Laparoscopic Inguinal Hernia Repair with Mesh

Anesthesia Implications

Position: Supine, arms tucked
Time: 30-60 min (short)
Blood Loss: Low (10-50 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Yes
Lead: Yes

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

Laparoscopic cases (general considerations): The patient’s peritoneum is insufflated (which is called a pneumoperitoneum), and instrumentation will be inserted into the abdomen. General anesthesia, ETT tube, and paralytics are necessary. Some of the procedures are rather short, so make sure the timing is right to reverse the paralytic. The pressure in peritoneum affects the organs of that space. Anything more than 10 mmHg will begin to alter hemodynamics. Cardiac output is decreased and SVR is increased. Peak inspiratory pressures rise. Renal vessels will be compressed, which reduces flow to the kidneys, and activates the renin angiotensin aldosterone system (RAAS). Reduced blood to the kidney means reduced urine output. Peak inspiratory and plateau pressures will also increase. The gas used to insufflate the peritoneum is CO2 – so, as you might guess, hypercarbia can develop – and with it, acidosis. You’ll see this sometimes reflected in the end-tidal CO2. This is all adding to the stress response we try to avoid in anesthesia.

Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram – otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.

A hernia is any protrusion/bulge out of the tissues that normally contain it. The abdominal wall contains multiple tissues including muscle and connective tissue which spans from the xiphoid process to the pubic symphasis and iliac crest.

Abdominal hernias are primarily caused by a weakening of the tissues contain the abdominal viscera.

Abdominal hernias may be classified as ventral, groin (inguinal and femoral subclassifications), pelvic, and flank. Approximately 5 million American’s have abdominal hernias. The majority are groin hernias.

Further classification may be used in conjunction with the etiology: congenital (such as gastroschisis or omphalocele) and acquired (weakening or disruption of the wall tissues).

Far more common in men (10x) than women.