A 32-year-old woman undergoes laparoscopic excision of ovarian endometrioma. During surgery with the patient in Trendelenburg position and pneumoperitoneum at 15 mmHg, the anesthesiologist notes peak airway pressures rising from 25 to 40 cmH2O, oxygen saturation dropping to 88%, and blood pressure decreasing. Apply the appropriate immediate intervention.
AIncrease tidal volume and respiratory rate
BIncrease FiO2 and administer fluid bolus only
CRelease pneumoperitoneum and decrease Trendelenburg
DAdminister bronchodilators for bronchospasm
ECheck for endobronchial intubation and reposition tube
A 65-year-old man with locally advanced rectal cancer 6 cm from the anal verge completes neoadjuvant chemoradiation with good response. MRI shows tumor downsizing to 3 cm with no nodal involvement. The patient strongly prefers sphincter preservation. The surgeon can perform either open low anterior resection or robotic-assisted total mesorectal excision. Evaluate the optimal approach considering oncologic and functional outcomes.
AOpen low anterior resection for better tactile feedback
BAbdominoperineal resection for oncologic safety
CTransanal endoscopic microsurgery for organ preservation
DRobotic-assisted TME for improved visualization in pelvis
EWatch and wait approach given excellent response
A 50-year-old man with morbid obesity (BMI 48) undergoes laparoscopic sleeve gastrectomy. On postoperative day 5, he develops tachycardia, oliguria, and confusion. CT shows a small fluid collection along the staple line. Drain output is minimal. He is started on antibiotics. Twenty-four hours later, he remains tachycardic with rising lactate despite fluids. Evaluate the management priority.
AUrgent laparoscopic exploration with drainage
BIncrease antibiotic coverage and vasopressor support
CContinue antibiotics and obtain interventional radiology drainage
DEndoscopic stent placement across the leak
EImmediate open exploration, washout, and feeding jejunostomy
+ 7 more in the PDF
Browse all chapters