Colectomy - Revision history

Chris.Rishel: Text replacement - "Art line" to "Arterial line"

2022-04-05T19:40:07Z

Text replacement - "Art line" to "Arterial line"

← Older revision		Revision as of 12:40, 5 April 2022
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	5-Lead EKG		5-Lead EKG
	Urine output		Urine output
	+/- ~~Art~~ line		+/- Arterial line
	\| considerations_preoperative = Full stomach precautions if acute abdomen		\| considerations_preoperative = Full stomach precautions if acute abdomen
	\| considerations_intraoperative = Goal directed fluid therapy		\| considerations_intraoperative = Goal directed fluid therapy

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

2022-02-22T05:45:12Z

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

← Older revision		Revision as of 22:45, 21 February 2022
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	\|Bowel rupture can cause sepsis or septic shock and hemodynamic instability.		\|Bowel rupture can cause sepsis or septic shock and hemodynamic instability.
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|If bowel obstruction and abdominal dissension, there may be impaired diaphragmatic excursion, which could negatively impact FRC and result in more rapid desaturations. Ensure adequate preoxygenation		\|If bowel obstruction and abdominal dissension, there may be impaired diaphragmatic excursion, which could negatively impact FRC and result in more rapid desaturations. Ensure adequate preoxygenation
	\|-		\|-

Tony.Wang: typos

2021-11-29T16:21:40Z

typos

← Older revision		Revision as of 09:21, 29 November 2021
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	}}		}}

	A '''colectomy''' is a surgical procedure to remove all or part of the colon. A partial colectomy (also known a segmental or hemi-colectomy) involves removing a portion of the colon, followed by the creation of an anastomosis or stoma. With more advanced disease, the entire large intestine is removed (total colectomy). Colectomies are often done laparoscopically. Common indications for the procedure include cancer, bowel obstruction, colitis, or diverticulitis.		A '''colectomy''' is a surgical procedure to remove all or part of the colon. A partial colectomy (also known a segmental or hemi-colectomy) involves removing a portion of the colon, followed by the creation of an anastomosis or stoma. With more advanced disease, the entire large intestine is removed (total colectomy). Colectomies are often done laparoscopically or robotically. Common indications for the procedure include cancer, bowel obstruction, colitis, or diverticulitis.

	== Preoperative management ==		== Preoperative management ==
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	* Consider pre-loading patients that are hypovolemic		* Consider pre-loading patients that are hypovolemic
	* Presurgical ERAS protocol		* Presurgical ERAS protocol
	* Consider preop acetaminophen / gabapentin / ~~celcoxib~~		* Consider preop acetaminophen / gabapentin / celecoxib
	* Evaluate for anemia and consider corrective options, if needed		* Evaluate for anemia and consider corrective options, if needed
	* Verify desired pre-incision antibiotics		* Verify desired pre-incision antibiotics
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	* General endotracheal anesthesia +/- epidural (for open cases)		* General endotracheal anesthesia +/- epidural (for open cases)
	* Standard maintenance (avoid N<small>2</small>0)		* Standard maintenance (avoid N<small>2</small>O)
	** Run epidural if present		** Run epidural if present
	* Maintain euvolemia		* Maintain euvolemia
	** Avoid excessive hypovolemia or hypervolemia		** Avoid excessive hypovolemia or hypervolemia

Tony.Wang at 02:11, 20 July 2021

2021-07-20T02:11:41Z

← Older revision		Revision as of 19:11, 19 July 2021
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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. --> ===

			* Consider truncal block
	* Consider thoracic epidural (for open procedures)<ref>{{Cite journal\|last=Nimmo\|first=Susan M\|last2=Harrington\|first2=Lorraine S\|date=2014-10-01\|title=What is the role of epidural analgesia in abdominal surgery?\|url=https://doi.org/10.1093/bjaceaccp/mkt062\|journal=Continuing Education in Anaesthesia Critical Care & Pain\|volume=14\|issue=5\|pages=224–229\|doi=10.1093/bjaceaccp/mkt062\|issn=1743-1816}}</ref>		* Consider thoracic epidural (for open procedures)<ref>{{Cite journal\|last=Nimmo\|first=Susan M\|last2=Harrington\|first2=Lorraine S\|date=2014-10-01\|title=What is the role of epidural analgesia in abdominal surgery?\|url=https://doi.org/10.1093/bjaceaccp/mkt062\|journal=Continuing Education in Anaesthesia Critical Care & Pain\|volume=14\|issue=5\|pages=224–229\|doi=10.1093/bjaceaccp/mkt062\|issn=1743-1816}}</ref>
	** Improved post-op pain, earlier return of bowel function, faster ambulation, improved dietary tolerance		** Improved post-op pain, earlier return of bowel function, faster ambulation, improved dietary tolerance

