Classifieds for every web site!

SURGICAL WEBSITES             KIDNEY SURGERY         POSTGRADUATE SURGERY LINKS 

BREAST DISEASE     Breast cancer Breast lump Breast awareness Breast calcifications  Breast cysts Breast pain Duct ectasia Fat necrosis Fibroadenoma Hyperplasia Intraductal papilloma Phyllodes tumour Sclerosing adenosis                                                                                                                                                 

LIVER ABSCESS      Anatomy of liver Physiology of liver Method of examination of liver Haematology of liver disease. Amoebic liver abscess .Pyogenic liver abscess. Percutaneous needle aspiration of liver abscess. Case study.  Result Result continued  Discussion                                                                 

CHOLECYSTECTOMY    Introduction   Historical Review  Anatomy of Gallbladder Physiology of Gallbladder Physiologic effects of pneumoperitoneum Pathology  of Gallbladder Investigations Pre- operative preparation of laparoscopic cholecystectomy Contraindications  Treatment modalities for gallstones.  Anaesthesia                                                                                                                       

INGUINAL HERNIA    HOW SURGICAL OPERATION IS DONE     THYROID EXAMINATION MANAGEMENT OF SEVERELY INJURED PATIENT      SEPSIS AND MULTIPLE ORGAN FAILURE CHEST TRAUMA     BRONCHOGENIC CARCINOMA     TETANUS AND ANAEROBIC INFECTIONS 

ANAESTHESIA IN LAPAROSCOPIC SURGERY

 

In laparoscopic surgery pneumoperitoneum is created with pressurised CO₂. The resulting increase in intra-abdominal pressure displaces the diaphragm cephalad causes decrease in lung compliance and an increase in peak respiratory pressure. Atelectasis diminishes the functional residual capacity ventilation perfusion mismatch and pulmonary shunting contribute to a decrease in arterial oxygenation. One would expect these changes to be exaggerated in obese patients with a long history of tobacco. The American Anaesthesiologist Association Classification Status (ASA) was used to assess co-morbidity, because it is relatively simple and has been shown to correlate well with outcome ¹²³. A head down position is (Trendelenburg's position) is commonly requested during insertion of Veress needle and cannula. This position causes this position cause cephalad shift of abdominal viscera and diaphragm and reducing the functional residual capacity. After insufflation the position is reversed and the functional residual capacity increases and the work of breathing decreases. Study was done to see the effects of intraperitoneal administration of Bupivicane it suggest that the administration of 20 ml of local anaesthetics intraperitoneally is not effective in reducing postoperative pain, improving lung function, or attenuating the metabolic endocrine response after laparoscopic cholecystectomy ¹²⁴.

 

ANAESTHESIA INDUCTION AND MAINTENANCE:

      These patients are premeditated with oral diazepam 10 mg. General anaesthesia with endotracheal intubation with positive pressure ventilation is usually favoured for many reasons: the risk of regurgitation from increased intra-abdominal pressure during insufflation; the necessity of controlled ventilation to prevent hypercapnia; the relatively high peak inspiratory pressures required because of pneumoperitoneum. 25 % thiopentone 3-5 mg / kg and suxamethonium 1-1.5 mg / kg are used for the induction of anaesthesia. Inhalation anaesthesia of nitrous oxide and halothane is given by appropriate size cuffed endotracheal tube and maintained with oxygen and ventilated with respirator. Supplemented by a narcotic analgesic, nalbuphine. The need of muscle paralysis during surgery to allow lower insufflation pressure provide better visualisation and prevent unexpected movement and the placement of nasogastric tube and gastric decompression to minimise the risk of visceral perforation during trocar introduction and optimal visualisation. Atracurium is given for neuromuscular blockade.

 

 

 

MONITORING:

      All patients are monitored for a minimum of 2 hours in the recovery room and the day care surgery room.