Anesthesia for Digestive Laparoscopy Practice Quiz (13 questions)

1. How is laparoscopic access to the peritoneal cavity established?

A. A trocar is passed through an upper abdominal incision, and oxygen is insufflated.

B. A Veress needle is passed through an inguinal incision, and saline is instilled.

C. A trocar is passed through a subumbilical incision, and air is aspirated.

D. A Veress needle is passed through a subumbilical incision, and carbon dioxide is insufflated.

Answer: (D)

Explanation

Laparoscopic access is created by inserting a Veress needle through a subumbilical incision and insufflating the peritoneal cavity with carbon dioxide. Using a different gas or access route would not match this described process.

2. Which broad change has been associated with the minimally invasive laparoscopic approach?

A. Narrowed surgical indications and more medical contraindications.

B. Expanded surgical indications and more medical contraindications.

C. Expanded surgical indications and fewer medical contraindications.

D. Narrowed surgical indications and fewer medical contraindications.

Answer: (C)

Explanation

Laparoscopy has been associated with broader surgical indications and fewer medical contraindications. The opposite pairing, narrower indications with more contraindications, reverses both stated effects.

3. What immediate physiological changes result from carbon dioxide insufflation during laparoscopy?

A. Decreased intra-abdominal pressure and decreased blood carbon dioxide.

B. Increased intra-abdominal pressure and decreased blood carbon dioxide.

C. Increased intra-abdominal pressure and increased blood carbon dioxide.

D. Decreased intra-abdominal pressure and increased blood carbon dioxide.

Answer: (C)

Explanation

Carbon dioxide insufflation raises intra-abdominal pressure and increases blood carbon dioxide. The plausible alternative that pairs increased pressure with lower blood carbon dioxide contradicts the stated gas effect.

4. Which cardiovascular pattern can occur during pneumoperitoneum?

A. Reduced venous return and cardiac output, increased systemic vascular resistance, and possible lower-limb venous stasis.

B. Increased venous return and cardiac output, reduced systemic vascular resistance, and possible lower-limb venous stasis.

C. Reduced venous return and cardiac output, reduced systemic vascular resistance, and possible lower-limb venous stasis.

D. Increased venous return and cardiac output, increased systemic vascular resistance, and reduced lower-limb venous stasis.

Answer: (A)

Explanation

Pneumoperitoneum can reduce venous return and cardiac output while increasing systemic vascular resistance, and it may cause venous stasis in the lower limbs. The alternative suggesting increased venous return and output conflicts with the described cardiovascular effects.

5. During head-down positioning with pneumoperitoneum, which respiratory effect may occur?

A. A shunt may develop, alongside increased diaphragmatic excursion and reduced insufflation pressure and carbon dioxide levels.

B. A shunt may develop, alongside reduced diaphragmatic excursion and increased insufflation pressure and carbon dioxide levels.

C. An anterior dead-space effect may develop, alongside increased diaphragmatic excursion and reduced carbon dioxide levels.

D. Secondary endobronchial intubation may occur, alongside increased diaphragmatic excursion and reduced insufflation pressure.

Answer: (B)

Explanation

Pneumoperitoneum reduces diaphragmatic excursion, especially posteriorly, and raises insufflation pressures and carbon dioxide levels; a shunt may occur in the head-down position. The distractor describing increased diaphragmatic excursion and reduced pressures reverses key effects.

6. Which combination best describes postoperative benefits associated with laparoscopy?

A. Less pain, earlier ambulation, less ileus, smaller scars, and a shorter hospital stay.

B. Less pain, later ambulation, more ileus, smaller scars, and a shorter hospital stay.

C. Less pain, earlier ambulation, less ileus, smaller scars, and a longer hospital stay.

D. More pain, earlier ambulation, less ileus, larger scars, and a shorter hospital stay.

Answer: (A)

Explanation

Postoperative benefits include less pain, earlier ambulation, less ileus, smaller scars, and a shorter hospital stay; reduced restrictive respiratory syndrome is also reported. The alternative with later ambulation and more ileus reverses two of the stated benefits.

7. Which patient profile is identified as potentially benefiting from laparoscopic surgery?

A. A patient with stable respiratory insufficiency regardless of carbon dioxide levels, or pregnancy extending beyond the second trimester.

B. A patient with unstable cardiac function and emphysema, or severe restrictive disease regardless of carbon dioxide levels.

C. A patient with intracranial hypertension and shock, or a ventriculoperitoneal shunt with impaired cardiac function.

D. A patient with stable coronary disease and obesity, or stable respiratory insufficiency assessed in light of carbon dioxide levels.

