Laparoscopy
Clinical Procedure
 
Aliases:
Laparoscopic surgery
Laparascopic surgery
Laprascopic surgery

Topic aliases are alternate phrasings for a particular topic.


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For specific neonate issue see neonatal laparoscopy

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If the patient develops a haemodynamically unstable CO2 pneumothorax (capnothorax), instruct the surgeon to deflate the peritoneum. If the patient is stable, consider increasing PEEP to decrease the intraperitoneal/intrapleural pressure gradient.

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At risk of parasympathetic bradycardia and hypotension on abdominal insufflation/pneumoperitineum. If the patient is unstable, instruct the surgeon to deflate urgently, and administer fluids/atropine if it persists.

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Consider the fact that circulation time is prolonged in bradycardic patients when administering drugs. May need to commence external chest compressions to increase cardiac output.
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Capnothorax (CO2 pneumothorax) Is relatively common, but consequential only when it causes respiratory or cardiovascular compromise. #ref

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Patients with underlying chronic obstructive pulmonary disease (COPD) or morbid obesity are at high risk for pulmonary decompensation and may require PEEP for adequate gas exchange

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Ensure there is no slip/slide sheet under the patient. Any significant table tilt or roll to improve surgical view may result in the patient falling onto the ground.

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Head down (trendelenberg) position may advance endotracheal tube endobronchially, resulting in inadvertant one lung ventilation

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At risk of CO2 venous-embolism

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If suspected, deflate immediately, left lateral tilt/head down to float gas away from heart, administer intravenous fluids.
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Be vigilant for concealed hypovolaemia.
In these patients the fall in cardiac output due to reduced venous return will be exaggerated.
#ref

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