1. ANESTHESIA FOR LAPROSCOPY SURGERIES
G.K.Kumar

2. What’s the significance?
Differences between LS surgery & Op surgery.
Anesthesia: Requirements
Techniques
Complications

3. Key point
Physics & Physiology of Laparoscopy surgeries.

4. Physiological changes about laprascopic surgeries1 3 2

5. Influencing factors-3P’s.
Pressure-intra abdominal pressure changes[IAP]
Positional changes
PaCO2 changes

6. Laprascopy Vs Laparatomy
Factors
Lap’scopy
Lap’tomy
CVS
Depression
stimulation
RS changes ++ +
Endocrine response
Positional Changes
Anesthesia requirement ==

7. Influencing factors-3P’s.
Pressure-intra abdominal pressure changes[IAP]
Positional changes
PaCO2 changes

8. Pressure –[IAP] changes
Hemodynamic alterations[>10mmHg]
Respiratory changes [ >14mmHg]
Other changes

9. Pressure –[IAP] CVS changes
Cardiac output-10 to 30% fall
SVR
PVR
BP & Arrythmogenicity

10. Pressure –[IAP] CVS changes
Venous resistance
Pooling of blood
Caval compression CO

11. Pressure –[IAP] CVS changes
Intrathoracic pr
Peritoneal receptor
Vas.resistance
Of intraab organs
Neurohumoral factors
SVR CO

12. 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

13. Pressure –[IAP] -management
Normal patients can tolerate the changes,significant in compromised pts.
SVR decreased by-NTG
-Nicardipine
-Dobutamine
3.preload augmentation-IVF
-position

14. Pressure –[IAP] CVS changes

15. 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

16. Pressure –[IAP] RSchanges
paCO2
ETCO2 pH

17. Pressure –[IAP] RS changes

18. Pressure –[IAP] other changes
RBF - U>O up to 50%
Stagnation of venous BF –risk of TE
ICP normal if PaCO2 normal
IOP

19. Positional changes Trendelenburg R. Trendelenburg Lithotomy
-CVS,RS,ICP,IOP changes.
-Aspiration.
-Air embolism.
-Nerve injury.

20. PaCO2-changes PaCo2 progressive increased
Due to-absorption from peritonium.
-Vp/Vq mismatch
-Positional changes

21. PaCO2-changes

22. 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 ++}

23. 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)

24. 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