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Course submitted for accreditation in Belgium
Program
All hours indicated are CET
| 09:00am |
INTRODUCTION
Jan Paul Mulier (AZ Sint-Jan Brugge) |
|
| 09:05am |
LOW IMPACT: TIPS & TRICKS
Matthieu Clanet (Chirec Delta Brussels)
|
| 09:30am |
LOW IMPACT ROBOTIC PROSTATECTOMY
Charles Chatzopoulos (Chirec Delta Brussels)
|
| 10:00am |
USE OF LOW PRESSURE AND SMOKE EVACUATION IN THE CONTEXT OF COVID-19
Ruben De Groote (OLV Aalst)
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| 10:30am |
LOW IMPACT SURGERY BY IMPROVING ANESTHETIC SUPPRESSION OF STRESS
Jan Paul Mulier (AZ Sint-Jan Brugge)
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| 11:00am |
MEDICO-LEGAL ASPECTS OF THE SURGEON- ANESTHETIST COLLABORATION
Fabien Clément (Judge at the French Court of First Instance in Brussels)
|
| 11:30am |
PANEL DISCUSSION
|
Shooting date : 2020-06-20
Last update : 2020-09-07
Last update : 2020-09-07
Low Impact Surgery And Anesthesia In Laparoscopy
LOW IMPACT SURGERY AND ANESTHESIA IN LAPAROSCOPY Symposium How can we optimize outcomes through efficient collaboration ? Course submitted for accreditation in Belgium ...
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LOW IMPACT SURGERY AND ANESTHESIA IN LAPAROSCOPY
Day 1
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Admar A. In the laparascopy surgery do you have ETT or LMA ?
and do you use N2O
Admar A. laprascopy surgery for histerctomy or cystectomy
Admar A. slide blurr
Abdelazeem E. when we say OFA, does this include no opioids at induction of anesthesia?
Jan Paul M. OFA stay for opioid free anesthesia and means no opioid given before or during anesthesia till the last stitch, also not for induction and intubation. if you give an opioid after surgery it is an analgesic, not an anesthetic.. I know that this discussion is more semantic but important to know what you mean with it. Opioids given intra operative could be to block surgical stress, to stop spontaneous breathing to induce bradycardia or hypotension. Opioids given postoperative should work as analgesics and this is best achieved if tolerance did not develop yet due to the high doses given intra operative.
Abdelazeem E. what is your opinion on use of moderate versus deep NMB in laparoscopy?
Jan Paul M. depending on the abdominal compliance (abd C) and the starting IAPressure at volume zero (PV0) you might be able to work with a moderate NMB when setting IAP above 12. ( ex if PV0 = 4 and abd C= 0,5L/mmHg you need 4+6=10 mmHg to get 3 liter workspace) with a deep NMB you can drop PV0 to 2 mmHg and use 8 mmHg still getting 3 liter the minimum good workspace) if the patient is obese the PV0 can start at 10 and if male with central obesity C can be only 0,1 L/mmHg meaning that even 20 mmHg is not enough and just gives 1 liter only. A deep NMB is now essential to reduce PV0 to lets assume 7 ( you have to measure as every patient is different) and this gives now at 20 mmHG 1,3 liter instead of 1 liter...
If you want to use lowest IAP possible then it helps always to go to deep NMB and drop a few mmHg lower. Next to workspace there should be no movement where you have several options: deep NMB, deep hypnosis ( 2 MAC) or high dose opioids and hyperinflation as the last three will block respiratory centers ut not relax the muscles. However today we know that deep hypnosis, high dose opioids and hyperventilation are not without any risk while deep NMB is at no risk on the condition that you measure NMT and reverse till a TOF of 100 %
Abdelazeem E. we still not open the OR fully for elective cases due to covid. I learned yesterday that you already back to normal. Do you have any prognostic tools which we can put ahead during planning of reopening of the OR for elective cases?
Abdelazeem E. is there evidence that viral transmission can happen during pneumoperitoneum and also with smoke of the cautery: with reference to covid era.
Nebojsa G. I see that Anesthesiologyst work "alone", without anesthesia nurse. As I uderstood, scrub nurse is asistent to anesthesiologyst and surgical team. Is it usual in Belgium?
Abdelazeem E. yesterday we heard of reduced opioid technique arguing with OFA. Do you have any comment?
Jan Paul M. As I replied yesterday: it takes time to be able to reduce opioids but on one condition and that is that you add other drugs that suppress the surgical stress! If giving enough you can avoid all opioids intra operative even without loco regional blocks and classical analgesics but you will classical analgesics, loco regional blocks if possible post operative. AND in major surgery without loco regional you will need as analgesic ( not as anesthetic) after awakening a low dose of opioids in some patients and this not wrong and still opioid free anesthesia and indeed NOT opioid-free analgesia. the required opioid dose now postoperative is substantial ( 25 to 50%) lower and therefore also the impact on having less opioid side effects as respiratory depression, PONV, ileum just to name some..
Nebojsa G. When you are giving dexamethasone, during induction or some time before surgery. Considering trah it takes time for effect.
Jan Paul M. it is essential to load drugs up early before induction or incision, depending on the pharmacokinetics: dexmedetomidine should be given at least 15 min before induction, dexamethasone (no clear studies yet) might be needed before PP insufflation but some studies ( in mice) have shown anti inflammatory effects still when given at end of laparoscopy! Ketamine should be given as a bolus 5 10 min before incision of the skin or other stimulating act, lidocaine iv, magnesium iv are both rapid working and better to give just before or after propofol given the strong vasodilatory effects that can give a warm flush in the head... No need for early loading but if you want to load give them very slowly and diluted, never as bolus if before induction.
Abdelazeem E. Risk of covid transmission during patient hospitalization and surgical procedure, that is now included in the consent form. Is it enough or if covid infection occur the patient can sue the hospital and doctors?