Roux-en-Y gastric bypass - Revision history

Chris.Rishel at 07:15, 5 April 2022

2022-04-05T07:15:46Z

← Older revision		Revision as of 00:15, 5 April 2022
Line 4:		Line 4:
	\| lines_access = PIV		\| lines_access = PIV
	OG tube		OG tube
	\| monitors = Standard~~, nasal temp~~		\| monitors = Standard
			Temperature (not esophageal)
	\| considerations_preoperative = Potential difficult ventilation and airway management		\| considerations_preoperative = Potential difficult ventilation and airway management
	\| considerations_intraoperative = Rapid sequence, ramped position		\| considerations_intraoperative = Rapid sequence, ramped position
	\| considerations_postoperative = PONV, IV ~~tylenol~~		\| considerations_postoperative = PONV
			IV acetaminophen
	}}		}}

	A procedural variant for gastric partitioning for morbid obesity to reduce food intake where the stomach is partitioned into a proximal and distal pouch (<50mL) with an anastomosis to the jejunum to drain the proximal pouch<ref>{{Cite journal\|last=Heymsfield\|first=Steven B.\|last2=Wadden\|first2=Thomas A.\|date=2017-04-13\|title=Mechanisms, Pathophysiology, and Management of Obesity\|url=https://pubmed.ncbi.nlm.nih.gov/28402780\|journal=The New England Journal of Medicine\|volume=376\|issue=15\|pages=1492\|doi=10.1056/NEJMc1701944\|issn=1533-4406\|pmid=28402780}}</ref>. Food then bypasses over 95% of the stomach, duodenum, and jejunum. Many patients who have Roux-en-Y gastric bypass lose more than 25% of weight after 1 year<ref>{{Cite journal\|last=Ikramuddin\|first=Sayeed\|last2=Korner\|first2=Judith\|last3=Lee\|first3=Wei-Jei\|last4=Connett\|first4=John E.\|last5=Inabnet\|first5=William B.\|last6=Billington\|first6=Charles J.\|last7=Thomas\|first7=Avis J.\|last8=Leslie\|first8=Daniel B.\|last9=Chong\|first9=Keong\|last10=Jeffery\|first10=Robert W.\|last11=Ahmed\|first11=Leaque\|date=2013-06-05\|title=Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial\|url=https://pubmed.ncbi.nlm.nih.gov/23736733\|journal=JAMA\|volume=309\|issue=21\|pages=2240–2249\|doi=10.1001/jama.2013.5835\|issn=1538-3598\|pmc=3954742\|pmid=23736733}}</ref>. Patients who had Roux-en-Y gastric bypass experienced higher remission and lower rates of hypertension, diabetes, and hyperlipidemia<ref>{{Cite journal\|last=Adams\|first=Ted D.\|last2=Davidson\|first2=Lance E.\|last3=Litwin\|first3=Sheldon E.\|last4=Kim\|first4=Jaewhan\|last5=Kolotkin\|first5=Ronette L.\|last6=Nanjee\|first6=M. Nazeem\|last7=Gutierrez\|first7=Jonathan M.\|last8=Frogley\|first8=Sara J.\|last9=Ibele\|first9=Anna R.