ANESTHESIA FOR LAPROSCOPY SURGERIES G.K.Kumar
What’s the significance? Differences between . LS surgery & Op surgery. Anesthesia: Requirements Techniques Complications
Key point Physics & Physiology of Laparoscopy surgeries.
Physiological changes about laprascopic surgeries 1 3 2
Influencing factors-3P’s. Pressure-intra abdominal pressure changes[IAP] Positional changes PaCO2 changes
Laprascopy Vs Laparatomy Factors Lap’scopy Lap’tomy CVS Depression stimulation RS changes ++ + Endocrine response Positional Changes Anesthesia requirement ==
Influencing factors-3P’s. Pressure-intra abdominal pressure changes[IAP] Positional changes PaCO2 changes
Pressure –[IAP] changes Hemodynamic alterations[>10mmHg] Respiratory changes [ >14mmHg] Other changes
Pressure –[IAP] CVS changes Cardiac output-10 to 30% fall SVR PVR BP & Arrythmogenicity
Pressure –[IAP] CVS changes Venous resistance Pooling of blood Caval compression CO
Pressure –[IAP] CVS changes Intrathoracic pr Peritoneal receptor Vas.resistance Of intraab organs Neurohumoral factors SVR CO
Pressure –[IAP] CVS changes Cardiac output-due to venous return Systemic &pulmonary vascular resistance –due to mechanical & neurohumoral factors [RAS,catecholamines,VP] Reaches plateau after 15-30mins
Pressure –[IAP] -management Normal patients can tolerate the changes,significant in compromised pts. SVR decreased by-NTG -Nicardipine -Dobutamine 3.preload augmentation-IVF -position
Pressure –[IAP] CVS changes
Pressure –[IAP] RS changes Begin when IAP >14mmHg Compliance sed by 30-50% FRC sed due to elevated diaphragm Vp/Vq mismatch due to Paw Reaches plateau after 15-30mins
Pressure –[IAP] RSchanges paCO2 ETCO2 pH
Pressure –[IAP] RS changes
Pressure –[IAP] other changes RBF - U>O up to 50% Stagnation of venous BF –risk of TE ICP normal if PaCO2 normal IOP
Positional changes Trendelenburg R. Trendelenburg Lithotomy -CVS,RS,ICP,IOP changes. -Aspiration. -Air embolism. -Nerve injury.
PaCO2-changes PaCo2 progressive increased Due to-absorption from peritonium. -Vp/Vq mismatch -Positional changes
PaCO2-changes
Insufflating gas Oswald blood/gas coefficient Explosiveness/combustion Co2 0.87,noninflammable GAS OBGC Ex’n N2o 0.47 + N 0.061 ++ O2 0.031 Xe 0.14 -- {Embolism ++}
Post op pain management Less pain stimuli Pain mainly-visceral - (cf:parietal pain in open surgeries) -shoulder tip &neck pain (80%in 24hrs,50%in48hrs)
Post op pain management Topical/infiltration Intraperitoneal adminiatration of LA-80ml of 0.5%lig/0.125bup Thoracic epidural B/L rectus shealth block Preemptive NSAID