FLS Pneumoperitoneum and Insufflation Flashcards

What is the recommended initial intraabdominal pressure (IAP) for creating pneumoperitoneum in a standard adult laparoscopic procedure?

Answer: 12–15 mmHg

A working pressure of 12–15 mmHg provides adequate visualization while minimizing hemodynamic and respiratory compromise in most adults.

Which gas is most commonly used for laparoscopic insufflation and why?

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.

A sudden drop in end-tidal CO₂ (EtCO₂) combined with cardiovascular collapse during insufflation most likely indicates:

Answer: CO₂ gas embolism

A massive CO₂ embolism causes a 'millwheel' murmur, cardiovascular collapse, and a precipitous fall in EtCO₂ as venous return is obstructed.

The Veress needle technique relies on a spring-loaded blunt obturator that advances when the needle enters which structure?

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.

Which of the following initial insufflation flow rates is most appropriate when using the Veress needle to confirm correct placement?

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.

Subcutaneous emphysema during laparoscopy is most reliably detected by:

Answer: Crepitus on palpation of the chest and neck

CO₂ tracking along fascial planes produces palpable crepitus over the chest and neck, confirming subcutaneous emphysema.