\|last10=Brinton\|first10=Eliot A.\|last11=Hopkins\|first11=Paul N.\|date=2017-09-21\|title=Weight and Metabolic Outcomes 12 Years after Gastric Bypass\|url=http://www.nejm.org/doi/10.1056/NEJMoa1700459\|journal=New England Journal of Medicine\|language=en\|volume=377\|issue=12\|pages=1143–1155\|doi=10.1056/NEJMoa1700459\|issn=0028-4793\|pmc=PMC5737957\|pmid=28930514}}</ref>.		A '''Roux-en-Y gastric bypass''' is a procedural variant for gastric partitioning for morbid obesity to reduce food intake where the stomach is partitioned into a proximal and distal pouch (<50mL) with an anastomosis to the jejunum to drain the proximal pouch<ref>{{Cite journal\|last=Heymsfield\|first=Steven B.\|last2=Wadden\|first2=Thomas A.\|date=2017-04-13\|title=Mechanisms, Pathophysiology, and Management of Obesity\|url=https://pubmed.ncbi.nlm.nih.gov/28402780\|journal=The New England Journal of Medicine\|volume=376\|issue=15\|pages=1492\|doi=10.1056/NEJMc1701944\|issn=1533-4406\|pmid=28402780}}</ref>. Food then bypasses over 95% of the stomach, duodenum, and jejunum. Many patients who have Roux-en-Y gastric bypass lose more than 25% of weight after 1 year<ref>{{Cite journal\|last=Ikramuddin\|first=Sayeed\|last2=Korner\|first2=Judith\|last3=Lee\|first3=Wei-Jei\|last4=Connett\|first4=John E.\|last5=Inabnet\|first5=William B.\|last6=Billington\|first6=Charles J.\|last7=Thomas\|first7=Avis J.\|last8=Leslie\|first8=Daniel B.\|last9=Chong\|first9=Keong\|last10=Jeffery\|first10=Robert W.\|last11=Ahmed\|first11=Leaque\|date=2013-06-05\|title=Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial\|url=https://pubmed.ncbi.nlm.nih.gov/23736733\|journal=JAMA\|volume=309\|issue=21\|pages=2240–2249\|doi=10.1001/jama.2013.5835\|issn=1538-3598\|pmc=3954742\|pmid=23736733}}</ref>. Patients who had Roux-en-Y gastric bypass experienced higher remission and lower rates of hypertension, diabetes, and hyperlipidemia<ref>{{Cite journal\|last=Adams\|first=Ted D.\|last2=Davidson\|first2=Lance E.\|last3=Litwin\|first3=Sheldon E.\|last4=Kim\|first4=Jaewhan\|last5=Kolotkin\|first5=Ronette L.\|last6=Nanjee\|first6=M. Nazeem\|last7=Gutierrez\|first7=Jonathan M.\|last8=Frogley\|first8=Sara J.\|last9=Ibele\|first9=Anna R.\|last10=Brinton\|first10=Eliot A.\|last11=Hopkins\|first11=Paul N.\|date=2017-09-21\|title=Weight and Metabolic Outcomes 12 Years after Gastric Bypass\|url=http://www.nejm.org/doi/10.1056/NEJMoa1700459\|journal=New England Journal of Medicine\|language=en\|volume=377\|issue=12\|pages=1143–1155\|doi=10.1056/NEJMoa1700459\|issn=0028-4793\|pmc=PMC5737957\|pmid=28930514}}</ref>.

