FLS FLS Pneumoperitoneum and Insufflation 1 — Questions and Answers
Question 1: What is the recommended initial intraabdominal pressure (IAP) for creating pneumoperitoneum in a standard adult laparoscopic procedure?
- 8–10 mmHg
- 12–15 mmHg (Correct answer)
- 18–20 mmHg
- 5–7 mmHg
Correct answer: 12–15 mmHg
A working pressure of 12–15 mmHg provides adequate visualization while minimizing hemodynamic and respiratory compromise in most adults.
Question 2: Which gas is most commonly used for laparoscopic insufflation and why?
- Oxygen — highly soluble
- Nitrous oxide — non-flammable
- Carbon dioxide — rapidly absorbed and non-flammable (Correct answer)
- Helium — inert and colorless
Correct answer: Carbon dioxide — rapidly absorbed and non-flammable
Carbon dioxide is preferred because it is highly soluble in blood, rapidly eliminated by the lungs, and non-flammable, reducing risk of gas embolism and surgical fire.
Question 3: A sudden drop in end-tidal COâ‚‚ (EtCOâ‚‚) combined with cardiovascular collapse during insufflation most likely indicates:
- Subcutaneous emphysema
- COâ‚‚ gas embolism (Correct answer)
- Tension pneumothorax
- Vasovagal response
Correct answer: COâ‚‚ gas embolism
A massive COâ‚‚ embolism causes a 'millwheel' murmur, cardiovascular collapse, and a precipitous fall in EtCOâ‚‚ as venous return is obstructed.
Question 4: The Veress needle technique relies on a spring-loaded blunt obturator that advances when the needle enters which structure?
- Subcutaneous fat
- The anterior fascia
- The peritoneal cavity (Correct answer)
- The retroperitoneum
Correct answer: The peritoneal cavity
Once the sharp tip passes through the peritoneum and resistance drops, the spring-loaded blunt stylet springs forward to protect intraabdominal organs.
Question 5: Which of the following initial insufflation flow rates is most appropriate when using the Veress needle to confirm correct placement?
- 15–20 L/min
- 1–2 L/min (Correct answer)
- 8–10 L/min
- 5–6 L/min
Correct answer: 1–2 L/min
Starting at a low flow rate (1–2 L/min) allows monitoring of pressure rise; a rapid pressure increase at low flow suggests incorrect placement.
Question 6: Subcutaneous emphysema during laparoscopy is most reliably detected by:
- A drop in peak airway pressure
- Crepitus on palpation of the chest and neck (Correct answer)
- Decrease in heart rate
- Increase in EtCOâ‚‚ with stable hemodynamics
Correct answer: Crepitus on palpation of the chest and neck
COâ‚‚ tracking along fascial planes produces palpable crepitus over the chest and neck, confirming subcutaneous emphysema.
FLS FLS Pneumoperitoneum and Insufflation 1
What is the recommended initial intraabdominal pressure (IAP) for creating pneumoperitoneum in a standard adult laparoscopic procedure?