Week 15 Handout Flipped Classrooms: Hernia Repair

Question 1

What is a hernia?

Answer 1

A protrusion of tissue through a weakened muscle wall.

Question 2

What is hernia repair?

Answer 2

A common surgical correction of a hernia.

Question 3

What are the types of hernias?

Answer 3

Inguinal, femoral, umbilical, incisional, hiatal, congenital diaphragmatic.

Question 4

What is the most common type of hernia?

Answer 4

Inguinal hernia, located in the groin region.

Question 5

Which type of hernia is more common in women?

Answer 5

Femoral hernia, located below the inguinal ligament.

Question 6

What type of hernia is common in infants?

Answer 6

Umbilical hernia, near the navel.

Question 7

What is an incisional hernia?

Answer 7

Occurs at previous weakness in surgical incision sites.

Question 8

What is a hiatal hernia?

Answer 8

Stomach protrudes into thorax via diaphragm.

Question 9

What is a congenital diaphragmatic hernia?

Answer 9

A birth defect where abdominal contents herniate into the chest.

Question 10

What are the anesthetic concerns for obese patients?

Answer 10

Difficult airway, aspiration risk, positioning challenges.

Question 11

What are the anesthetic concerns for elderly patients?

Answer 11

Increased cardiovascular and pulmonary complication risks.

Question 12

What are the anesthetic concerns for COPD patients?

Answer 12

Risk of hypoventilation and pulmonary complications.

Question 13

What are the anesthetic concerns for diabetic patients?

Answer 13

Poor wound healing and increased infection risk.

Question 14

What is included in preoperative preparation?

Answer 14

History & physical, labs (CBC, BMP, coagulation panel), airway assessment, pre-medications, anesthesia plan.

Question 15

What pre-medications are commonly used?

Answer 15

Acid-reducing medications like famotidine or sodium citrate.

Question 16

What anesthesia is preferred for laparoscopic hernia repair?

Answer 16

General anesthesia.

Question 17

What type of anesthesia may be used for inguinal hernia repair?

Answer 17

Regional anesthesia, requiring cooperative patients.

Question 18

What is preferred for airway management during laparoscopy?

Answer 18

Endotracheal tube (ETT) is preferred; LMA may be used in simple cases.

Question 19

What muscle relaxants are often needed?

Answer 19

Muscle relaxants are often needed for laparoscopy to relax the abdominal wall.

Question 20

What should be avoided during anesthesia?

Answer 20

Nitrous oxide, as it can expand bowel gas and increase postoperative nausea and vomiting (PONV).

Question 21

What is the typical patient positioning for hernia repair?

Answer 21

Supine for most open and laparoscopic repairs; Trendelenburg may be used in laparoscopy.

Question 22

What is critical to avoid during patient positioning?

Answer 22

Padding to avoid pressure injuries, especially in long procedures.

Question 23

What is the goal of intraoperative fluid management?

Answer 23

Maintain euvolemia.

Question 24

What fluids are typically used in intraoperative management?

Answer 24

Crystalloids such as Lactated Ringer’s (LR) or Normal Saline (NS).

Question 25

What should urine output be monitored for?

Answer 25

Urine output should be greater than 0.5 mL/kg/hr.

Question 26

What should you be prepared for during surgery?

Answer 26

Be prepared for blood transfusion if unexpected bleeding occurs.

Question 27

What is the first step in intraoperative events?

Answer 27

Induction & positioning tailored to patient size, comorbidities, risk factors, and hernia type.

Question 28

What should be monitored during incision?

Answer 28

Monitor for hemodynamic changes, pain, and risk of bowel/nerve injury.

Question 29

What may be required for a strangulated hernia?

Answer 29

Bowel resection may be necessary.

Question 30

What may require conversion during surgery?

Answer 30

Conversion from laparoscopic to open may be necessary.

Question 31

What are the risks during hemostasis & closure?