	==Preoperative management==		==Preoperative management==
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	*Bleeding		*Bleeding
	*~~Thromboemobolic~~ events		*Thromboembolic events
	*Aspiration		*Aspiration
	*Backwall suture of ~~anastamosis~~		*Backwall suture of anastomosis
	*Mortality is 0.2-0.3% with a laparoscopic approach<ref>{{Citation\|last=O'Brien\|first=Paul\|title=Surgical Treatment of Obesity\|date=2000\|url=http://www.ncbi.nlm.nih.gov/books/NBK279090/\|work=Endotext\|editor-last=Feingold\|editor-first=Kenneth R.\|place=South Dartmouth (MA)\|publisher=MDText.com, Inc.\|pmid=25905316\|access-date=2021-06-05\|editor2-last=Anawalt\|editor2-first=Bradley\|editor3-last=Boyce\|editor3-first=Alison\|editor4-last=Chrousos\|editor4-first=George}}</ref>		*Mortality is 0.2-0.3% with a laparoscopic approach<ref>{{Citation\|last=O'Brien\|first=Paul\|title=Surgical Treatment of Obesity\|date=2000\|url=http://www.ncbi.nlm.nih.gov/books/NBK279090/\|work=Endotext\|editor-last=Feingold\|editor-first=Kenneth R.\|place=South Dartmouth (MA)\|publisher=MDText.com, Inc.\|pmid=25905316\|access-date=2021-06-05\|editor2-last=Anawalt\|editor2-first=Bradley\|editor3-last=Boyce\|editor3-first=Alison\|editor4-last=Chrousos\|editor4-first=George}}</ref>
	*25% of patients require revision of their procedures after 10 years of follow-up<ref>{{Citation\|last=O'Brien\|first=Paul\|title=Surgical Treatment of Obesity\|date=2000\|url=http://www.ncbi.nlm.nih.gov/books/NBK279090/\|work=Endotext\|editor-last=Feingold\|editor-first=Kenneth R.\|place=South Dartmouth (MA)\|publisher=MDText.com, Inc.\|pmid=25905316\|access-date=2021-06-05\|editor2-last=Anawalt\|editor2-first=Bradley\|editor3-last=Boyce\|editor3-first=Alison\|editor4-last=Chrousos\|editor4-first=George}}</ref>		*25% of patients require revision of their procedures after 10 years of follow-up<ref>{{Citation\|last=O'Brien\|first=Paul\|title=Surgical Treatment of Obesity\|date=2000\|url=http://www.ncbi.nlm.nih.gov/books/NBK279090/\|work=Endotext\|editor-last=Feingold\|editor-first=Kenneth R.\|place=South Dartmouth (MA)\|publisher=MDText.com, Inc.\|pmid=25905316\|access-date=2021-06-05\|editor2-last=Anawalt\|editor2-first=Bradley\|editor3-last=Boyce\|editor3-first=Alison\|editor4-last=Chrousos\|editor4-first=George}}</ref>
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	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
			<references />
			[[Category:General surgery]]
			[[Category:Stomach surgery]]
			[[Category:Bariatric surgery]]
			[[Category:Gastric bypass surgery]]

