Adrenalectomy - Revision history

Tsmurphy at 10:46, 26 April 2023

2023-04-26T10:46:05Z

← Older revision		Revision as of 03:46, 26 April 2023
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	=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===		=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
	Key in the preoperative workup is determining if ~~the~~ the mass functional and/or if it it malignant. Functional tumors could produce cushings syndrome, hyper aldosteronism, or a pheochromocytoma		Key in the preoperative workup is determining if the mass is functional and/or if it is malignant. Functional tumors could produce cushings syndrome, hyper aldosteronism, or a pheochromocytoma
	{\| class="wikitable"		{\| class="wikitable"
	\|+		\|+

Mitchel.DeVita at 08:57, 30 May 2022

2022-05-30T08:57:47Z

← Older revision		Revision as of 01:57, 30 May 2022
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	{{Infobox surgical case reference		{{Infobox surgical case reference
	\| anesthesia_type =		\| anesthesia_type = General
	\| airway =		\| airway = ETT
	\| lines_access =		\| lines_access = 2 PIVs, +/- Arterial line
	\| monitors =		\| monitors = standard
	\| considerations_preoperative =		\| considerations_preoperative = Electrolytes
	\| considerations_intraoperative =		\| considerations_intraoperative = Rapid hemodynamic changes
	\| considerations_postoperative =		\| considerations_postoperative = Tumor withdrawal requiring steroid replacement
	}}		}}

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	=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===		=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
			Key in the preoperative workup is determining if the the mass functional and/or if it it malignant. Functional tumors could produce cushings syndrome, hyper aldosteronism, or a pheochromocytoma
	{\| class="wikitable"		{\| class="wikitable"
	\|+		\|+
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	\|-		\|-
	\|Neurologic		\|Neurologic
	\|		\|Investigate headaches, fatigue, syncope
	\|-		\|-
	\|Cardiovascular		\|Cardiovascular
	\|		\|HTN, cardiac remodeling, HLD,
	\|-		\|-
	\|Pulmonary		\|Pulmonary
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	\|-		\|-
	\|Renal		\|Renal
	\|		\|Hypernatremia, hypokalemia
	\|-		\|-
	\|Endocrine		\|Endocrine
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	\|-		\|-
	\|Other		\|Other
	\|		\|Obesity/cushingoid
	\|}		\|}

	=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===		=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===

			* Electrocardiogram to investigate potential arrhythmias or signs of electrolyte changes
			* Consider ECHO if clinical suspicion of cardiac remodeling/heart failure, long standing HTN, functional changes
			* CBC
			* CMP especially important for electrolyte evaluation
			* (typically preformed preop in adrenal mass workup) dexamethasone suppression test
			* Plasma metanephrines (Normetanephrine, Norepinephrine, Epinephrine , Dopamine) if concern for pheo

	=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
			If the mass is small and nonfunctional, the surgical procedure can be straight foreword with minimal disruptions expected to the endocrine system. However if the mass is functional, tumor manipulation can precipitate large changes in glucose, electrolytes (potassium/sodium), blood pressure and HR.

	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
			Consider TAP block or epidural depending on extent of resection

	== Intraoperative management ==		== Intraoperative management ==

	=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===		=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
			2 peripheral IVs

			Arterial line for monitoring rapid hemodynamic changes and possibly frequent blood draws if functional tumor. If nonfunctional, typically no arterial line required

	=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
			Standard

	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
			Lateral with surgical side up

	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
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	=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===		=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
			PACU, typically, however can require ICU depending on extent of resection and changes in endocrine system

	=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
			PCA for IV opiate therapy

			Consider regional such as TAP block vs Epidural if larger resection expected

	=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

Chris.Rishel: Text replacement - "|Respiratory" to "|Pulmonary"

2022-02-22T05:45:52Z

Text replacement - "|Respiratory" to "|Pulmonary"

← Older revision		Revision as of 22:45, 21 February 2022
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	\|		\|
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|		\|
	\|-		\|-

Chris.Rishel: Draft of procedure overview with links to pheo articles

2021-06-08T20:48:47Z

Draft of procedure overview with links to pheo articles

← Older revision	Revision as of 13:48, 8 June 2021
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		{{Infobox surgical case reference
		\| anesthesia_type =
		\| airway =
		\| lines_access =
		\| monitors =
		\| considerations_preoperative =
		\| considerations_intraoperative =
		\| considerations_postoperative =
		}}

		An '''adrenalectomy''' is a surgical procedure to remove one or both adrenal glands, and is typically performed to remove a hormone-secreting tumor. The anesthetic approach to this procedure varies depending on the hormones produced by the tumor. If the tumor is a [[pheochromocytoma]], unique considerations for preoperative optimization and perioperative management are required (see [[excision of pheochromocytoma]]).

		== Preoperative management ==

		=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
		{\| class="wikitable"
		\|+
		!System
		!Considerations
		\|-
		\|Neurologic
		\|
		\|-
		\|Cardiovascular
		\|
		\|-
		\|Respiratory
		\|
		\|-
		\|Gastrointestinal
		\|
		\|-
		\|Hematologic
		\|
		\|-
		\|Renal
		\|
		\|-
		\|Endocrine
		\|
		\|-
		\|Other
		\|
		\|}

		=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===

		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===

		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

		== Intraoperative management ==

		=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===

		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===

		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

		== Postoperative management ==

		=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===

		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===

		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

		== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==

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

		== References ==

		[[Category:Surgical procedures]]

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2021-04-21T23:48:51Z

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