Download FLS Module 2 Questions AND Answers 2025 and more Exams Advanced Education in PDF only on Docsity!
FLS Module 2
Indications for using local anesthesia in laparoscopy - answer no conclusive evidence that it will prevent visceral pain but can be helpful for tubal ligations, diagnostic laparoscopies or hernia repairs Types of local anesthesia - answer Bupivacaine, Ropivacaine, Lidocaine Advantages of epidural anesthesia - answer Decreased post-operative anesthesia and decreased length of post-op ileus as well as improved muscle relaxation. What medication can you give to prevent Brady arrhythmias in lap surgery? - answerProphylactic atropine prevents bradyarrhythmias caused by pneumoperitoneum but causes excessive dry mouth so better to give intra-op rather than pre-op. Can give glycopyrrolate What class of meds are used pre-op for relaxation of patients - answerBenzos. For relaxation and also to give amnesia. What meds should patient take prior to surgery? - answerH2 blocker or non-particulate antacid sodium citrate to minimize effects of aspiration should it occur. Also any chronic cardiovascular or pulmonary medications What components are important for anesthetizing a patient for laparoscopy - answerIV induction + GETA and neuromuscular blockade Can you use an LMA for laparoscopy? - answercontroversial Does the use of nitrous oxide as an insufflating gas cause bowel distension - answerusually not seen (rare) unless patient has a bowel obstruction Common patient positions in surgery - answerSupine, Trendelenburg, Reverse T-burg, Lithotomy, lateral decubitus How should you position the arms in a pelvic laparoscopic surgery - answerArm tucked to the sides. Ensure hands are not near a break in the table to avoid a hand injury if table is flexed during surgery How should you position the arms in an upper abdominal surgery - answerArms abducted to 90 degree angle but not greater than 90 to avoid brachial plexus stretch injury
What are some key elements to keeping patient safe in a steep reverse Trendelenburg position - answerFoot board to keep patient from sliding, safety belt to keep patients knees from buckling Keys to safely positioning a patient in lithotomy position - answerFit the equipment to the patient, not the patient to the equipment. Allen stirups preferable to candy cane stirrups given more movements. In an omentectomy, what level should the knees be placed in the lithotomy position for optimal positioning? - answerFor open surgery such as omenectomy it's important to make sure the knees are level with the torso to keep the instruments from interfering with the knees Decubitus position precautions - answeravoid stretch in brachial plexus, roll in the the axilla on the dependent side, with a an arm board for the contralateral arm. Can use a bean bag but it cannot extend too far anterior or posterior to avoid interference with port placement and manipulation What is the risk to using a vacuum sealed bean bag rather than pillows or blankets for positioning a patient - answerHigher risk of pressure injury with the vacuum sealed bag as it is more firm than pillows or blankets What position do you need to consider for adrenal surgery? - answerLateral decubitus with the table flexed to increase the dimension between the costal margin and the iliac crest. Allows more space for access to the target organ. modified decubitus - answerAllows for rotation between supine and lateral decubitus positioning. Must adequately secure the patient. has all of the benefits of lateral decub but able to quickly rotate to supine if needing to convert to an open procedure midline incision. Avoids flank or subcostal incision which may be intolerable Surgeries where the modified decubitus position are used - answersplenectomy, nephrectomy, adrenalectomy What procedure can be performed using local anesthesia alone or with mild sedation - answerDiagnostic laparoscopy Important factors for positioning a patient for laparoscopic surgery - answerAvoidance of position related nerve injuries, prevention of DVT, ensuring adequate exposure for target organ Advantages of general anesthesia - answerallows for complete neuromuscular relaxation, good control of ventilation, more flexibility in patient positioning
