Anesthesia For Laparoscopic Surgery Quiz

During laparoscopy, the patient's abdomen is inflated with carbon dioxide gas, which can cause a decrease in Functional Residual Capacity (FRC), the volume of air remaining in the lungs after a normal exhalation. However, healthy patients have compensatory mechanisms to maintain adequate oxygen levels, such as increased respiratory rate and cardiac output. Therefore, hypoxemia (low oxygen levels) due to decreased FRC is uncommon in healthy patients during laparoscopy.

Pressure volume loop monitors can help in the diagnosis of possible bronchospasm, pneumothorax, and endobronchial intubation because they provide real-time information about the changes in pressure and volume during the respiratory cycle. Bronchospasm, which is a constriction of the airways, can be detected by observing a decrease in the volume of air expelled during exhalation. Pneumothorax, which is the presence of air in the pleural cavity, can be identified by abnormal pressure changes in the lungs. Endobronchial intubation, where the endotracheal tube is mistakenly placed in the bronchus instead of the trachea, can be detected by observing asymmetrical pressure-volume loops. Therefore, pressure volume loop monitors are valuable tools in diagnosing these conditions.

The incidence of fatal pulmonary embolism is lower following laparoscopic cholecystectomy than after open surgery because laparoscopic cholecystectomy is a minimally invasive procedure that involves smaller incisions and less trauma to the body. This reduces the risk of blood clots forming in the veins of the legs, which can then travel to the lungs and cause a pulmonary embolism. Additionally, the shorter hospital stay and faster recovery associated with laparoscopic cholecystectomy may also contribute to a lower risk of fatal pulmonary embolism.

The potential complications associated with trocar insertion include GI perforations, major vascular trauma, and hepatic and splenic tears. These complications can occur due to the insertion of the trocar into the abdominal cavity, which can inadvertently damage organs or blood vessels. Therefore, all of these complications are possible when performing trocar insertion.

Urine output decreases significantly following pneumoperitoneal deflation because during pneumoperitoneal deflation, the pressure within the abdominal cavity is reduced. This reduction in pressure can lead to decreased blood flow to the kidneys, resulting in decreased urine production. Additionally, the release of the pneumoperitoneum can cause a temporary disruption in kidney function, further contributing to the decrease in urine output.

ETCO2, or end-tidal carbon dioxide, is a measure of the concentration of carbon dioxide at the end of expiration. It is commonly used as a surrogate for arterial carbon dioxide levels (PaCO2) in monitoring patients during anesthesia. However, in ASA 3 patients with cardiopulmonary disease, ETCO2 may not accurately reflect PaCO2 levels during CO2 insufflation. This is because cardiopulmonary disease can affect the ventilation-perfusion matching in the lungs, leading to a discrepancy between ETCO2 and PaCO2. Therefore, ETCO2 should be interpreted with caution in these patients, and alternative methods of monitoring PaCO2 should be considered.

The false statement during laparoscopy is that LMA (Laryngeal Mask Airway) can be used in laparoscopic cholecystectomy. LMA is not recommended for laparoscopic procedures because it does not provide a secure airway and can interfere with the surgical field. Endotracheal intubation with a cuffed endotracheal tube is preferred during laparoscopy to maintain a clear airway and prevent aspiration. Bladder decompression is also recommended to prevent bladder distension and potential injury during the procedure.

Complications of laparoscopic cholecystectomy can include bile duct injuries, which are more common and can be more extensive and higher in the ductal system. One common form of injury is misidentification of the common bile duct (CBD) and subsequent clamping or resection. Therefore, all of the given options are correct as they all describe different aspects of complications associated with laparoscopic cholecystectomy.

The correct answer is "All". This means that all of the given statements are true regarding regional anesthesia during laparoscopy. This includes the requirement of T2 level anesthesia, as well as the occasional shoulder pain that may occur due to diaphragmatic irritation.

The question is asking for potential intraoperative complications of pneumoperitoneum, excluding one option. The correct answer is "None" because all of the options listed (pneumomediastinum, subcutaneous emphysema, and cardiac arrhythmia) are potential complications of pneumoperitoneum.

The recommended IAP threshold to avoid cardiovascular compromise is less than 12 mmHg. This means that if the intra-abdominal pressure (IAP) exceeds 12 mmHg, it can lead to cardiovascular problems. Keeping the IAP below this threshold helps prevent complications such as decreased blood flow and organ dysfunction.

Thromboembolism of the lower legs is due to both increased intraabdominal pressure and head-up position. Increased intraabdominal pressure can lead to compression of the veins in the legs, impairing blood flow and increasing the risk of blood clot formation. Similarly, the head-up position can also contribute to impaired blood flow in the lower legs, as it can increase the pressure on the veins and hinder the return of blood to the heart. Therefore, both factors can independently or synergistically contribute to the development of thromboembolism in the lower legs.

The correct answer is "Place patient in headup left lateral decubitus position". This is because placing the patient in a headup left lateral decubitus position can worsen the CO2 gas embolism by allowing the gas to travel to the right side of the heart and potentially cause further complications. The other options listed are appropriate treatments for CO2 gas embolism.

