Craniotomy for tumor resection - Revision history

Tony.Wang at 14:23, 24 May 2023

2023-05-24T14:23:41Z

@@ Line 73: / Line 73: @@
 === 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. --> ===
@@ Line 92: / Line 93: @@
 === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
 Mayfield pins are placed after intubation. Positioning depends on tumor location, but may include supine, prone, park bench, or beach chair.
+{| class="wikitable"
-==== Supine ====
+|+
-Generally the easiest to position.
+!Position
 === 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. --> ===

Tony.Wang at 13:58, 24 May 2023

2023-05-24T13:58:40Z

← Older revision		Revision as of 06:58, 24 May 2023
Line 77:		Line 77:

	=== 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. --> ===
			Generally avoid sedating premedication that may affect neuro exam after extubation

	=== 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. --> ===
Line 83:		Line 84:

	=== 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. --> ===
	~~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.		* At least 2 large bore 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<!-- 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. --> ===

	=== 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. --> ===
	Mayfield pins are placed after intubation.		Mayfield pins are placed after intubation. Positioning depends on tumor location, but may include supine, prone, park bench, or beach chair.

			==== Supine ====
			Generally the easiest to position.

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

			Inhaled anesthetics should be avoided due to dampening of neuromonitoring signals. Reasonable considerations would be TIVA (propofol/remifentanil) or a combination of propofol/sevoflurane.

			If MEP, EMG, or BAERs are needed, then patient cannot be fully paralyzed. Generally must maintain 2+ twitches on TOF monitoring. Vecuronium infusions should be considered for smoother signaling monitoring. If SSEPs or EEG, then patient can be fully paralyzed.

			As these are painful procedures, consider titrating fentanyl up to 5 mcg/kg.

	=== 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. --> ===
			Maintain normotensive and avoid bucking, all of which can lead to increased ICP

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

Jthom159: added positioning and maintence details

2022-05-02T14:10:51Z

added positioning and maintence details

← Older revision		Revision as of 07:10, 2 May 2022
Line 83:		Line 83:

	=== 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. --> ===
			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<!-- 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. --> ===

	=== 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. --> ===
			Mayfield pins are placed after intubation.

	=== 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. --> ===
			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<!-- 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. --> ===

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

2022-04-05T19:39:29Z

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

← Older revision		Revision as of 12:39, 5 April 2022
Line 3:		Line 3:
	\| airway = ETT		\| airway = ETT
	\| lines_access = Large bore IV		\| lines_access = Large bore IV
	~~Art~~ line		Arterial line
	± Central line		± Central line
	\| monitors = Standard		\| monitors = Standard

Chris.Rishel at 07:21, 5 April 2022

2022-04-05T07:21:06Z

← Older revision		Revision as of 00:21, 5 April 2022
Line 4:		Line 4:
	\| lines_access = Large bore IV		\| lines_access = Large bore IV
	Art line		Art line
	~~±Central~~ line		± Central line
	\| monitors = Standard~~<br />~~		\| monitors = Standard
	5-lead ECG~~<br />~~		5-lead ECG
	Core temp~~<br />~~		Core temp
	UOP~~<br/>~~		UOP
	ABP~~<br />~~		ABP
	~~±CVP<br />~~		± CVP
	~~±Neuromonitoring~~		± Neuromonitoring
	\| considerations_preoperative = Characterize neurologic deficits~~<br />~~		\| considerations_preoperative = Characterize neurologic deficits
	Evaluate for ↑ ICP		Evaluate for ↑ ICP
	\| considerations_intraoperative = Manage ICP		\| considerations_intraoperative = Manage ICP

Chris.Rishel at 01:39, 5 April 2022

2022-04-05T01:39:13Z

← Older revision		Revision as of 18:39, 4 April 2022
Line 140:		Line 140:

	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
			[[Category:Neurosurgery]]
			[[Category:Intracranial neurosurgery]]

Chris.Rishel at 01:38, 5 April 2022

2022-04-05T01:38:46Z

← Older revision	Revision as of 18:38, 4 April 2022
Line 1:	Line 1:
		{{Infobox surgical procedure
		\| anesthesia_type = General
		\| airway = ETT
		\| lines_access = Large bore IV
		Art line
		±Central line
		\| monitors = Standard<br />
		5-lead ECG<br />
		Core temp<br />
		UOP<br/>
		ABP<br />
		±CVP<br />
		±Neuromonitoring
		\| considerations_preoperative = Characterize neurologic deficits<br />
		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<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
		{\| 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<!-- 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 wikitable-horizontal-scroll"
		\|+
		!
		!Variant 1
		!Variant 2
		\|-
		\|Unique considerations
		\|
		\|
		\|-
		\|Position
		\|
		\|
		\|-
		\|Surgical time
		\|
		\|
		\|-
		\|EBL
		\|
		\|
		\|-
		\|Postoperative disposition
		\|
		\|
		\|-
		\|Pain management
		\|
		\|
		\|-
		\|Potential complications
		\|
		\|
		\|}

		== References ==

		[[Category:Surgical procedures]]

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