Skip to main content

laparoscopy..missed hazards


It is theoretically sound to avoid N2O during laparoscopy for at least two reasons:
First, it diffuses into the abdominal cavity in concentrations sufficient to support combustion of intestinal gas.1
second, it will diffuse into CO2 bubbles and emboli,increasing their size and potenial for an obstructive event.
Adequate muscle relaxation is required during laparoscopy so that:
Spontaneous respiratory effort does not impair the surgical procedure or risk increasing the gradient for embolic gas to enter the central circulation
Most studies but not all report a decrease in left ventricular function and cardiac output (cardiac output decreased 7–24%).
In addition, with assumption of the reverse Trendelenburg position, cardiac index may decrease by 50% of preanesthesia and preinsufflation values.
Venous stasis of the lower extremities also occurs, with attendant concerns for embolic phenomenon 3,4
Relatively small CO2 emboli have been detected by transesophageal echocardiography in 69% of patients, classified by the American Society of Anesthesiologists as physical status ASA1 to ASA3, who undergo laparoscopic cholecystectomy.5
Fatal massive CO2 embolism has been reported, including a report of death from delayed CO2 embolism associated with gas trapping in the portal circulation .6
1-Diemunsch PA, Torp KD, Van Dorsselaer T et al. Nitrous oxide fraction in the carbon dioxide pneumoperitoneum during laparoscopy under general inhaled anesthesia in pigs. Anesth Analg. 2000;90:951–3.

2-Neukman GG. Laparoscopy explosion hazards with nitrous oxide. Anesthesiology 1993;78:875.
3-Celli BR, Rodriques KS, Snider GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing
pulmonary complications after abdominal surgery. Am Rev Respir Dis 1984;130:12.
4-Millard JA, Hill BB, Cook PS, et al. Intermittent sequential pneumatic compression in prevention of venous stasis associated with pneumoperitoneum during
laparoscopic cholecystectomy. Arch Surg 1993;128:914.
5-Derouin M, Couture P, Boudreault D,et al. Detection of gas embolism by transesophageal echocardiography during laparoscopic cholecystectomy.
Anesth Analg 1996;82:119.
6-Lantz PE, Smith JD. Fatal carbon dioxide embolism complicating attempted laparoscopic cholecystectomy: case report and literature review.
J Forensic Sci 1994;39:1468.
Labels:

Comments

Post a Comment

Popular posts from this blog

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

Lumbar and thoracic epidural in Pediatrics-Technical aspect

The midline approach is most commonly used. The ligamentum   flavum is considerably thinner and less dense in infants than in older children and adults. This makes recognition of engagement in the ligament more difficult and requires both extra care and slower, more deliberate passage of the needle to avoid subarachnoid puncture. The angle of approach to the epidural space is slightly more perpendicular to the plane of the back than in older children and adults, owing to the orientation of the spinous   processes in infants and small children. The loss of resistance technique should be used, but only with saline, not air. There are several reports of venous air embolism in infants and children when air was used to test for loss of resistance Use a short (5 cm) 18-gauge Tuohy needle and a 20- or 21-gauge catheter in infants and children. Epidural kits specifically for infants and children are available Maximum of 0.4 mg/kg/hr of bupivacaine after the initial block is estab...
Post a Comment
Read more