Anesthesia

What are the advantages of performing laparoscopic surgery over open surgical procedures?

The advantages of laparoscopic surgery over open surgery include a precise incision hence a smaller open wound than in open surgery. This procedure exposes patients to less pain and blood loss than open surgery. In laparoscopic surgery, patients take less analgesia (medication for relieving pain) compared to open surgery; hence they experience milder effects from the drug. Additionally, since this process involves fine instruments, patients are often less likely to suffer from tissue trauma. The general recovery period following a laparoscopic procedure is less than in open surgery.

When performing a pneumoperitoneum, the abdomen is usually inflated to what maximum pressure?

During pneumoperitoneum, the patient’s abdomen undergoes inflation with Carbon dioxide at a pressure of between 10 and 12 mm Hg. This creates a capnothorax, which increases the operating exposure.

What are the major respiratory complications that can occur from placing the patient in the Trendelenburg position to facilitate visualization during laparoscopy?

The steep Trendelenburg position increases the likelihood of upper airway blockage after extubation and the development of substantial upper airway edema. Additionally, creating pneumoperitoneum while in this position reduces the distance of the vocal cords relative to the carina. This potentially displaces the endotracheal tube causing intubation of the endobronchial.

Which two factors are responsible for most of the hemodynamic changes associated with laparoscopic surgery?                                                                                                                           

As previously noted, a steep Trendelenburg positioning and pneumoperitoneum are concurrently used. Using these two processes has made it difficult to manage hemodynamics and ventilation in patients. Pneumoperitoneum increases the abdomen’s internal pressure, leading to hemodynamic changes that can get worse in case of bleeding. Consequently, pneumoperitoneum and Trendelenburg positioning are the two main factors associated with hemodynamic changes during laparoscopy.

How does the ETCO2 change (↑or ↓) during laparoscopy?                           

The Steep Trendelenburg position significantly affects gas exchange and ventilation in the abdomen. Additionally, due to the increase in intraabdominal and gravitational pressures, lung compliance reduces, raising airway resistance. In the end, the descent of the diaphragm is restricted. It is also important to note that at this point, the creation of pneumoperitoneum is necessary. This process leads to a continued increase in plateau and peak pressures. Consequently, it is correct to say that end-tidal carbon dioxide (ETCO2) increases during laparoscopic surgery.

What are two proposed reasons for avoiding nitrous oxide during laparoscopy?

Nitrous Oxide has been widely used in various types of surgery. However, in laparoscopic surgery, the use of nitrous oxide has been an issue. First, there have been observations that avoiding this anesthetic reduces side effects such as impaired wound healing. Secondly, nitrous oxide accumulates in the pneumoperitoneum during laparoscopic, prompting most surgeons to avoid its use.

What is the cause of subcutaneous emphysema?

During laparoscopy, various factors can lead to subcutaneous emphysema. These include intraabdominal pressure of more than 15 mmHg, using cannulas greater than five while using a laparoscope as a lever, and its long arm as a force multiplier. Others are several trials at the abdominal entrance, long hours of procedures lasting on average a minimum of 3.5 hours, and a positive (ETCO2) greater than 50 mmHg.

Why do some patients complain of shoulder pain?

The shoulder pain problem is linked to using carbon dioxide to create pneumoperitoneum. The gas is preferred for various reasons, including its low cost, ready availability, and the respiratory system’s ability to expel the gas from the abdomen. However, the prolonged absorption of carbon dioxide causes respiratory acidosis. The gas is also a diaphragmatic irritant. This is the reason patients complain about postoperative shoulder discomfort.

What negative cardiac effects may be seen with insufflation of the abdomen?

Insufflation at high pressure prolongs QT dispersion (QTd) for patients undergoing laparoscopy. This QTd results in the instability of the ventricular. Therefore, once this parameter is prolonged, it exposes the patients to a risk of suffering from arrhythmias.

What are some of the most significant physiologic effects of profound hypercapnia?

Prolonged hypercarbia increases the patient’s heartbeat and rate of birthing and reduces general vascular resistance.

Which is the most common insufflation gas used in laparoscopic surgeries?

Carbon dioxide (CO2) is the ideal gas for laparoscopic surgeries. This is because the body can easily expel the gas through the respiratory system after use. Additionally, the gas does not support combustion.

What is a cholangiogram, and why is it done sometimes with a cholecystectomy?                                                               

A cholangiogram is a real-time x-ray of the bile tubes that connect the liver to the small intestines. Cholecystectomy may be used in this process as it gives a clear structure of the bile ducts. Consequently, it makes it easier for practitioners to avoid injuries during dissection and identify the presence of other anomalies such as fistulas and cysts.

Where is the Sphincter of Oddi located?                                                       

The Sphincter of Oddi is located where the bile duct, the duodenum, and the pancreatic duct meet.

During a laparoscopic cholecystectomy, the surgeon states that he cannot perform the cholangiogram due to a spasm of the Sphincter of Oddi. Which narcotic is implicated in causing this spasm?

Morphine is a narcotic believed to cause spasms at the Sphincter of Oddi. Botox injection, Sphincterotomy, and calcium and nitrate channel blockers are some medications and medical treatment plans used to treat spasms in the Sphincter of Oddi.

What are the S & S of gas embolism, and how would you manage this situation?

Loss of breath, inconsistent heartbeat and pain in the joints, blurred vision, and itchy skin are common signs and symptoms of gas embolism. Following detection of the condition, the patient is often subjected to a high oxygen flow, with their bodies placed in a lateral decubitus position on the right side. Definitively, hyperbaric oxygen therapy is used as the management plan for this condition.

Reference

Nagelhout, J. J., & Plaus, K. (2018). Nurse anesthesia – E-book (6th ed.). Elsevier Health Sciences.

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