Management of Complications During Laparoscopic Surgery

The patient is a 65-year-old male who has a long-standing history of COPD. He has been having dyspnea on exertion for the past 2 weeks. He was placed on BiPAP and transferred to the ICU. The learner will evaluate and facilitate the resuscitation of the patient.

Learning Objectives

– Learner will demonstrate how to evaluate the cause of elevated peak airway pressures during laparoscopic surgery
a. Learner will perform a physical exam (auscultate the patient’s lungs and evaluate the patient’s skin), ensure that all connections from patient to ventilator are intact, and inspect endotracheal tube to ensure patency

– Learner will demonstrate how to manage elevated peak airway pressures during laparoscopic surgery
a. Learner will maintain the patient on 100 percent inspired oxygen, suction out the patient’s endotracheal tube, and assess the cause of elevated peak pressure

– Learner will demonstrate their ability to diagnose and manage anaphylaxis acutely in the operating room
a. Learner will look for signs of anaphylaxis on a physical exam
b. Learner will administer bronchodilators and epinephrine to stabilize bronchospasm and hypotension and repeat these treatments until patient is stabilized
c. Learner will administer hydrocortisone, famotidine, diphenhydramine

– Learner will demonstrate ability to communicate effectively with surgical colleagues
a. Learner will communicate instability of the patient with the surgeon
b. Learner will discuss acuity of anaphylaxis with surgeon and decide disposition of the patient

– Learner will demonstrate ability to ensure that the patient has proper follow-up and long term care.
a. Learner will ensure tryptase level is drawn in OR and that patient has follow-up with allergist to help determine cause of anaphylaxis