Thirty minutes into a laparoscopic procedure, visualization becomes inadequate to proceed. The insufflation monitor shows an intra-abdominal pressure of 20 mm Hg and no flow of CO2. What is the most likely explanation?
A An empty CO2 canister
B CO2 leak from the abdominal wall
C Inadequate muscle relaxation
D Improper insufflator settings
E Dislodged insufflation tubing
When visualization inexplicably deteriorates during a laparoscopic procedure, the cause is most often inadvertent loss of the pneumoperitoneum that has been maintaining the operative exposure. This may occur for several reasons, but in this case, intra-abdominal pressure is high with no gas flow in the presence of decreased pneumoperitoneum. This scenario is most commonly caused by abdominal muscle contraction because of inadequate paralysis, but occlusion of the insufflation tubing could produce similar findings. Peritoneal gas leaks via trocar sites or through a trocar may produce impaired visualization, but this will be manifested as low pressure and a high gas flow rate.
Answer = C
A An empty CO2 canister
B CO2 leak from the abdominal wall
C Inadequate muscle relaxation
D Improper insufflator settings
E Dislodged insufflation tubing
When visualization inexplicably deteriorates during a laparoscopic procedure, the cause is most often inadvertent loss of the pneumoperitoneum that has been maintaining the operative exposure. This may occur for several reasons, but in this case, intra-abdominal pressure is high with no gas flow in the presence of decreased pneumoperitoneum. This scenario is most commonly caused by abdominal muscle contraction because of inadequate paralysis, but occlusion of the insufflation tubing could produce similar findings. Peritoneal gas leaks via trocar sites or through a trocar may produce impaired visualization, but this will be manifested as low pressure and a high gas flow rate.
Answer = C
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