Mastectomy - Revision history

Chris.Rishel at 06:23, 5 April 2022

2022-04-05T06:23:13Z

← Older revision		Revision as of 23:23, 4 April 2022
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	{{Infobox surgical case reference		{{Infobox surgical case reference
	\| anesthesia_type = General		\| anesthesia_type = General
	\| airway = ETT ~~vs.~~ LMA ~~vs. spontaneous~~		\| airway = ETT
	\| lines_access = PIV ~~x 1~~-2		LMA
	\| monitors = Standard ~~monitors~~		\| lines_access = PIV x1-2
	\| considerations_preoperative = ~~Place IV~~ in non-operative ~~extremity~~		\| monitors = Standard
			\| considerations_preoperative = PIV in non-operative arm
	\| considerations_intraoperative =		\| considerations_intraoperative =
	\| considerations_postoperative =		\| considerations_postoperative = PONV
	}}		}}

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	\|-		\|-
	\|Cardiovascular		\|Cardiovascular
	\|Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible. Use of trastuzamab can cause reversible decrease in LV function.		\|Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible.
			Use of trastuzamab can cause reversible decrease in LV function.
	\|-		\|-
	\|Pulmonary		\|Pulmonary

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

2022-02-22T05:45:21Z

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

← Older revision		Revision as of 22:45, 21 February 2022
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	\|Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible. Use of trastuzamab can cause reversible decrease in LV function.		\|Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible. Use of trastuzamab can cause reversible decrease in LV function.
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|Patients receiving radiation therapy to the chest/thorax can have respiratory compromise		\|Patients receiving radiation therapy to the chest/thorax can have respiratory compromise
	\|-		\|-

Chris.Rishel at 21:38, 21 February 2022

2022-02-21T21:38:22Z

← Older revision		Revision as of 14:38, 21 February 2022
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	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
			<references />
			[[Category:General surgery]]
			[[Category:Breast surgery]]

Huckfinne: add no airway

2021-11-04T21:27:15Z

add no airway

← Older revision		Revision as of 14:27, 4 November 2021
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	{{Infobox surgical case reference		{{Infobox surgical case reference
	\| anesthesia_type = General		\| anesthesia_type = General
	\| airway = ETT vs. LMA		\| airway = ETT vs. LMA vs. spontaneous
	\| lines_access = PIV x 1-2		\| lines_access = PIV x 1-2
	\| monitors = Standard monitors		\| monitors = Standard monitors

Barrett.Larson at 02:55, 26 May 2021

2021-05-26T02:55:14Z

← Older revision		Revision as of 19:55, 25 May 2021
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	* Repositioning may be required		* Repositioning may be required
	* Avoid brachial plexus stretch		* Avoid brachial plexus stretch
			* Repositioning may be required if reconstruction is also being done (i.e. latissimus doors flap)

	=== 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. --> ===

Barrett.Larson at 02:54, 26 May 2021

2021-05-26T02:54:04Z

← Older revision		Revision as of 19:54, 25 May 2021
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	\| anesthesia_type = General		\| anesthesia_type = General
	\| airway = ETT vs. LMA		\| airway = ETT vs. LMA
	\| lines_access = PIV		\| lines_access = PIV x 1-2
	\| monitors = Standard monitors		\| monitors = Standard monitors
	\| considerations_preoperative = Place IV in non-operative extremity		\| considerations_preoperative = Place IV in non-operative extremity
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	* Consider acetaminophen, gabapentin and/or celecoxib		* Consider acetaminophen, gabapentin and/or celecoxib
	* Anxiolysis, as needed		* Anxiolysis, as needed
	* ~~ERA~~ protocol		* ERAS protocol

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

	* ~~20g~~ PIV (non-operative extremity)		* PIV x 1-2 (non-operative extremity)
	* Place BP cuff on non-operative extremity		* Place BP cuff on non-operative extremity

	=== 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 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. --> ===

			* Standard maintenance
			* Surgeon may prefer no paralytic for the axillary direction
			* Maintain normovolemia -goal-directed fluid management
			* Maintain normothermia - warming blanket
			* Avoid anemia and blood transfusions
			* Watch out for potential pneumothorax with deep surgical exploration

	=== 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. --> ===

			* PONV prophylaxis (females are more susceptible to PONV)

	== Postoperative management ==		== Postoperative management ==
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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. --> ===

			* Emphasize multimodal pain management

	=== 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. --> ===
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	\|+		\|+
	!		!
	!~~Variant 1~~		!Total mastectomy
	!~~Variant 2~~		!Modified radical mastectomy
	\|-		\|-
	\|Unique considerations		\|Unique considerations

Barrett.Larson at 02:43, 26 May 2021

2021-05-26T02:43:03Z

← Older revision		Revision as of 19:43, 25 May 2021
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	\|-		\|-
	\|Respiratory		\|Respiratory
	\|		\|Patients receiving radiation therapy to the chest/thorax can have respiratory compromise
	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
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	=== 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. --> ===

	* CBC with diff and platelet count		* CBC with diff and platelet count
			** May have anemia or thrombocytopenia due to chemo
			* EKG
			* Consider echo
			** May have cardiomyopathy due to chemotherapy

	=== 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. --> ===

	=== 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. --> ===

			* Consider acetaminophen, gabapentin and/or celecoxib
			* Anxiolysis, as needed
			* ERA protocol

