NAGELHOUT CHAPTER 34:
ANESTHESIA FOR LAPAROSCOPIC
SURGERY WITH CORRECT SOLUTIONS
Surgeons in _________________, ______________ and _____________________
are using laparscopy to perform increasingly more complex diagnostic and therapeutic
procedures - ANSWER-gynecology
urology
general surgery
The installation of air or gas into the peritoneal cavity under controlled pressure -
ANSWER-pneumoperitoneum
Although complications associated with laparoscopic surgery are rare,
___________________ and ____________________ are responsible for a significant
proportion of those that do occur - ANSWER-initial entry into the abdominal cavity
establishment of the pneumoperitoneum
Two entry methods are used most commonly for the establishment of the
pneumoperitoneum during laparoscopic surgey: - ANSWER-the closed technique or the
open (Hasson) procedure
Why is carbon dioxide the gas of choice in most instances of pneumoperitoneums? -
ANSWER-it is nontoxic, nonflammable, and is readily absorbed into the blood stream
with minimal risk of air embolization.
It produces less hemodynamic effects when compared with other nonflammable gases
Whereas clinical complications have not been demonstrated following transitory
elevations in intrabdominal pressure, prolonged periods of
_________________________ may be associated with significant physiologic effects -
ANSWER-high intraabdominal pressure and tension (such as those required for
successful laparscopy)
Multiple studies demonstrate that the creation of a pneumoperitoneum is associated
with significant changes in hemodynamics, such as: - ANSWER--Increase SVR
-Increase MAP
-Increase CVP
-Increase PAOP
-Increase Left ventricular wall stress
-Increase in venous return at IAP <10
-Decrease CO initially, then increase
, -Decrease venous return at IAP >10
-No change in HR (may initially increase because of hypercapnia or catecholamine
release
_______________________ and _______________________________ are implicated
as causative factors in the hemodynamic responses seen with pneumoperitoneums -
ANSWER-compression of the intraabdominal vessels and release of neuroendocrine
hormones (vasopressin and renin)
The increases in _______ and ________ are observed regardless of whether the
pneumoperitoneum is created under low pressure (12 mm HG) or high pressure (20
mmHg) - ANSWER-MAP and SVR
The choice of technique is determined by the surgeon; however, the evidence indicates
that patients who are ____________, ______________ or ________________, are at
increased risk for laparoscopic entry-related injuries at the umbilical entry point, and
they may benefit from an alternative entry procedure such as the open or left upper-
quadrant (Palmer's point) entry technique - ANSWER-extremely thin, obese, or known
to have abdominal adhesions
The closed technique involves the use of a spring-loaded needle known as a Veress
needle to pierce the abdominal wall at its thinnest point, either in the ______ or
___________ region - ANSWER-infraumbilical or intraumbilical
in women undergoing laparscopic procedures, studies have shown that intrabdominal
pressure of _____________ or less reliably indicates correct placement of an
umbilically placed Veress needle - ANSWER-10 mmHg
The magnitude of patient response to pneumoperitoneum depends upon multiple
factors, including: - ANSWER-1) the degree of intraabdominal pressure generated
during creation of the pneumoperitoneum
2) length of surgery
3) patient position
4) patient age
5) perioperative volume status
6) the presence of preexisting pulmonary and/or cardiovascular disease
Changes in ________________ appear to have a greater effect on central pressures
than does the penumoperitoneum itself - ANSWER-position
Steep Trandelenburg produces significant increases in __________________ because
it increases hydrostatic pressure at the level of the external auditory meaturs -
ANSWER-central venous pressure
The decreases in stroke volume caused by increased intraabdominal pressures can be
offset through: - ANSWER-adequate perioperative hydration, changes in patient
ANESTHESIA FOR LAPAROSCOPIC
SURGERY WITH CORRECT SOLUTIONS
Surgeons in _________________, ______________ and _____________________
are using laparscopy to perform increasingly more complex diagnostic and therapeutic
procedures - ANSWER-gynecology
urology
general surgery
The installation of air or gas into the peritoneal cavity under controlled pressure -
ANSWER-pneumoperitoneum
Although complications associated with laparoscopic surgery are rare,
___________________ and ____________________ are responsible for a significant
proportion of those that do occur - ANSWER-initial entry into the abdominal cavity
establishment of the pneumoperitoneum
Two entry methods are used most commonly for the establishment of the
pneumoperitoneum during laparoscopic surgey: - ANSWER-the closed technique or the
open (Hasson) procedure
Why is carbon dioxide the gas of choice in most instances of pneumoperitoneums? -
ANSWER-it is nontoxic, nonflammable, and is readily absorbed into the blood stream
with minimal risk of air embolization.
It produces less hemodynamic effects when compared with other nonflammable gases
Whereas clinical complications have not been demonstrated following transitory
elevations in intrabdominal pressure, prolonged periods of
_________________________ may be associated with significant physiologic effects -
ANSWER-high intraabdominal pressure and tension (such as those required for
successful laparscopy)
Multiple studies demonstrate that the creation of a pneumoperitoneum is associated
with significant changes in hemodynamics, such as: - ANSWER--Increase SVR
-Increase MAP
-Increase CVP
-Increase PAOP
-Increase Left ventricular wall stress
-Increase in venous return at IAP <10
-Decrease CO initially, then increase
, -Decrease venous return at IAP >10
-No change in HR (may initially increase because of hypercapnia or catecholamine
release
_______________________ and _______________________________ are implicated
as causative factors in the hemodynamic responses seen with pneumoperitoneums -
ANSWER-compression of the intraabdominal vessels and release of neuroendocrine
hormones (vasopressin and renin)
The increases in _______ and ________ are observed regardless of whether the
pneumoperitoneum is created under low pressure (12 mm HG) or high pressure (20
mmHg) - ANSWER-MAP and SVR
The choice of technique is determined by the surgeon; however, the evidence indicates
that patients who are ____________, ______________ or ________________, are at
increased risk for laparoscopic entry-related injuries at the umbilical entry point, and
they may benefit from an alternative entry procedure such as the open or left upper-
quadrant (Palmer's point) entry technique - ANSWER-extremely thin, obese, or known
to have abdominal adhesions
The closed technique involves the use of a spring-loaded needle known as a Veress
needle to pierce the abdominal wall at its thinnest point, either in the ______ or
___________ region - ANSWER-infraumbilical or intraumbilical
in women undergoing laparscopic procedures, studies have shown that intrabdominal
pressure of _____________ or less reliably indicates correct placement of an
umbilically placed Veress needle - ANSWER-10 mmHg
The magnitude of patient response to pneumoperitoneum depends upon multiple
factors, including: - ANSWER-1) the degree of intraabdominal pressure generated
during creation of the pneumoperitoneum
2) length of surgery
3) patient position
4) patient age
5) perioperative volume status
6) the presence of preexisting pulmonary and/or cardiovascular disease
Changes in ________________ appear to have a greater effect on central pressures
than does the penumoperitoneum itself - ANSWER-position
Steep Trandelenburg produces significant increases in __________________ because
it increases hydrostatic pressure at the level of the external auditory meaturs -
ANSWER-central venous pressure
The decreases in stroke volume caused by increased intraabdominal pressures can be
offset through: - ANSWER-adequate perioperative hydration, changes in patient