What are alternate gases used for pneumoperitoneum - answerNitrous oxide, air, helium, argon What are the benefits of using nitrous oxide as the insufflation medium? - answerless acid base disturbance, increased tolerance without general anesthesia, less post-op pain. When is nitrous oxide considered combustible for a laparoscopic insufflation medium? - answerwhen a combustible gas is present in the abdomen such as hydrogen or methane. So, do not use in the case of suspected bowel injury. But it does NOT suppress combustion. Is nitrous oxide combustible - answerNo, it is not flammable itself and can be used with monopolar electrocautery. BUT it does not SUPPRESS combustion like CO2 does. What are benefits of using Argon or Helium as insufflation mediums? - answerThey are inert gases and eliminate the risk of hypercarbia and acidosis. What are the drawbacks of using Argon or Helium as insufflation mediums? - answerDecreased solubility therefore increased risk of gas embolus. Much more expensive and insufflators not readily available. What are the changes in preload and afterload in patients undergoing laparosopic sugery? - answerincreased preload, increased afterload and decreased cardiac output What exacerbates the decreased CO in laparoscopy? - answerDecreased CO that is exacerbated by hypovolemia and steep T-burg. Manifests as hypotension, decreased HR, decreased UOP, and vagally induced bradycaria What do you do if you notice decreased cardiac output/hemodynamic instability during laparoscopy - answerDesufflate immediately, check insufflator settings and function, check for adequate relaxation, check intravascular volume status, check for other causes of hypotension (i.e. bleeding) Most common change to heart rhythm from pneumoperitoneum - answerBradycaria - due to teh pressure effects of the pneumo Other changes can include: Sinus tachycardia - usually mild and self-limited PVC's - rarely problematic Why does bradycardia occur? When does it usually present itself? How do you treat it?
- answerAssociated with the pressure effects of pneumoperitoneum. It is vagally mediated and presentes soon after establishement of pneumo. If severe, stop insufflation, and desufflate. Once return to normal, re-establish pneumo at lower flow rate and pressure. If continues, consider converting to open or aborting procedure.
What are the effects on the venous system with pneumoperitoneum? - answerIncreased vena cava resistance. Flow rates drop 26-39% during pneumo putting patient's at higher risk for VTE List 5 risk factors for VTE - answerHx of prior, age >40, immobility, varicose veins, cancer, CKD, obesity, peri-partum, CHF, MI, hormone replacement therapy, OCP's, multiparity, inflammatory bowel disease, severe infection Describe the mechanism of decreased urine production as it is related to pneumoperitoneum - answerIncreased abdominal pressure --> decreased renal profusion --> decreased filtration rate --> decreased UOP. What is the mechanism of oliguria post-operatively in patients s/p laparoscopy - answerA secondary release of renin and ADH leads to sodium adn free water reabsorption and oliguria. ost-operatively UOP remains low until hormonal mediators resume hemostasis, this can lead to physicians providing too much IVF leading to pulmonary edema, especially in patients with poor cardiac function. Will patients be more likely to be hyperthermic or hypothermic in laparoscopy? - answerHypothermic How do you prevent hypothermia - answerwarmed IVF, Barehugger, warm room temp. Using warm irrigation fluid has not been shown to have any significant effects. How common is a gas emoblism? How does it present? - answer<1% of cases. Sudden cardiovascular collapse due to lack of venous return: Hypotension, tachycardia, JVD, and a "mill wheel murmur." What do you do when you suspect a gas embolus? - answerStop insufflation, place patient in T-burg in left lateral decubitus position to prevent gas embolus to get to the right heart system, give fluid bolus to reverse severe hypotension, and place central line to evacuate or break up the embolus in the right heart chamber. How do we minimize risk of transmission of infectious particles from patient to OR staff in laparoscopy - answerUse filters for all suction devices, universal protection (eye protection, gloves, impervious gowns) What is important to do in a "final look" before removing the camera in laparoscopy? - answerCheck the surgical bed for hemostasis, perform survey of abdomen to rule out occult injury to remote organs, let out some of the pneumoperitoneum for a "low pressure test." What are the most common causes of unrecognized bleeding in laparoscopy? - answerTrocar injury of abdominal wall vessels, injury to vessels and organs away from operative field, tamponade of venous bleeding due to pneumoperitoneum.
