Documente Academic
Documente Profesional
Documente Cultură
and
Laparoscopic
Surgery
Waldemar P. Siahaan, MD
Anesthesia Department
MAMC
OBJECTIVES
Pressurized CO2
Pneumoperitoneum
Increase Intra Abdominal Pressure (IAP)
Displaced diaphragm cephalad
Decrease in lung compliance
Compensate attemption
Ex:Increasing the tidal volume
or Respiratory Rate
Increase Mean Intrathoracic
pressure
Hindering venous return
Increase the mean Pulmonary
artery pressure.
GENERAL ANESTHESIA
Perforated Viscus
HEMORRHAGE
-Inadvertent intravenous
placement of veress needle
-Open vessels on the liver
surface during GB dissection
Passage of CO2 into abdominal wall and peritoneal vessels, open vessels
VENOUS CO2 EMBOLISM
TREATMENT!!!
-Immediate release of the pneumoperitoneum
-Insertion of a central venous catheter
-Placement of patient. Head down and LLDP
-Peritoneal insufflation
-Manipulation of Viscera
Emptying of the stomach with NGT
Vagal Stimulation
Bradychardia/
Arrhythmias
Sinus Arrest
Metoclopromide / Plasil
Postoperative Considerations
-Increased IAP during penumoperitoneum
Venous stasis