Circumcision - Revision history

Dpavlic1 at 18:10, 2 August 2024

2024-08-02T18:10:40Z

← Older revision		Revision as of 11:10, 2 August 2024
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	* Set OR temperature to 70<sup>o</sup> to 75<sup>o</sup>		* Set OR temperature to 70<sup>o</sup> to 75<sup>o</sup>
	* Underbody ~~bair~~ hugger preheated		* Underbody bear hugger preheated

	=== 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. --> ===
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	* Caudal epidural, penile block, pudendal nerve block, or dorsal ring block for analgesia supplemented with general <ref name=":0" /><ref name=":1" /><ref>{{Cite journal\|last=Boisvert-Moreau\|first=Frédérique\|last2=Turcotte\|first2=Bruno\|last3=Albert\|first3=Natalie\|last4=Singbo\|first4=Narcisse\|last5=Moore\|first5=Katherine\|last6=Boivin\|first6=Ariane\|date=2022-11-17\|title=Randomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcision\|url=https://rapm.bmj.com/content/early/2022/11/16/rapm-2022-103785\|journal=Regional Anesthesia & Pain Medicine\|language=en\|doi=10.1136/rapm-2022-103785\|issn=1098-7339\|pmid=36396298}}</ref>'		* Caudal epidural, penile block, pudendal nerve block, or dorsal ring block for analgesia supplemented with general <ref name=":0" /><ref name=":1" /><ref>{{Cite journal\|last=Boisvert-Moreau\|first=Frédérique\|last2=Turcotte\|first2=Bruno\|last3=Albert\|first3=Natalie\|last4=Singbo\|first4=Narcisse\|last5=Moore\|first5=Katherine\|last6=Boivin\|first6=Ariane\|date=2022-11-17\|title=Randomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcision\|url=https://rapm.bmj.com/content/early/2022/11/16/rapm-2022-103785\|journal=Regional Anesthesia & Pain Medicine\|language=en\|doi=10.1136/rapm-2022-103785\|issn=1098-7339\|pmid=36396298}}</ref>'
	*Caudal: 0.25% Bupivacaine 1cc/kg		*Caudal: 0.25% Bupivacaine 1cc/kg OR 0.2% ropivacaine

	== Intraoperative management ==		== Intraoperative management ==
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	*** IV/PO opioids		*** IV/PO opioids
	*** Topical local anesthetic		*** Topical local anesthetic
	*** Regional block		*** Regional block (penile block, can be performed by surgeon or anesthesia)
	*** Caudal epidural		*** Caudal epidural

Jchen900 at 20:34, 16 August 2023

2023-08-16T20:34:37Z

← Older revision		Revision as of 13:34, 16 August 2023
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	=== 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. --> ===

	* Caudal epidural, penile block, or dorsal ring block for analgesia supplemented with general <ref name=":0" /><ref name=":1" />'		* Caudal epidural, penile block, pudendal nerve block, or dorsal ring block for analgesia supplemented with general <ref name=":0" /><ref name=":1" /><ref>{{Cite journal\|last=Boisvert-Moreau\|first=Frédérique\|last2=Turcotte\|first2=Bruno\|last3=Albert\|first3=Natalie\|last4=Singbo\|first4=Narcisse\|last5=Moore\|first5=Katherine\|last6=Boivin\|first6=Ariane\|date=2022-11-17\|title=Randomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcision\|url=https://rapm.bmj.com/content/early/2022/11/16/rapm-2022-103785\|journal=Regional Anesthesia & Pain Medicine\|language=en\|doi=10.1136/rapm-2022-103785\|issn=1098-7339\|pmid=36396298}}</ref>'
	*Caudal: 0.25% Bupivacaine 1cc/kg		*Caudal: 0.25% Bupivacaine 1cc/kg

Jashvin: Caudal dose

2023-02-02T14:40:36Z

Caudal dose

← Older revision		Revision as of 07:40, 2 February 2023
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	{{Infobox surgical procedure		{{Infobox surgical procedure
	\| anesthesia_type = General		\| anesthesia_type = General, Caudal Epidural
	\| airway = ETT vs LMA		\| airway = ETT vs LMA
	\| lines_access = PIV x 1		\| lines_access = PIV x 1
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	=== 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. --> ===

