FLS Pneumoperitoneum and Insufflation Flashcards

What is the primary cardiovascular effect of elevated intraabdominal pressure (>15 mmHg) during laparoscopy?

Answer: Decreased venous return and reduced cardiac output

Elevated IAP compresses the inferior vena cava, reducing venous return and preload, which decreases cardiac output.

The Palmer's point entry site for Veress needle insertion is located at:

Answer: 3 cm below the left costal margin in the midclavicular line

Palmer's point, 3 cm below the left costal margin in the midclavicular line, is used as an alternative entry site when umbilical adhesions are suspected.

During laparoscopy, hypercarbia (elevated PaCO₂) occurs primarily because:

Answer: CO₂ diffuses across the peritoneum into the bloodstream

CO₂ used for insufflation readily diffuses across the peritoneal membrane into the bloodstream, raising PaCO₂ and requiring increased minute ventilation.

A 'hissing' sound heard when the Veress needle is inserted into the abdomen most likely indicates:

Answer: Correct peritoneal entry with free gas flow

A hissing sound as gas flows freely indicates the needle tip is in the peritoneal cavity with low resistance, confirming correct placement.

The 'aspiration test' during Veress needle placement involves attaching a syringe and aspirating; a positive (correct placement) result is:

Answer: No aspirate and free saline instillation without resistance

No aspirate combined with free instillation of saline (which drops in without resistance) confirms the needle is in the free peritoneal space.

Which patient position is most commonly used to facilitate pneumoperitoneum creation and trocar placement in pelvic laparoscopic surgery?

Answer: Lithotomy with Trendelenburg (head down)

Trendelenburg position causes bowel to fall toward the upper abdomen, clearing the pelvis for better visualization and instrument access.