Bad effect pf laparoscopic surgery
| Discussion in 'All Categories' started by Denish Staw - Nov 3rd, 2011 10:31 pm. | |
Denish Staw
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Dear Doctor I want to know what are the side effect of laparoscopic surgery on our body. |
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re: Bad effect pf laparoscopic surgery
by Dr M.K. Gupta -
Nov 3rd, 2011
10:35 pm
#1
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Dr M.K. Gupta
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Dear Staw Laparoscopic surgery as such does not have any bad effect but the pneumoperitoneum which we create is creating some bad effect. Pneumoperitoneum raises intra-abdominal pressure. Physiological changes are minimized if the intra-abdominal pressure |
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re: Bad effect pf laparoscopic surgery
by Dr M.K. Gupta -
Nov 3rd, 2011
10:37 pm
#2
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Dr M.K. Gupta
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Pneumoperitoneum raises intra-abdominal pressure. Physiological changes are minimized if the intra-abdominal pressure less than 15 mmHg. This value should be monitored on the insuflation equipment. Physiological effects include: Respiratory: Diaphragmatic displacement, reduced lung volumes and compliance, increased airway resistance, increased V/Q mismatch, hypoxia/hypercapnia from hypoventilation, increased risk of regurgitation CVS: Increased systemic vascular resistance, raised mean arterial pressure, compression of IVC, reduced venous return, reduced cardiac output Renal: Reduced renal blood flow, reduced glomerular filtration rate, reduced urine output |
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re: Bad effect pf laparoscopic surgery
by Dr M.K. Gupta -
Nov 3rd, 2011
10:58 pm
#3
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Dr M.K. Gupta
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Dear Staw Below is some general principles: General principles for laparoscopic surgery Laparoscopic techniques have been developed for many operations including cholecystectomy, fundoplication, vagotomy, hemicolectomy, hernia repair, appendicectomy, and oesophagectomy. Compared with laparotomy the major advantages are: Reduced tissue trauma required for surgical exposure. Reduced wound size and postoperative pain. Improved postoperative respiratory function: Following open cholecystectomy FVC is reduced by approximately 50percent and changes are still evident up to 72 h postoperatively. Following laparoscopic cholecystectomy FVC is reduced by approximately 30percent and is normal at 24 h postoperatively. Reduced postoperative ileus. Earlier mobilization. Shorter hospital stay. Surgical requirements Gravitational displacement of abdominal viscera from the operative site. Decompression of abdominal viscera, especially the stomach (nasogastrictube) and bladder (urinary catheter). Prevents injury on trocar insertion. Pneumoperitoneum. This separates the abdominal wall from the viscera. An intra-abdominal pressure of 15 mmHg is adequate for most procedures. Modern equipment has an automatic limit on abdominal pressure. Beware older equipment which may not have an automatic limit, as can deliver gas flows producing an intra-abdominal pressure greater than 40 mmHg. Carbon dioxide can be used to create the pneumoperitoneum. This has the advantage of being non-combustible allowing the use of diathermy or laser. Disadvantages include systemic absorption and peritoneal irritation producing pain. Intra-operative effects of laparoscopic surgery Pneumoperitoneum raises intra-abdominal pressure. Physiological changes are minimized if the intra-abdominal pressure less than 15 mmHg. This value should be monitored on the insuflation equipment. Physiological effects include: Respiratory Diaphragmatic displacement, reduced lung volumes and compliance, increased airway resistance, increased V/Q mismatch, hypoxia/hypercapnia from hypoventilation, increased risk of regurgitation CVS Increased systemic vascular resistance, raised mean arterial pressure, compression of IVC, reduced venous return, reduced cardiac output Renal Reduced renal blood flow, reduced glomerular filtration rate, reduced urine output Patient positioning. With upper abdominal procedures the patient is placed head up (reverse Trendelenberg position). For lower abdominal procedures the patient is placed head down (Trendelenberg position). The usual tilt is 15 |
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re: Bad effect pf laparoscopic surgery
by Dr M.K. Gupta -
Nov 3rd, 2011
11:05 pm
#4
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Dr M.K. Gupta
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Anaesthetic management Preoperative Contraindications to laparoscopic surgery are relative. Successful laparoscopic procedures have been carried out on patients who were anticoagulated, markedly obese, or pregnant. Fit and young patients tolerate the physiological changes well. Elderly patients and those with cardiac or pulmonary disease have more marked and varied responses. NCEPOD 1996/1997 recommended caution in patients who were ASA less than 3, age more than 69 years, those who had a history of cardiac failure, and those with widespread ischaemic heart disease. Patients with marked respiratory or cardiac disease must be thoroughly reviewed and optimized preoperatively and have a surgeon experienced in the procedure as the operator. Beware of patients being admitted on the day of surgery without the appropriate preoperative preparation. Prescribe paracetamol 1 g PO and an NSAID, e.g. diclofenac 50 to 100 mg PO, 2 h preoperatively. Be prepared to convert to an open procedure (1 |