Answer: (D)

Explanation

Potentially benefiting groups include patients with stable coronary disease or obesity, as well as those with stable respiratory insufficiency depending on carbon dioxide levels. Severe restrictive disease is listed as a risk, not as the contrasting stable respiratory condition.

8. Which issue should prompt preoperative assessment and discussion with the surgeon about the risk of conversion?

A. A planned laparoscopic approach, because it establishes acute glaucoma

B. A multiply operated abdomen, because it can affect operative feasibility and conversion risk

C. A history of uncomplicated surgery, because it predicts respiratory insufficiency

D. Obesity, because it is a contraindication requiring assessment before anesthesia

Answer: (B)

Explanation

A multiply operated abdomen is among the contraindications to identify, and conversion risk should be discussed with the surgeon. Obesity is described as an indication, while heart failure and respiratory insufficiency require assessment rather than being indications.

9. Which combination describes the anesthetic plan for the procedure?

A. Regional anesthesia, mechanical ventilation, and a nasotracheal tube

B. Regional anesthesia, spontaneous ventilation, and a laryngeal mask

C. General anesthesia, mechanical ventilation, and orotracheal intubation

D. General anesthesia, spontaneous ventilation, and a face mask

Answer: (C)

Explanation

The plan combines general anesthesia with mechanical ventilation and orotracheal intubation. A regional technique with spontaneous ventilation does not match this planned approach.

10. For a patient at risk, such as an ASA 3 patient, which monitoring approach is specified?

A. Use blood pressure monitoring in place of pulse oximetry and cardioscopy

B. Reserve blood pressure monitoring for patients without other risk factors

C. Add noninvasive or invasive blood pressure monitoring to the general monitoring set

D. Replace capnography and spirometry with invasive blood pressure monitoring

Answer: (C)

Explanation

At-risk patients, including those classified as ASA 3, are specified for noninvasive or invasive blood pressure monitoring alongside the general monitors. The other listed monitors remain part of the general set rather than being replaced.

11. Before insufflation, which ventilator targets should be set?

A. Tidal volume 8 ml/kg, respiratory rate 14/min, ratio 1:2, SpO₂ above 94%, end-tidal CO₂ 30 mmHg, and peak airway pressure below 30 cmH₂O

B. Tidal volume 8 ml/kg, respiratory rate 14/min, ratio 1:2, SpO₂ above 94%, end-tidal CO₂ 30 mmHg, and peak inspiratory pressure below 12 mmHg

C. Tidal volume 8 ml/kg, respiratory rate 12/min, ratio 1:2, SpO₂ above 94%, end-tidal CO₂ 30 mmHg, and peak airway pressure below 30 cmH₂O

D. Tidal volume 10 ml/kg, respiratory rate 14/min, ratio 1:2, SpO₂ above 94%, end-tidal CO₂ 30 mmHg, and peak airway pressure below 30 cmH₂O

Answer: (A)

Explanation

Before insufflation, the specified settings include tidal volume 8 ml/kg, a rate of 14/min, a 1:2 ratio, and the stated oxygenation, CO₂, and peak airway pressure targets. The below-12-mmHg peak inspiratory pressure value is a post-insufflation check, not this pre-insufflation target.

12. During insufflation, a patient develops bradycardia and hypotension; which response best matches the stated hemodynamic approach?

A. Keep diastolic blood pressure variation below 30% of baseline, using vasoactive drugs without fluid loading

B. Keep systolic blood pressure variation below 30% of baseline, using fluid loading with or without vasoactive drugs as needed

C. Allow systolic blood pressure variation above 30% of baseline, using fluid restriction and sedation as needed

D. Keep systolic blood pressure fixed at its preoperative value, using fluid loading in every case

Answer: (B)

Explanation

Insufflation can cause bradycardia and hypotension, and the target is to limit systolic blood pressure variation to below 30% of the preoperative value, with fluid loading and possibly vasoactive drugs. The target concerns systolic variation, not diastolic variation.

13. If pneumothorax is suspected during surgery, which sequence of actions is appropriate?

A. Diagnose clinically, stop surgery, exsufflate the pneumoperitoneum, drain the chest with or without needle decompression, and convert to laparotomy if needed

B. Stop surgery, maintain the pneumoperitoneum, perform needle decompression, and resume surgery without reassessment

C. Diagnose clinically, reduce insufflation pressure, continue surgery, give vasoactive drugs, and convert if needed

D. Confirm radiologically, continue surgery, maintain the pneumoperitoneum, drain the chest, and convert only after recovery

Answer: (A)

Explanation

Management calls for clinical diagnosis, stopping surgery, exsufflating the pneumoperitoneum, and chest drainage with or without needle decompression, with laparotomy if required. Continuing surgery while maintaining the pneumoperitoneum conflicts with the specified immediate steps.