Laparoscopic Surgery, Pneumoperitoneum Pathophysiology, and Surgical Positioning Mechanics — WACS Viva & Clinical Scenarios (General Anaesthesia)

Exam-style laparoscopic surgery, pneumoperitoneum pathophysiology, and surgical positioning mechanics viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 56-year-old male with moderate chronic obstructive pulmonary disease (COPD) is scheduled for laparoscopic left hemicolectomy under general anaesthesia. Following CO₂ insufflation to 15 mmHg and placement in steep Trendelenburg position, his peak airway pressure rises from 22 to 38 cmH₂O, PaCO₂ rises to 62 mmHg, and Mean Arterial Pressure (MAP) drops by 25%. Explain your comprehensive anaesthetic and ventilatory management.
• SCENARIO 2: A 32-year-old woman undergoes laparoscopic appendicectomy. Shortly after umbilical trocar insertion and rapid high-flow CO₂ insufflation, her EtCO₂ abruptly drops from 36 mmHg to 8 mmHg, heart rate jumps to 135 bpm, blood pressure plummets to 55/30 mmHg, and oxygen saturation drops to 74%. Detail your emergency diagnostic and therapeutic sequence.
• SCENARIO 3: A 62-year-old male undergoes a 5-hour robotic-assisted laparoscopic radical prostatectomy in 30-degree steep Trendelenburg position. At the conclusion of surgery, you notice significant conjunctival chemosis and facial oedema. How do you assess the airway, determine extubation readiness, and manage potential neurological and ocular positioning complications?
• SCENARIO 4: A 42-year-old female undergoing laparoscopic cholecystectomy develops extensive surgical emphysema extending from the abdominal wall up into the neck, face, and upper chest 45 minutes into the operation, with EtCO₂ progressively rising to 68 mmHg despite hyperventilation. Detail your diagnostic considerations, anaesthetic interventions, and safe conclusion of surgery.