Thoracic outlet syndrome surgery

2022-09-10T14:30:32Z

Jthom159: Added info about set up and anesthetic considerations

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = PIV
| monitors = Standard
| considerations_preoperative = Generally young healthy females
| considerations_intraoperative =
| considerations_postoperative = PONV
}}

'''Thoracic outlet syndrome surgery''' includes procedures such as first rib resection and scalenectomy. Symptoms include pain, tingling, or weakness in the upper extremity, with vascular involvement including venous swelling, arterial flow disruption, and deep vein thrombosis.

== Overview ==

=== Indications ===

=== Surgical procedure ===

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|May have numbness/tingling in affected upper extremity
|-
|Cardiovascular
|May have vascular involvement (venous swelling, DVT, arterial compression)
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|May have DVT in the upper extremity affected and may be on anticoagulation
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===
Generally not necessary as most patients are young and healthy

=== Operating room setup ===

* If the surgeon wants to have neuro-monitoring to avoid injury to the brachaial plexus, you will need to avoid paralysis
**TIVA with succinylcholine for induction would be ideal
*Can set up for GA with paralysis if no need for neuro-monitoring

=== Patient preparation and premedication ===

* Anxiolysis as needed

=== Regional and neuraxial techniques ===

* Paravertebral Block may help with post-op pain control

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===
Standard induction for GETA, paralysis okay if no nerve monitoring needed

=== Positioning ===
Left or right lateral decubitus, with affected upper extremity in operative field facing up. Generally with shoulder roll.

=== Maintenance and surgical considerations ===
Avoid any IVs or BP cuff on the surgical side as that arm will be prepped and in the surgical field.

=== Emergence ===

== Postoperative management ==

=== Disposition ===

=== 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
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|
|}

== References ==

[[Category:Surgical procedures]]
[[Category:Vascular surgery]]

Craniotomy for tumor resection

2022-05-02T14:10:51Z

Jthom159: added positioning and maintence details

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = Large bore IV
Arterial line
± Central line
| monitors = Standard
5-lead ECG
Core temp
UOP
ABP
± CVP
± Neuromonitoring
| considerations_preoperative = Characterize neurologic deficits
Evaluate for ↑ ICP
| considerations_intraoperative = Manage ICP
| considerations_postoperative = PONV prophylaxis
}}

A '''craniotomy for tumor resection''' is a neurosurgical procedure to remove a brain tumor.

== Overview ==

=== Indications ===

=== Surgical procedure ===

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|Focused neuro exam to identify deficits
Evaluate for ↑ ICP

* Headache
* Nausea/vomiting
* Visual changes
* Seizures
|-
|Cardiovascular
|Evaluate for ↑ ICP

* HTN
* Bradycardia
* Respiratory irregularity
|-
|Pulmonary
|Evaluate for neurogenic pulmonary edema
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===

=== Operating room setup ===

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===

== Intraoperative management ==

=== Monitoring and access ===
At least 2 peripheral IVs.

Arterial Line needed if history of patient indicates need for closer hemodynamic monitoring or if there is concern for venous air embolism if surgical site is near the sinus and the position of the head is above the level of heart.

=== Induction and airway management ===

=== Positioning ===
Mayfield pins are placed after intubation.

=== Maintenance and surgical considerations ===
Maintenance should ensure that the patient does not move once in Mayfield pins and patient will be able to participate in a basic neurological exam upon emergence.

=== Emergence ===

== Postoperative management ==

=== Disposition ===

=== 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]]
[[Category:Neurosurgery]]
[[Category:Intracranial neurosurgery]]

WikiAnesthesia - User contributions [en]

Thoracic outlet syndrome surgery

Craniotomy for tumor resection