Question 1

Q: A 32-year-old woman undergoes laparoscopic excision of ovarian endometrioma. During surgery with the patient in Trendelenburg position and pneumoperitoneum at 15 mmHg, the anesthesiologist notes peak airway pressures rising from 25 to 40 cmH2O, oxygen saturation dropping to 88%, and blood pressure decreasing. Apply the appropriate immediate intervention.

Release pneumoperitoneum and decrease Trendelenburg. ***Release pneumoperitoneum and decrease Trendelenburg*** - High **peak airway pressures** (40 cmH2O), **hypoxemia**, and **hypotension** indicate severe physiological compromise from **pneumoperitoneum** and positioning. - Releasing the gas and leveling the patient immediately facilitates **diaphragmatic descent**, increases **lung compliance**, and restores **venous return** to improve cardiac output. *Increase tidal volume and respiratory rate* - Increasing **tidal volume** in the presence of already high airway pressures significantly increases the risk of **barotrauma** and further cardiovascular collapse. - This intervention does not address the mechanical cause of **diaphragmatic splinting** caused by the CO2 insufflation. *Increase FiO2 and administer fluid bolus only* - While oxygenation may temporarily improve, this fails to correct the **reduced functional residual capacity** caused by the **positive pressure** in the abdomen. - Fluids may not compensate for the **inferior vena cava compression** if the source of high **intra-abdominal pressure** remains unchanged. *Administer bronchodilators for bronchospasm* - High airway pressures in laparoscopy are usually due to **decreased thoracic compliance**, not necessarily **bronchospasm**. - The sudden drop in blood pressure suggests a hemodynamic/mechanical cause rather than an isolated **obstructive lung** pathology. *Check for endobronchial intubation and reposition tube* - While cephalad movement of the diaphragm can cause **endobronchial intubation**, it does not typically explain the systemic **hypotension** seen here. - This step should follow the **immediate release** of abdominal pressure, which is the most life-threatening contributor to the current vitals.

Question

A 32-year-old woman undergoes laparoscopic excision of ovarian endometrioma. During surgery with the patient in Trendelenburg position and pneumoperitoneum at 15 mmHg, the anesthesiologist notes peak airway pressures rising from 25 to 40 cmH2O, oxygen saturation dropping to 88%, and blood pressure decreasing. Apply the appropriate immediate intervention.

Accepted Answer

Release pneumoperitoneum and decrease Trendelenburg

Answer

Increase tidal volume and respiratory rate

Answer

Increase FiO2 and administer fluid bolus only

Answer

Administer bronchodilators for bronchospasm

Answer

Check for endobronchial intubation and reposition tube

Minimally Invasive Surgery — MCQs

Minimally Invasive Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?