During pneumoperitoneum, which is the introduction of gas into the peritoneal cavity during laparoscopic surgery, several changes occur in the pulmonary system. One of these changes is an increased peak inspiratory pressure, which refers to the maximum pressure generated during inhalation. This increase in pressure is due to the elevated intra-abdominal pressure caused by the gas, which can impede diaphragmatic movement and lead to increased resistance to airflow. As a result, the respiratory muscles have to work harder to overcome this resistance, leading to an increased peak inspiratory pressure. The other options, such as decreased PaCO2, increased vital capacity, and increased FRC, are not directly related to the pulmonary changes during pneumoperitoneum.

Tramadol is not associated with narcotic-induced spasm of the sphincter of Oddi. The sphincter of Oddi is a muscular valve that controls the flow of bile and pancreatic juice into the small intestine. Narcotics like morphine, Demerol, and fentanyl can cause spasm of this sphincter, leading to complications such as biliary colic and pancreatitis. However, Tramadol is a centrally acting analgesic that works through a different mechanism and does not have the same effect on the sphincter of Oddi.

CO2 is rapidly excreted via the lungs during gas insufflation in laparoscopy. This is because CO2 is a highly soluble gas that is easily absorbed by the bloodstream and eliminated through the respiratory system. The use of CO2 as the insufflation gas allows for a clear surgical field and minimizes the risk of gas embolism. Unlike other gases like nitrous oxide or helium, CO2 does not support combustion and is considered safe for use in laparoscopic procedures. The statement implies that CO2 is the preferred gas for insufflation during laparoscopy due to its rapid excretion and safety profile.

The given statement is false because left main bronchus intubation and hypoxemia in the head down position is not the most common form of injury during laparoscopic procedures. The most common form of injury is actually injury to blood vessels or organs due to trocar placement or manipulation of instruments.

The possible causes of acute hypotension or hypoxemia during laparoscopy include venous gas embolism, reflex increased vagal tone, and pneumothorax. Inadvertent extra peritoneal insufflation is not a cause of hypotension or hypoxemia during laparoscopy.

Pneumoperitoneum refers to the presence of air or gas in the peritoneal cavity, which can occur during certain surgical procedures. This condition can have various effects on the body. Subcutaneous emphysema refers to the presence of air or gas in the subcutaneous tissue, which can be a possible effect of pneumoperitoneum. Decreased cardiac index, increased mean arterial pressure (MAP), and increased systemic vascular resistance (SVR) are also potential effects of pneumoperitoneum. However, there would be no change in the plasma concentration of dopamine, epinephrine, and vasopressin, as these are hormones that are not directly affected by pneumoperitoneum.

Laparoscopic cholecystectomy can be performed safely during pregnancy, including the second trimester. The procedure is generally considered safe for both the mother and the fetus. The incidence of laparoscopic cholecystectomy in pregnant patients is low, at approximately 0.05%. The need for surgery in pregnant patients with gallstones is relatively high, at approximately 40%. During the procedure, intraabdominal pressure should be limited to minimize the risk of harm to the fetus.

Increased intra-abdominal pressure (IAP) during laparoscopy can cause a decrease in chest wall mechanical impedance. This is because the increased pressure in the abdomen can compress the diaphragm, leading to reduced lung compliance and decreased functional residual capacity (FRC). It can also cause a ventilation/perfusion (V/Q) mismatch, where there is an imbalance between the amount of air reaching the alveoli and the blood flow through the pulmonary capillaries. These physiological changes can contribute to intraoperative hypoxemia during laparoscopy.

The given statement is false. Nitrous oxide is not conclusively associated with an increased incidence of postoperative nausea and vomiting (PONV). While some studies have suggested a potential link, the evidence is not conclusive. Other factors such as patient characteristics, surgical procedures, and anesthetic techniques can also contribute to the incidence of PONV. Therefore, it is incorrect to state that there is conclusive evidence of nitrous oxide's association with increased PONV incidence.

Intraperitoneal insufflation is a process in which carbon dioxide (CO2) gas is introduced into the abdominal cavity during laparoscopic surgeries to create a pneumoperitoneum. The increased intra-abdominal pressure from the insufflation enhances the absorption of CO2 through the peritoneum and intestinal serosa. As a result, CO2 absorption is greater during intraperitoneal insufflation compared to other methods, such as insufflation in a body cavity with a smaller surface area. It's important to note that the increased CO2 absorption can lead to hypercapnia, acidosis, and other potential complications if not properly monitored and managed during the surgical procedure.

Bile duct injuries are actually more common with laparoscopic cholecystectomy, not open cholecystectomy. This is because the laparoscopic approach involves the use of small incisions and a camera, which can make it more difficult to visualize and safely manipulate the bile ducts. Open cholecystectomy, on the other hand, involves a larger incision and direct visualization of the bile ducts, reducing the risk of injury.

During a laparoscopic cholecystectomy, the surgeon uses a position that allows for better access to the gallbladder. Trendelenburg position is commonly used as it involves tilting the patient's head down and elevating the feet, which helps to move the abdominal organs away from the pelvis. Steep headup position is also used to improve access to the gallbladder. Left lateral decubitus position is used to shift the patient's weight onto their left side, allowing gravity to pull the liver and intestines away from the surgical site. However, right lateral decubitus position is not used during laparoscopic cholecystectomy as it does not provide the necessary access to the gallbladder.