WikiAnesthesia - User contributions [en]

Breast lumpectomy

2022-08-08T01:07:57Z

Ashwinibhat: added minor addition on considering TIVA

{{Infobox surgical case reference
| anesthesia_type = MAC or General
| airway = LMA/ETT if GA
| lines_access = PIV
| monitors = Standard
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative = PONV
}}A '''breast lumpectomy''' is the removal of a discrete portion or “lump” of breast tissue. This procedure is sometimes referred to as a '''partial mastectomy'''.

Sometimes the procedure is performed with wire localization, where a radiologist inserts the tip of a wire into the target tissue under fluoroscopic guidance preoperatively. This enables the surgeon to more precisely localize the lesion, and is more commonly performed for deeper lesions.

== Preoperative management ==
=== Patient evaluation  ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}
=== Labs and studies ===
=== Operating room setup  ===
=== Patient preparation and premedication  ===
=== Regional and neuraxial techniques  ===

== Intraoperative management ==
=== Monitoring and access  ===

* PIV x 1

* Place BP cuff off the surgical field
* Make sure EKG leads are not near the sterile field

=== Induction and airway management  ===

=== Positioning  ===

* Supine
* Arms out

=== Maintenance and surgical considerations  ===

* Consider TIVA or partial TIVA, due to higher risk of PONV (patient population tends to be older females, who are at higher risk of PONV) and faster emergence.

=== Emergence  ===

== Postoperative management ==
=== Disposition  ===

=== Pain management  ===

=== Potential complications  ===

== Procedure variants  ==

{| class="wikitable"
|+
!
!Superficial
!Deep
|-
|Unique considerations
|More likely MAC
|More likely GA
|-
|Position
|
|
|-
|Surgical time
|15-45 mins
|30-60 mins
|-
|EBL
|5-10cc
|5-10cc
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]
[[Category:General surgery]]
[[Category:Breast surgery]]

Vagus nerve stimulation

2022-08-01T00:59:29Z

Ashwinibhat: Added details

{{Infobox surgical case reference
| anesthesia_type = General
| airway = ETT
| lines_access = PIV
| monitors = Standard
| considerations_preoperative =
| considerations_intraoperative = Risk of asystoly/ severe bradycardia due to vagus nerve stimulation. Injury to major vessels in neck can lead to massive hemorrhage
| considerations_postoperative =
}}

Vagus nerve stimulator is an adjunctive therapy for refractile epilepsy. It is placed in the left cervical region. The generator/battery is placed in preaxillary area.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===
labs guided by general physical condition of patient

=== Operating room setup ===

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===
None. Incisions are small

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===

=== Positioning ===
Supine

=== Maintenance and surgical considerations ===
Isoflurane and Nitrous Oxide Maintenance preferred for rapid emergence to facilitate early neuro exam.

Patient neuromuscularly blocked throughout to reduce risk of inadvertent injury. No neuromonitoring during procedure.

=== Emergence ===

== Postoperative management ==

=== Disposition ===
PACU f/b early discharge hoe or as prefeered by primary service

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]

Nuss Bar Insertion

2022-07-31T03:48:07Z

Ashwinibhat: formatted article. Added detail on Valium pre-op

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = 2 PIVs, atleast one should be a Large bore IV (16G or lower).
| monitors = Standard
| considerations_preoperative = Administer Valium for muscle spasm
| considerations_intraoperative = Erector spinae block for analgesia. Potential for massive hemorrhage due to injury to heart or major vessels. Consider neuromoscular blockade as movement during important surgical events can lead to inadvertent damage to great vessels.
| considerations_postoperative = Significant post-op pain, consider valium administration for spasms.
}}

Provide a brief summary here.

== Overview ==

=== Indications ===
Pectus Excavatum

=== Surgical procedure ===
Nuss Bar insertion

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|
|-
|Cardiovascular
|Potential for injury to heart and great vessels during placement of Bar. Patient will have a pre-op echo to look at effect on cardiac function.
|-
|Pulmonary
|Patients usually have a Pulmpnary function test or "CPET". Results often provide useful information on amount of restrictive disease
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===
Check CBC and order Type and Screen

=== Operating room setup ===

=== Patient preparation and premedication ===
Diazepam is often administered as it helps with muscle spasm after surgery

=== Regional and neuraxial techniques ===
Erector Spinae Block

== Intraoperative management ==

=== Monitoring and access ===
Two large bore IVs preferred.

=== Induction and airway management ===

=== Positioning ===
Supine

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===
Patient will be admitted inpatient post surgery

=== Pain management ===
Valium for post-op muscle spasm. Consider Ketorolac

=== Potential complications ===
Need for mass transfusion due to injury to great vessels

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]

Nuss Bar Insertion

2022-07-28T12:34:33Z

Ashwinibhat: Started new page

{{Infobox surgical procedure
| anesthesia_type =
| airway =
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}

Provide a brief summary here.

== Overview ==

=== Indications ===
Pectus Excavatum

=== Surgical procedure ===
Nuss Bar insertion

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|ETT
|-
|Neurologic
|Erector Spinae Block for chest wall pain
|-
|Cardiovascular
|Potential for injury to heart and great vessels during placement of Bar. Place a large bore IV(16G) for possible need for resuscitation. Patient will have a pre-op echo to look at effect on cardiac function.
|-
|Pulmonary
|Patients usually have a Pulmpnary function test or "CPET". Results often provide useful information on amount of restrictive disease
|-
|Gastrointestinal
|
|-
|Hematologic
|Have Patient Typed & Screened
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===
Have Type and Screen Ready. Usually Patient will have CBC ordered by surgery prior to case sttart, otherwise should order.

=== Operating room setup ===

=== Patient preparation and premedication ===
Versed if necessary

=== Regional and neuraxial techniques ===
Erector Spinae Block

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===

=== Positioning ===

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===
Patient will be admitted inpatient post surgery

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]