopic complications occur during what? (AE/TI)

Answer 21

abdominal entry/trocar insertion

Question 22

what is done when there is a risk of urinary structure damage?

Answer 22

foley insertion and methylene blue instillation

Question 23

what is the most sensitive test/monitor for a gas embolism?

Answer 23

TEE

Question 24

TEE able to identify a gas emboli as small as how many mL/kg?

Answer 24

0.2 mL/kg

Question 25

Changes in doppler sounds and increase PA pressure when gas embolism volume is how many mL/kg?

Answer 25

0.5 mL/kg

Question 26

what is the name of the murmur that is a temporary loud, machinery-like churning or splashing d/t mixing of air in the right ventricle?

Answer 26

mill wheel murmur

Question 27

where is the mill wheel murmur best heard over? (P)

Answer 27

pericardium

Question 28

mill wheel murmur occurs when the gas volume is how many mL/kg?

Answer 28

2 mL/kg

Question 29

is mill wheel murmur a late or early sign?

Answer 29

late

Question 30

what are 4 s/s of mill wheel murmur? (IP, C, T, S)

Answer 30

increased pressure, cyanosis, tachycardia, syncope

Question 31

how should you position pt with a gas embolism?

Answer 31

left lateral decubitus

Question 32

what is the maneuver called when you place a pt on their left lateral decubitus? (DM)

Answer 32

durant maneuver

Question 33

what are 8 treatments of a gas embolism? (DCGI, DCN, AO, RP, FSFwNS, AGvCVC, SH,PPoLLD)

Answer 33

1. d/c gas insufflation 2. d/c N2O 3. administer 100% O2 4. release pneumoperitoneum 5. flood surgical field with NS 6. aspirate gas via CVC 7. support hemodynamics 8. position pt on LLD

Question 34

does a low CVP increase or decrease risk of a venous air embolism?

Answer 34

increases

Question 35

what are the 3 body adjacent body cavities gas can migrate? (P,P,P)

Answer 35

pneumothorax, pneumopericardium, pneumomediastinum

Question 36

CO2 can be a peritoneal and diaphragmatic irritant which is seen in postop pain where? (S)

Answer 36

shoulder

Question 37

prolonged CO2 absorption can cause what 2 things? (H, RA)

Answer 37

hypercarbia, respiratory acidosis

Question 38

If you are going to use an LMA, which kind are you going to use?

Answer 38

Pro-Seal

Question 39

why are you going to use a Pro-Seal?

Answer 39

ability to decompress the stomach

Question 40

what are the 3 rules of 15 for an LMA during laparoscopy?

Answer 40

1. < 15 degrees tilt 2. < 15 cmH2O 3. < 15 minutes

Question 41

majority of postop pain is day of surgery and is what type of pain? (V)

Answer 41

visceral

Question 42

shoulder pain is more likely on what postop day number?

Answer 42

#1

Question 43

PONV in laparoscopic pts is up to what %?

Answer 43

72%