Physiological changes seen in laparoscopy include all except:
(A) Increased ICP (B) Decreased FRC (C) Increased CVP (D) Increased pH
(D) Ans: D. Increased pH(Ref Bailey 27/e p87, 26/e p94,. http://www.laparoscopyhospitaLcom/physiological-changes!laparasconyhtm1)Metabolic acidosis (decrease pH) from CO, absorption is the primary derangement with laparoscopy.Laparoscopy:In laparoscopic surgeries, rigid endoscope introduced through a sleeve into peritoneal cavity.Needle used for pneumoperitoneum: Veress needle.Most commonly used gas: CO2.Physiological Effects of LaparoscopyCardiovascularIncreased intra-abdominal pressure a | CVP, | PCWP, | SVR & | MAP a | Preload &| afterload a decreasing cardiac output.PulmonaryCephalad shift of diaphragm decreases FRC, chest wall compliance and tidal volume increasing the work of breathing.RenalIncreased IAP decreases renal flow, decreasing GFR & reduced urine output.Raised pCO2 leads to RAAS stimulation. No long-term change in GFR/UO.GastrointestinalDecreased perfusion to intestines and stomach (as a result of increase IAP) decreases pHDecreased poal and hepatic flow leads to elevation of LFTs.Peripheral vascularIncidence of DVT, PE is generally lower post-laparoscopic procedures probably secondary to improved prophylaxisRisk is increased with longer procedures and reverse Trendelenberg position.