Dr Giridhar Panpalia Director- Devki hospital Akola

I want Laparoscopic surgeon !!!!

Fear Surgical Dissection Anesthetics

Anxiolytic as premedicant – Labet et al (anesthesiology 2012)

HypertensionPulmonary Edema

Macdermott JP Arch Surg 1995; Kawamura RJ Annal J surg 1999

THE ORIGINofMAN

B PH R

Pulmonary Edema ?Obeid F Arch surg 1995; puri GD Brit j Anes 1990

SpO2 ECG NIBP Ventilator

EtCO2

I told you to start O2 & you Started H2

Body has 120 liters of CO2 At IAP 15 ; flow of 200ml/hr CO2 absorbed is

20 to 30 ml/hr CO2 Absorption is maximum in first ½ hr Carbonic Acid – Shoulder pain Induces hypothermia – 0.3 C/50 lit of CO2

Shivering

Kendall Ap Anesthesilology 1996; Bures EP Brit J Anes 2010

Liquid Diet – previous day2 Tab Dulcox – HSNo Peglec (It causes Gaseous distention)Liquid diet – Fluid in bowel ; hence easily displaced

Bronchospasm Secretions Kink

Inspiratory pressure

B P

SpO2

EtCO2

Alpha2 receptor agonist Noradrenaline Renin Medulary pathways - vasomotor control Stress & serum cortisol

Quintin L – Anesthesiology 1991; Hayashi Y Br J Anes 1993

Route Oral (3-5Microgram) I V(1-2 Microgram)

Dose 3 to 5 micro 1 to 2 micro

Time 60 to 90 min 10 to 14 min

Effectivity Not sure Sure

Fix schedule Compulsory Not must

Titration Not Possible possible

Brimacombe J. The advantages of the laryngeal mask airway over the tracheal tube or facemask; A meta analysis. Can J Anaesth 1995; 42: 1019.

. Shribman AJ, Smith G, Achola KJ., Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987: 59 : 295 - 9.

Pennant JH, White PF; The laryngeal mask airway, its uses in Anaesthesiology.

Anesthesiology 1993; 73 : 144 - 63.

Parameters Controls Study p – Value* HR 113.04 ±6.03 109.60 ±8.53 0.0531

SBP 136.56 ±9.30 115.28 ±10.06 0.0001 DBP 94.32 ±6.82 79.52 ±7.35 0.0001

RPP 15466.08 ±1634.58 12645.28 ±1568.48 0.0001

MAP 108.40 ±7.00 91.44 ±6.18 0.0001

There was rise in all the parameters in both the groups but the rise was significantly low in the study group (p < 0.05)

(Student t test)

n =200

Parameters Control (ET) Study (LMA) p – Value

HR 112.40 ±8.04 106.96 ±16.02 0.0690

SBP 132 ±8.20 112.64 ±8.67 0.0001

DBP 93.76 ±6.72 78.08 ±7.93 0.0001

RPP 14865.92 ±1695.23 11997.68 ±1656.80 0.0001

MAP 106.51 ±6.61 89.60 ±7.01 0.0001

Student t test

The parameters in the study group were not significantly increased (p < 0.05)

Conventional

Laparoscopic