Barrett.Larson at 22:45, 15 May 2021

2021-05-15T22:45:38Z

← Older revision		Revision as of 15:45, 15 May 2021
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	\| anesthesia_type = General +/- Epidural		\| anesthesia_type = General +/- Epidural
	\| airway = ETT		\| airway = ETT
	\| lines_access = ~~PIV (~~1 or 2)		\| lines_access = 1-2 PIV <br/>
	\| monitors = Standard ASA		\| monitors = Standard ASA
	5-Lead EKG		5-Lead EKG
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	+/- Art line		+/- Art line
	\| considerations_preoperative = Full stomach precautions if acute abdomen		\| considerations_preoperative = Full stomach precautions if acute abdomen
	\| considerations_intraoperative =		\| considerations_intraoperative = Goal directed fluid therapy
	\| considerations_postoperative =		\| considerations_postoperative = Pain control <br/>
			PONV
	}}		}}

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	* Patients often have bowel prep		* Patients often have bowel prep
	** Patients typically dehydrated and may have electrolyte abnormalities		** Patients typically dehydrated and may have electrolyte abnormalities
	* Presurgical ERAS protocol		* Consider pre-loading patients that are hypovolemic
			* Presurgical ERAS protocol
	* Consider preop acetaminophen / gabapentin / celcoxib		* Consider preop acetaminophen / gabapentin / celcoxib
	* Consider pre-loading patients that are hypovolemic
	* Evaluate for anemia and consider corrective options, if needed		* Evaluate for anemia and consider corrective options, if needed
	* Verify desired pre-incision antibiotics		* Verify desired pre-incision antibiotics
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	* Potential for hypotension if patient hypovolemic or septic		* Potential for hypotension if patient hypovolemic or septic
	** Consider co-loading fluids		** Consider co-loading fluids
	** Consider pre-emptive vasopressor administrator with induction		** Consider pre-emptive vasopressor administrator with induction (or phenylephrine drip on standby)

	=== 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. --> ===
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	* Standard maintenance (avoid N<small>2</small>0)		* Standard maintenance (avoid N<small>2</small>0)
	** Run epidural if present		** Run epidural if present
	* Maintain euvolemia		* Maintain euvolemia
	** ~~Goal~~-~~Directed Fluid~~ Management		** Avoid excessive hypovolemia or hypervolemia
	** ~~Avoid excessive Intraoperative~~ fluids		** Individualized, stroke-volume-guided fluid administration<ref>{{Cite journal\|last=Yates\|first=David R. A.\|last2=Davies\|first2=Simon J.\|last3=Warnakulasuriya\|first3=Samantha R.\|last4=Wilson\|first4=R. Jonathan T.\|date=2014-12-01\|title=Volume Management and Resuscitation in Colorectal Surgery\|url=https://doi.org/10.1007/s40140-014-0078-1\|journal=Current Anesthesiology Reports\|language=en\|volume=4\|issue=4\|pages=376–385\|doi=10.1007/s40140-014-0078-1\|issn=2167-6275}}</ref>
			** Administer fluids towards a specified goal
	** Fluid losses can be significant (particularly for open cases)		** Fluid losses can be significant (particularly for open cases)
	*** Blood loss, third-spacing, insensible losses		*** Blood loss, third-spacing, insensible losses
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	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

	* ~~Extubate - if appropriate based~~ on hemodynamics, fluid status, respiratory status, neurologic status, etc.		* Typically extubate, depending on patient's hemodynamics, fluid status, respiratory status, neurologic status, etc.
	* PONV prophylaxis		* PONV prophylaxis

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	* Hemorrhage		* Hemorrhage
	* Visceral injuries		* Visceral injuries
			* Anastomotic leak
	* Sepsis / Septic shock		* Sepsis / Septic shock
	** Potential for hemodynamic instability due to evolving sepsis		** Potential for hemodynamic instability due to evolving sepsis
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	\|Surgical time		\|Surgical time
	\|1-3 hours		\|1-3 hours
	\|		\|1-3 hours
	\|-		\|-
	\|EBL		\|EBL

Barrett.Larson at 22:24, 15 May 2021

2021-05-15T22:24:20Z

← Older revision		Revision as of 15:24, 15 May 2021
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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. --> ===

			* Typically go to PACU
			* May require ICU, depending on magnitude of surgery and/or patient condition

	=== 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. --> ===
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	\|-		\|-
	\|Unique considerations		\|Unique considerations
	\|		\|More fluid shifts, more insensible fluid loss, higher bleeding risk, more pain
	\|		\|
	\|-		\|-
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	\|-		\|-
	\|EBL		\|EBL
	\|100-200 mL (although can be much higher, depending on ~~nature~~ of ~~disease burden~~)		\|100-200 mL (although can be much higher, depending on degree of pathology, technical complexity, and patient factors)
	\|<100		\|<100
	\|-		\|-