Answer 31

Risk of seroma and hematoma formation; monitor for wound dehiscence.

Question 32

What are common complications of hernia repair?

Answer 32

Surgical site infection, hernia recurrence, hematoma or seroma formation, nerve injury, mesh-related complications.

Question 33

What is the surgical purpose of hernia repair?

Answer 33

To correct tissue protrusion through muscle weakness.

Question 34

What are the key points for preoperative assessment?

Answer 34

Assess comorbidities, airway, labs, and plan anesthesia.

Question 35

What is the preferred anesthesia for laparoscopic hernia repair?

Answer 35

General anesthesia is preferred; regional anesthesia is possible for select open cases.

Question 36

What is the typical positioning for hernia repair?

Answer 36

Supine; Trendelenburg may be used laparoscopically.

Question 37

What are the key complications to be aware of?

Answer 37

Surgical site infection, recurrence, chronic pain, and mesh issues.

Question 38

Student Question: What is the primary reason nitrous oxide should be avoided during hernia surgery? A. It causes nausea B. It impairs neuromuscular blocking drugs C. It increases the risk of bleeding D. It can expand air-filled bowel loops

Answer 38

Correct Answer: D. It can expand air-filled bowel loops Rationale: Nitrous oxide diffuses into closed gas spaces and can expand air-filled bowel, which is especially problematic during laparoscopic procedures. Some surgeons request that nitrous oxide not be used, to reduce the risk of bowel expansion, which could hinder surgical exposure. Reference: Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed., p 785). Elsevier.

Question 39

Student Question: In laparoscopic hernia surgery, which positioning technique is commonly used? A. Reverse Trendelenburg B. Lithotomy C. Prone D. Trendelenburg

Answer 39

Correct Answer: D. Trendelenburg Rationale: Trendelenburg position may be used during laparoscopic repairs to improve visualization by shifting the abdominal contents away from the surgical field. The increasing use of robotic-assisted surgery often requires the use of step Trendelenburg and presents challenges in positioning. Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed., p 423). Elsevier.

Question 40

Student Question: In a patient with a strangulated bowel hernia, what is the surgeon most likely to do intraoperatively? A. Delay surgery B. Convert from laparoscopic to open approach C. Administer more antibiotics D. Attempt repair without anesthesia

Answer 40

Correct Answer: B. Convert from laparoscopic to open approach Rationale: If the bowel appears necrotic or strangulated, conversion from laparoscopic to open is necessary for resection and repair. Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed., p 785). Elsevier.

Question 41

Student Question: Which of the following patients are at increased risk for complications during hernia repair? (Select all that apply) A. Obese patients B. Diabetics C. Female patients D. Elderly individuals

Answer 41

Correct Answers: A, B, D Rationale: Obesity increases aspiration and intubation difficulty, diabetes impairs wound healing, and elderly patients are prone to cardiopulmonary complications. There is no significant evidence associated between gender and complications. Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed., p 806). Elsevier.

Question 42

Student Question: What are the benefits of laparoscopic hernia repair compared to open repair? (Select all that apply) A. Smaller incisions B. Lower risk of infection C. Increased bowel manipulation D. Decreased postoperative pain

Answer 42

Correct Answers: A, B, D Rationale: Laparoscopic techniques result in smaller incisions and generally reduce infection risk and postoperative pain. Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed., p 806). Elsevier.

Question 43

Student Question: What preoperative considerations are essential in planning anesthesia for hernia surgery? (Select all that apply) A. Airway assessment B. Cardiac stress test C. Coagulation panel D. Medication to reduce stomach acidity

Answer 43

Correct Answers: A, C, D Rationale: Pre-op evaluation includes a full airway assessment, labs such as coagulation panels, and medications to reduce gastric acidity to prevent aspiration. Although best practice data do not support a specific regimen, modifying the acidity of gastric contents remains a common preoperative practice. Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed., p 786). Elsevier