Complications from abdominal insufflation скачать в хорошем качестве

Complications from abdominal insufflation

Hemodynamic Effects During Insufflation: Bradycardia (due to vagal stimulation) Hypercapnia Reduced preload Potential rapid cardiovascular decompensation from gas embolism or vascular/organ injuries Subcutaneous Emphysema Cause: Improper placement of needles/trocars leading to gas tracking into tissues Risk factors: Surgery over 200 minutes; over 6 surgical ports; Age over 65 years Signs: Hypercarbia resistant to ventilation changes, tissue crepitus/swelling Management: Usually self-resolving, monitor for airway compromise if in head/neck Capnothorax More common in Nissen fundoplication Signs: Hypoxemia, hypercapnia, ↑ airway pressures Diagnosis: Chest X-ray or transthoracic ultrasound Management: If unstable → Immediate needle decompression or chest tube. If stable → Reduce insufflation pressure, hyperventilate, increase PEEP Capnomediastinum and Capnopericardium Rare but risk significant hemodynamic collapse Diagnosis: Chest radiography Treatment: Desufflation and supportive care with hyperventilation Gas Embolism Common but rarely causes hemodynamic issues Signs: Hypotension; Hypoxemia; ECG changes (right heart strain, arrhythmias) Special risk: Patients with atrial communications (ASD, PFO) risk cerebral/coronary ischemia Management: Desufflation; Increased ventilation; Head-down positioning to move gas from pulmonary artery.