	=== 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 paravertebral blocks		* Consider paravertebral blocks, transversus abdomens plane (TAP) block, or thoracic epidural
	* Studies have shown a trend towards increasing utilization of peripheral nerve blocks (PNB) for mastectomy. As of 2018, ~13% of cases involved a PNB according to the National Anesthesia Clinical Outcomes Registry<ref>{{Cite journal\|last=Lam\|first=Stephanie\|last2=Qu\|first2=Helena\|last3=Hannum\|first3=Margaret\|last4=Tan\|first4=Kay See\|last5=Afonso\|first5=Anoushka\|last6=Tokita\|first6=Hanae K.\|last7=McCormick\|first7=Patrick J.\|date=2021-05-24\|title=Trends in Peripheral Nerve Block Usage in Mastectomy and Lumpectomy: Analysis of a National Database From 2010 to 2018\|url=https://journals.lww.com/anesthesia-analgesia/Abstract/9900/Trends_in_Peripheral_Nerve_Block_Usage_in.56.aspx\|journal=Anesthesia & Analgesia\|language=en-US\|pages=10.1213/ANE.0000000000005368\|doi=10.1213/ANE.0000000000005368\|issn=0003-2999}}</ref>.		* Studies have shown a trend towards increasing utilization of peripheral nerve blocks (PNB) for mastectomy. As of 2018, ~13% of cases involved a PNB according to the National Anesthesia Clinical Outcomes Registry<ref>{{Cite journal\|last=Lam\|first=Stephanie\|last2=Qu\|first2=Helena\|last3=Hannum\|first3=Margaret\|last4=Tan\|first4=Kay See\|last5=Afonso\|first5=Anoushka\|last6=Tokita\|first6=Hanae K.\|last7=McCormick\|first7=Patrick J.\|date=2021-05-24\|title=Trends in Peripheral Nerve Block Usage in Mastectomy and Lumpectomy: Analysis of a National Database From 2010 to 2018\|url=https://journals.lww.com/anesthesia-analgesia/Abstract/9900/Trends_in_Peripheral_Nerve_Block_Usage_in.56.aspx\|journal=Anesthesia & Analgesia\|language=en-US\|pages=10.1213/ANE.0000000000005368\|doi=10.1213/ANE.0000000000005368\|issn=0003-2999}}</ref>.

Barrett.Larson at 02:37, 26 May 2021

2021-05-26T02:37:45Z

← Older revision		Revision as of 19:37, 25 May 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 ~~Paravertebral Blocks~~		* Consider paravertebral blocks
			* Studies have shown a trend towards increasing utilization of peripheral nerve blocks (PNB) for mastectomy. As of 2018, ~13% of cases involved a PNB according to the National Anesthesia Clinical Outcomes Registry<ref>{{Cite journal\|last=Lam\|first=Stephanie\|last2=Qu\|first2=Helena\|last3=Hannum\|first3=Margaret\|last4=Tan\|first4=Kay See\|last5=Afonso\|first5=Anoushka\|last6=Tokita\|first6=Hanae K.\|last7=McCormick\|first7=Patrick J.\|date=2021-05-24\|title=Trends in Peripheral Nerve Block Usage in Mastectomy and Lumpectomy: Analysis of a National Database From 2010 to 2018\|url=https://journals.lww.com/anesthesia-analgesia/Abstract/9900/Trends_in_Peripheral_Nerve_Block_Usage_in.56.aspx\|journal=Anesthesia & Analgesia\|language=en-US\|pages=10.1213/ANE.0000000000005368\|doi=10.1213/ANE.0000000000005368\|issn=0003-2999}}</ref>.

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

Eeshwar.Chandrasekar at 14:48, 18 May 2021

2021-05-18T14:48:46Z

← Older revision		Revision as of 07:48, 18 May 2021
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	}}		}}

	A total '''mastectomy''' refers to the complete removal of breast tissue. A modified radical mastectomy refers to the removal of the breast and the corresponding axillary lymph nodes.		A total '''mastectomy''' (simple mastectomy) refers to the complete removal of breast tissue. A modified radical mastectomy refers to the removal of the breast and the corresponding axillary lymph nodes.

	== Preoperative management ==		== Preoperative management ==
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	\|-		\|-
	\|Cardiovascular		\|Cardiovascular
	\|		\|Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible. Use of trastuzamab can cause reversible decrease in LV function.
	\|-		\|-
	\|Respiratory		\|Respiratory
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	\|-		\|-
	\|Hematologic		\|Hematologic
	\|		\|Chemotherapy can cause anemia and thrombocytopenia.
	\|-		\|-
	\|Renal		\|Renal
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	=== 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. --> ===

			* CBC with diff and platelet count

	=== 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. --> ===
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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 Paravertebral Blocks

	== Intraoperative management ==		== Intraoperative management ==
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	* Ipsilateral arm may be prepped into field		* Ipsilateral arm may be prepped into field
	* Repositioning may be required		* Repositioning may be required
			* Avoid brachial plexus stretch

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

			* PONV
			* Lymphedema
			* Seroma
			* Pneumothorax

	== 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). --> ==

Barrett.Larson at 23:28, 15 May 2021

2021-05-15T23:28:25Z

← Older revision		Revision as of 16:28, 15 May 2021
Line 9:		Line 9:
	}}		}}

	A total '''mastectomy''' refers to the complete removal of breast tissue. A modified radical mastectomy refers to the removal of the breast and the corresponding axillary lymph nodes.		A total '''mastectomy''' refers to the complete removal of breast tissue. A modified radical mastectomy refers to the removal of the breast and the corresponding axillary lymph nodes.

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