	* Caudal epidural, penile block, or dorsal ring block for analgesia supplemented with general <ref name=":0" /><ref name=":1" />		* Caudal epidural, penile block, or dorsal ring block for analgesia supplemented with general <ref name=":0" /><ref name=":1" />'
			*Caudal: 0.25% Bupivacaine 1cc/kg

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

Chris.Rishel at 13:40, 24 January 2022

2022-01-24T13:40:47Z

← Older revision		Revision as of 06:40, 24 January 2022
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	}}		}}

	Circumcision is a procedure involving the foreskin removal of the penis exposing the glans penis. Indication includes family reasons, phimosis or recurrent balanitis <ref name=":0">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref><ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1117280100\|title=A guide to pediatric anesthesia\|date=2020\|others=Craig Sims, Dana Weber, Chris Johnson\|isbn=978-3-030-19246-4\|edition=2nd ed\|location=Cham\|oclc=1117280100}}</ref>. Most ~~circumcision~~ occur in the newborn nursery performed by pediatrician or obstetrician with different clamps when patients are neonates<ref name=":0" /><ref name=":2">{{Cite book\|url=https://www.worldcat.org/oclc/1137179895\|title=Gregory's pediatric anesthesia\|date=2020\|others=Dean B. Andropoulos, George A. Gregory\|isbn=978-1-119-37151-9\|edition=Sixth edition\|location=Hoboken, NJ\|oclc=1137179895}}</ref>. However, if circumcision is performed in the operating room, the procedure begins with two incisions to remove the penile skin surrounding and covering the glans penis which is the most common method in the operating room<ref name=":2" />.		'''Circumcision''' is a procedure involving the foreskin removal of the penis exposing the glans penis. Indication includes family reasons, phimosis or recurrent balanitis <ref name=":0">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref><ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1117280100\|title=A guide to pediatric anesthesia\|date=2020\|others=Craig Sims, Dana Weber, Chris Johnson\|isbn=978-3-030-19246-4\|edition=2nd ed\|location=Cham\|oclc=1117280100}}</ref>. Most circumcisions occur in the newborn nursery performed by pediatrician or obstetrician with different clamps when patients are neonates<ref name=":0" /><ref name=":2">{{Cite book\|url=https://www.worldcat.org/oclc/1137179895\|title=Gregory's pediatric anesthesia\|date=2020\|others=Dean B. Andropoulos, George A. Gregory\|isbn=978-1-119-37151-9\|edition=Sixth edition\|location=Hoboken, NJ\|oclc=1137179895}}</ref>. However, if circumcision is performed in the operating room, the procedure begins with two incisions to remove the penile skin surrounding and covering the glans penis which is the most common method in the operating room<ref name=":2" />.

	== Preoperative management ==		== Preoperative management ==

Cornel.Chiu at 05:17, 21 January 2022

2022-01-21T05:17:26Z

← Older revision		Revision as of 22:17, 20 January 2022
Line 9:		Line 9:
	}}		}}

	Circumcision is a procedure involving the foreskin removal of the penis exposing the glans penis. Indication includes family reasons, phimosis or recurrent balanitis <ref name=":0">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref><ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1117280100\|title=A guide to pediatric anesthesia\|date=2020\|others=Craig Sims, Dana Weber, Chris Johnson\|isbn=978-3-030-19246-4\|edition=2nd ed\|location=Cham\|oclc=1117280100}}</ref>. Most circumcision occur in the newborn ~~nurses~~ performed by pediatrician or obstetrician with different clamps when patients are neonates<ref name=":0" /><ref name=":2">{{Cite book\|url=https://www.worldcat.org/oclc/1137179895\|title=Gregory's pediatric anesthesia\|date=2020\|others=Dean B. Andropoulos, George A. Gregory\|isbn=978-1-119-37151-9\|edition=Sixth edition\|location=Hoboken, NJ\|oclc=1137179895}}</ref>. However, if circumcision is performed in the operating room, the procedure begins with two incisions to remove the penile skin surrounding and covering the glans penis which is the most common method in the operating room<ref name=":2" />.		Circumcision is a procedure involving the foreskin removal of the penis exposing the glans penis. Indication includes family reasons, phimosis or recurrent balanitis <ref name=":0">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref><ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1117280100\|title=A guide to pediatric anesthesia\|date=2020\|others=Craig Sims, Dana Weber, Chris Johnson\|isbn=978-3-030-19246-4\|edition=2nd ed\|location=Cham\|oclc=1117280100}}</ref>. Most circumcision occur in the newborn nursery performed by pediatrician or obstetrician with different clamps when patients are neonates<ref name=":0" /><ref name=":2">{{Cite book\|url=https://www.worldcat.org/oclc/1137179895\|title=Gregory's pediatric anesthesia\|date=2020\|others=Dean B. Andropoulos, George A. Gregory\|isbn=978-1-119-37151-9\|edition=Sixth edition\|location=Hoboken, NJ\|oclc=1137179895}}</ref>. However, if circumcision is performed in the operating room, the procedure begins with two incisions to remove the penile skin surrounding and covering the glans penis which is the most common method in the operating room<ref name=":2" />.