Barrett.Larson at 22:18, 15 May 2021

2021-05-15T22:18:31Z

← Older revision		Revision as of 15:18, 15 May 2021
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	* Patients often have bowel prep		* Patients often have bowel prep
			** Patients typically dehydrated and may have electrolyte abnormalities
	* Presurgical ERAS protocol		* Presurgical ERAS protocol
	* Consider preop acetaminophen / gabapentin / celcoxib		* Consider preop acetaminophen / gabapentin / celcoxib
	* Consider pre-loading patients that are hypovolemic		* Consider pre-loading patients that are hypovolemic
			* Evaluate for anemia and consider corrective options, if needed
	* Verify desired pre-incision antibiotics		* Verify desired pre-incision antibiotics

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	* Consider thoracic epidural (for open procedures)<ref>{{Cite journal\|last=Nimmo\|first=Susan M\|last2=Harrington\|first2=Lorraine S\|date=2014-10-01\|title=What is the role of epidural analgesia in abdominal surgery?\|url=https://doi.org/10.1093/bjaceaccp/mkt062\|journal=Continuing Education in Anaesthesia Critical Care & Pain\|volume=14\|issue=5\|pages=224–229\|doi=10.1093/bjaceaccp/mkt062\|issn=1743-1816}}</ref>		* Consider thoracic epidural (for open procedures)<ref>{{Cite journal\|last=Nimmo\|first=Susan M\|last2=Harrington\|first2=Lorraine S\|date=2014-10-01\|title=What is the role of epidural analgesia in abdominal surgery?\|url=https://doi.org/10.1093/bjaceaccp/mkt062\|journal=Continuing Education in Anaesthesia Critical Care & Pain\|volume=14\|issue=5\|pages=224–229\|doi=10.1093/bjaceaccp/mkt062\|issn=1743-1816}}</ref>
	** Improved post-op pain, earlier return of bowel function, faster ambulation		** Improved post-op pain, earlier return of bowel function, faster ambulation, improved dietary tolerance

	== Intraoperative management ==		== Intraoperative management ==
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	* Maintain euvolemia		* Maintain euvolemia
	** Goal-Directed Fluid Management		** Goal-Directed Fluid Management
			** Avoid excessive Intraoperative fluids
	** Fluid losses can be significant (particularly for open cases)		** Fluid losses can be significant (particularly for open cases)
	*** Blood loss, third-spacing, insensible losses		*** Blood loss, third-spacing, insensible losses
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	** Be particularly vigilant in open cases, where heat losses are greater		** Be particularly vigilant in open cases, where heat losses are greater
	* Place OG tube (or NG if going to be left in post-operatively)		* Place OG tube (or NG if going to be left in post-operatively)
			* Consider opiate-sparing analgesia

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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	\|-		\|-
	\|Position		\|Position
	\|		\|Supine
	\|		\|Supine
	\|-		\|-
	\|Surgical time		\|Surgical time
	\|		\|1-3 hours
	\|		\|
	\|-		\|-
	\|EBL		\|EBL
	\|		\|100-200 mL (although can be much higher, depending on nature of disease burden)
	\|		\|<100
	\|-		\|-
	\|Postoperative disposition		\|Postoperative disposition
	\|		\|PACU
	\|		\|PACU
	\|-		\|-
	\|Pain management		\|Pain management
	\|		\|Pain typically high. Consider multi-modal pain regimen, epidural anesthesia, PCA
	\|		\|Pain typically moderate
	\|-		\|-
	\|Potential complications		\|Potential complications

Barrett.Larson at 22:02, 15 May 2021

2021-05-15T22:02:40Z

← Older revision		Revision as of 15:02, 15 May 2021
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	* BMP / Electrolytes		* BMP / Electrolytes
	* Coags		* Coags
	* Consider T&S or T&C~~, particularly if open~~		* Consider T&S or T&C
	*		*

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	* Typically only 1 PIV for laparoscopic and 2 for open cases		* Typically only 1 PIV for laparoscopic and 2 for open cases
	** Upgrade access if anticipate more significant blood loss or fluid shifts		** Upgrade IV access if anticipate more significant blood loss or fluid shifts
			** Confirm IVs still good after tucking arms
	*		*

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	* Supine		* Supine
	* May need steep Trendelenburg ~~if laparoscopic~~		* May need steep Trendelenburg or Reverse Trendelenburg
			* Possible lithotomy

