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ANESTHESIA FOR LAPROSCOPY SURGERIES

ANESTHESIA FOR LAPROSCOPY SURGERIES. G.K.Kumar. What’s the significance?. Differences between . LS surgery & Op surgery. Anesthesia: Requirements Techniques

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ANESTHESIA FOR LAPROSCOPY SURGERIES

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  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 surgeries 1 3 2

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

  6. Laprascopy Vs Laparatomy

  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 IAP Venous resistance Pooling of blood Caval compression CO

  11. Pressure –[IAP] CVS changes IAP 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 C P

  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

  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

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