	== Preoperative management ==		== Preoperative management ==

Cornel.Chiu: Each section

2022-01-20T22:14:43Z

Each section

New page

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT vs LMA
| lines_access = PIV x 1
| monitors = Standard, Temperature
| considerations_preoperative = OR and table pre-warmed
| considerations_intraoperative = Temperature
| considerations_postoperative = Emergence delirium
}}

Circumcision is a procedure involving the foreskin removal of the penis exposing the glans penis. Indication includes family reasons, phimosis or recurrent balanitis <ref name=":0">{{Cite book|url=https://www.worldcat.org/oclc/1117874404|title=Anesthesiologist's manual of surgical procedures|date=2020|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu|isbn=978-1-4698-2916-6|edition=Sixth edition|location=Philadelphia|oclc=1117874404}}</ref><ref name=":1">{{Cite book|url=https://www.worldcat.org/oclc/1117280100|title=A guide to pediatric anesthesia|date=2020|others=Craig Sims, Dana Weber, Chris Johnson|isbn=978-3-030-19246-4|edition=2nd ed|location=Cham|oclc=1117280100}}</ref>. Most circumcision occur in the newborn nurses performed by pediatrician or obstetrician with different clamps when patients are neonates<ref name=":0" /><ref name=":2">{{Cite book|url=https://www.worldcat.org/oclc/1137179895|title=Gregory's pediatric anesthesia|date=2020|others=Dean B. Andropoulos, George A. Gregory|isbn=978-1-119-37151-9|edition=Sixth edition|location=Hoboken, NJ|oclc=1137179895}}</ref>. However, if circumcision is performed in the operating room, the procedure begins with two incisions to remove the penile skin surrounding and covering the glans penis which is the most common method in the operating room<ref name=":2" />.

== Preoperative management ==

=== Operating room setup ===

* Set OR temperature to 70o to 75o
* Underbody bair hugger preheated

=== Patient preparation and premedication ===

* PO midazolam for anxiety in children experiencing separation anxiety
* PO acetaminophen for pain

=== Regional and neuraxial techniques ===

* Caudal epidural, penile block, or dorsal ring block for analgesia supplemented with general <ref name=":0" /><ref name=":1" />

== Intraoperative management ==

=== Monitoring and access ===

* Standard ASA monitors
* Temperature
* PIV x 1

=== Induction and airway management ===

* Mask induction with sevoflurane +/- N2O
** ETT vs LMA
* IV induction for patients > 10 years old

=== Positioning ===

* Supine

=== Maintenance and surgical considerations ===

* Maintenance with volatile anesthetics, IV anesthetic or a combination
* Monitor temperature and ensure large surface areas are covered with warm blankets

=== Emergence ===

* Emergence delirium

== Postoperative management ==

=== Disposition ===

* PACU
* Usually discharged home

=== Pain management ===

* Pain is mild
** Multimodal
*** PO/PR/IV acetaminophen
*** IV/PO NSAIDs
*** IV/PO opioids
*** Topical local anesthetic
*** Regional block
*** Caudal epidural

=== Potential complications ===

* Infection
* Hematoma

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Circumcision
|-
|Position
|Supine
|-
|Surgical time
|30 minutes
|-
|EBL
|Minimal
|-
|Postoperative disposition
|Home
|-
|Pain management
|Mild , multimodal
|-
|Potential complications
|Infection, hematoma
|}

== References ==

[[Category:Surgical procedures]]