	=== 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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	* Standard maintenance (avoid N<small>2</small>0)		* Standard maintenance (avoid N<small>2</small>0)
	** Run epidural if present		** Run epidural if present
			* Maintain euvolemia
			** Goal-Directed Fluid Management
			** Fluid losses can be significant (particularly for open cases)
			*** Blood loss, third-spacing, insensible losses
	* Maintain normothermia		* Maintain normothermia
	** Be particularly vigilant in open cases, where heat losses are greater		** Be particularly vigilant in open cases, where heat losses are greater
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	=== 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. --> ===

			* Multi-modal pain management
			* Epidural / PCA
			* Consider non-opiate adjuncts

	=== 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. --> ===

			* Hemorrhage
			* Visceral injuries
			* Sepsis / Septic shock
			** Potential for hemodynamic instability due to evolving sepsis
			* Aspiration
			* VTE
			* PONV

	== 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). --> ==		== 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). --> ==
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	\|+		\|+
	!		!
	!~~Variant 1~~		!Open colectomy
	!~~Variant 2~~		!Laparoscopic colectomy
	\|-		\|-
	\|Unique considerations		\|Unique considerations

Barrett.Larson at 21:53, 15 May 2021

2021-05-15T21:53:17Z

← Older revision		Revision as of 14:53, 15 May 2021
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	* Presurgical ERAS protocol		* Presurgical ERAS protocol
	* Consider preop acetaminophen / gabapentin / celcoxib		* Consider preop acetaminophen / gabapentin / celcoxib
			* Consider pre-loading patients that are hypovolemic
			* Verify desired pre-incision antibiotics

	=== 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 thoracic epidural (for open procedures)		* Consider thoracic epidural (for open procedures)<ref>{{Cite journal\|last=Nimmo\|first=Susan M\|last2=Harrington\|first2=Lorraine S\|date=2014-10-01\|title=What is the role of epidural analgesia in abdominal surgery?\|url=https://doi.org/10.1093/bjaceaccp/mkt062\|journal=Continuing Education in Anaesthesia Critical Care & Pain\|volume=14\|issue=5\|pages=224–229\|doi=10.1093/bjaceaccp/mkt062\|issn=1743-1816}}</ref>
			** Improved post-op pain, earlier return of bowel function, faster ambulation

	== Intraoperative management ==		== Intraoperative management ==
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	* Typically only 1 PIV for laparoscopic and 2 for open cases		* Typically only 1 PIV for laparoscopic and 2 for open cases
	** ~~Upgraded~~ access if anticipate more significant blood loss or fluid shifts		** Upgrade access if anticipate more significant blood loss or fluid shifts
			*

	=== 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. --> ===

	* RSI if bowel obstruction or distended abdomen		* RSI if bowel obstruction, distended abdomen, urgent/emergent, or non-NPO cases
			** +/- cricoid pressure
			** +/- removal of a pre-existing NG tube prior to induction
			* Potential for hypotension if patient hypovolemic or septic
			** Consider co-loading fluids
			** Consider pre-emptive vasopressor administrator with induction

	=== 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. --> ===
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	=== 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. --> ===

			* General endotracheal anesthesia +/- epidural (for open cases)
			* Standard maintenance (avoid N<small>2</small>0)
			** Run epidural if present
			* Maintain normothermia
			** Be particularly vigilant in open cases, where heat losses are greater
			* Place OG tube (or NG if going to be left in post-operatively)

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

			* Extubate - if appropriate based on hemodynamics, fluid status, respiratory status, neurologic status, etc.
			* PONV prophylaxis

	== Postoperative management ==		== Postoperative management ==

Barrett.Larson at 21:34, 15 May 2021

2021-05-15T21:34:54Z

← Older revision		Revision as of 14:34, 15 May 2021
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	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
	\|		\|Bowel obstruction increases risk for aspiration. Consider NG tube to decompress stomach.
	\|-		\|-
	\|Hematologic		\|Hematologic
	\|		\|Anemia can result from cancer, chronic inflammation and GI blood loss. Dehydration can cause hemoconcentration and mask anemia. GI malabsorption can impair coagulation system.
	\|-		\|-
	\|Renal		\|Renal
	\|If oral intake reduced or there's been vomiting, there may be electrolyte abnormalities.		\|If oral intake reduced or there's been vomiting, there may be electrolyte abnormalities. Potential for metabolic acidosis in patients with diarrhea or having a bowel prep.
	\|-		\|-
	\|Endocrine		\|Endocrine
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	* Patients often have bowel prep		* Patients often have bowel prep
			* Presurgical ERAS protocol
			* Consider preop acetaminophen / gabapentin / celcoxib

	=== 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 thoracic epidural if open		* Consider thoracic epidural (for open procedures)

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