Flash Cards

Clinical exam 2 – Gyn & lap surgery

Question Answer
What is a hysteroscopy (slide 2-1)? inside of the uterus is fiberoptically visualized by dilating w/ gas (CO2) or fluids (LR or glycine)
2 Advantages of laparoscopy are (slide 2-2): less pain, less pulm dysfxn postop
What are some adverse effects of laparoscopy (slide 2-3)? hypercapnia, increases resistance (PIP) to ventilation, hypoxia d/t V/Q mismatch & decreased FRC; arrhythmias (vagal stretching = brady); low cardiac output; organ or blood vessel puncture w/ gas embolism and/or hemorrhage
What should be the pressure of the machine delivering the gas used for insufflation (slide 2-3)? should be less than 15 mmHg
Physiologic complications of pneumoperitoneum are caused by these 3 principle things (slide 3-1): mechanical pressure, neurohumoral substance release (vasopressin, renin, norepi, dopamine)
Hemodynamic change to SVR d/t pneumoperitoneum is (slide 3-2): SVR increases (d/t renin, vasopressin, & mechanical compression of intra-abd vessels)
Hemodynamic changes to CVP d/t pneumoperitoneum are (slide 3-2): CVP increases (if IAP <20 mmHg) or decreases (if IAP >30 mmHg) & is confounded by position & intravasc volume status. probably d/t mechanical pressure on abd vessels
Hemodynamic change to stroke volume d/t pneumoperitoneum are (slide 3-3): reduced, probably d/t increased afterload & decreased right filling pressures (preload)
Hemodynamic change to cardiac output d/t pneumoperitoneum are (slide 3-3): complex, variable, usually decreased; depends on position, hydration, amount of IAP; CO may increase d/t neurohumoral factors (renin & vasopressin) & increased HR
Hemodynamic change to BP d/t pneumoperitoneum are (slide 3-3): usually increases concurrent w/ increased SVR
What causes arrhythmias during laparascopy (slide 4-2)? reflex increases of vagal tone may result from sudden stretching of peritoneum & electrocoagulation of fallopian tubes
What types of arrhythmias may occur during laparascopy (slide 4-2)? bradycardia, cardiac arrhythmias, & asystole
What accentuates vagal stimulation during laparoscopy (slide 4-2)? if level of anesthesia is too superficial or if pt is taking beta blockers
What is the treatment for arrhythmias that may occur during laparascopy (slide 4-2)? interruption of insufflation, atropine, & deepening of anesthesia after recovery of heart rate
During laparascopy, when do cardiac irregularities most likely occur (slide 4-3)? early during insufflation, when pathophysiologic hemodynamic changes are the most intense
What can high insufflation pressures do to EKG (slide 4-3)? QT prolongation
During CO2 pneumoperitoneum, how long does it take for PaCO2 to reach plateau (slide 5-1)? 15 – 30 min after the beginning of CO2 insufflation
Hypercapnic levels > 50 mmHg may cause (5-1): arrhythmias, increased cerebral blood flow & ICP, peripheral vasodilation, pulm vasoconstriction
A significant rise in PaCO2 during laparoscopic procedure may be due to: CO2 SQ emphysema
Treatment for SQ CO2 emphysema due to lap procedure is: temporarily interrupt insufflation to allow CO2 elimination & resume after correction of hypercapnia using lower insufflation pressure, controlled mechanical ventilation until hypercapnia is corrected (esp COPD pts)
CO2 in the pleural space is called: capnothorax
The most feared and dangerous complication of laparoscopic surgery is: gas embolism
What injuries may occur from lithotomy position? common peroneal nerve, saphenous nerve (pressure over medial tibial condyle), sciatic nerve may be stretched by hyperflexion of hip & extension of knee, popliteal fossa compression
When pt is placed in trend/steep trend, what intervention must be done w/ ETT? check bilateral breath sounds to make sure ETT did not move during reposition
complications of head down positioning combined w/ pneumoperitoneum are: V/Q mismatch (hypoxia, etCO2 + paCO2); shunt, deadspace
If LMA will be used for lap surgery, what is the 15 rule that must be followed? no more than 15 degrees head down, 15 in, 15 cm H2O IAP
What level of neuraxial blockade is indicated for pelvic cases? T6 – T8
What part of the brain does oxytocin come from? posterior pituitary
Fast infusion of oxytocin may cause (4 things): vasodilation, hypotension, flushing, reflex tachycardia
Oxytocin is structurally similar to _____ and high doses may cause _______ ADH; water retention

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