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

2022-02-22T05:45:34Z

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

← Older revision		Revision as of 22:45, 21 February 2022
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	OSA causing pulmonary arterial hypertension		OSA causing pulmonary arterial hypertension
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|Evaluate BMI for decreased FRC		\|Evaluate BMI for decreased FRC

Nkamdar at 17:49, 5 June 2021

2021-06-05T17:49:34Z

← Older revision		Revision as of 10:49, 5 June 2021
Line 10:		Line 10:
	}}		}}

	A procedural variant for gastric partitioning for morbid obesity to reduce food intake where the stomach is partitioned into a proximal and distal pouch (<50mL) with an anastomosis to the jejunum to drain the proximal pouch<ref>{{Cite journal\|last=Heymsfield\|first=Steven B.\|last2=Wadden\|first2=Thomas A.\|date=2017-04-13\|title=Mechanisms, Pathophysiology, and Management of Obesity\|url=https://pubmed.ncbi.nlm.nih.gov/28402780\|journal=The New England Journal of Medicine\|volume=376\|issue=15\|pages=1492\|doi=10.1056/NEJMc1701944\|issn=1533-4406\|pmid=28402780}}</ref>. Food then bypasses over 95% of the stomach, duodenum, and jejunum. Many patients who have Roux-en-Y gastric bypass lose more than 25% of weight after 1 year<ref>{{Cite journal\|last=Ikramuddin\|first=Sayeed\|last2=Korner\|first2=Judith\|last3=Lee\|first3=Wei-Jei\|last4=Connett\|first4=John E.\|last5=Inabnet\|first5=William B.\|last6=Billington\|first6=Charles J.\|last7=Thomas\|first7=Avis J.\|last8=Leslie\|first8=Daniel B.\|last9=Chong\|first9=Keong\|last10=Jeffery\|first10=Robert W.\|last11=Ahmed\|first11=Leaque\|date=2013-06-05\|title=Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial\|url=https://pubmed.ncbi.nlm.nih.gov/23736733\|journal=JAMA\|volume=309\|issue=21\|pages=2240–2249\|doi=10.1001/jama.2013.5835\|issn=1538-3598\|pmc=3954742\|pmid=23736733}}</ref>.		A procedural variant for gastric partitioning for morbid obesity to reduce food intake where the stomach is partitioned into a proximal and distal pouch (<50mL) with an anastomosis to the jejunum to drain the proximal pouch<ref>{{Cite journal\|last=Heymsfield\|first=Steven B.\|last2=Wadden\|first2=Thomas A.\|date=2017-04-13\|title=Mechanisms, Pathophysiology, and Management of Obesity\|url=https://pubmed.ncbi.nlm.nih.gov/28402780\|journal=The New England Journal of Medicine\|volume=376\|issue=15\|pages=1492\|doi=10.1056/NEJMc1701944\|issn=1533-4406\|pmid=28402780}}</ref>. Food then bypasses over 95% of the stomach, duodenum, and jejunum. Many patients who have Roux-en-Y gastric bypass lose more than 25% of weight after 1 year<ref>{{Cite journal\|last=Ikramuddin\|first=Sayeed\|last2=Korner\|first2=Judith\|last3=Lee\|first3=Wei-Jei\|last4=Connett\|first4=John E.\|last5=Inabnet\|first5=William B.\|last6=Billington\|first6=Charles J.\|last7=Thomas\|first7=Avis J.\|last8=Leslie\|first8=Daniel B.\|last9=Chong\|first9=Keong\|last10=Jeffery\|first10=Robert W.\|last11=Ahmed\|first11=Leaque\|date=2013-06-05\|title=Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial\|url=https://pubmed.ncbi.nlm.nih.gov/23736733\|journal=JAMA\|volume=309\|issue=21\|pages=2240–2249\|doi=10.1001/jama.2013.5835\|issn=1538-3598\|pmc=3954742\|pmid=23736733}}</ref>. Patients who had Roux-en-Y gastric bypass experienced higher remission and lower rates of hypertension, diabetes, and hyperlipidemia<ref>{{Cite journal\|last=Adams\|first=Ted D.\|last2=Davidson\|first2=Lance E.\|last3=Litwin\|first3=Sheldon E.\|last4=Kim\|first4=Jaewhan\|last5=Kolotkin\|first5=Ronette L.\|last6=Nanjee\|first6=M. Nazeem\|last7=Gutierrez\|first7=Jonathan M.\|last8=Frogley\|first8=Sara J.\|last9=Ibele\|first9=Anna R.\|last10=Brinton\|first10=Eliot A.\|last11=Hopkins\|first11=Paul N.\|date=2017-09-21\|title=Weight and Metabolic Outcomes 12 Years after Gastric Bypass\|url=http://www.nejm.org/doi/10.1056/NEJMoa1700459\|journal=New England Journal of Medicine\|language=en\|volume=377\|issue=12\|pages=1143–1155\|doi=10.1056/NEJMoa1700459\|issn=0028-4793\|pmc=PMC5737957\|pmid=28930514}}</ref>.

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

Nkamdar: citations

2021-06-05T17:43:40Z

citations

← Older revision		Revision as of 10:43, 5 June 2021
Line 10:		Line 10:
	}}		}}

	A procedural variant for gastric partitioning for morbid obesity where the stomach is partitioned into a proximal and distal pouch with an anastomosis to the jejunum to drain the proximal pouch.		A procedural variant for gastric partitioning for morbid obesity to reduce food intake where the stomach is partitioned into a proximal and distal pouch (<50mL) with an anastomosis to the jejunum to drain the proximal pouch<ref>{{Cite journal\|last=Heymsfield\|first=Steven B.\|last2=Wadden\|first2=Thomas A.\|date=2017-04-13\|title=Mechanisms, Pathophysiology, and Management of Obesity\|url=https://pubmed.ncbi.nlm.nih.gov/28402780\|journal=The New England Journal of Medicine\|volume=376\|issue=15\|pages=1492\|doi=10.1056/NEJMc1701944\|issn=1533-4406\|pmid=28402780}}</ref>. Food then bypasses over 95% of the stomach, duodenum, and jejunum. Many patients who have Roux-en-Y gastric bypass lose more than 25% of weight after 1 year<ref>{{Cite journal\|last=Ikramuddin\|first=Sayeed\|last2=Korner\|first2=Judith\|last3=Lee\|first3=Wei-Jei\|last4=Connett\|first4=John E.\|last5=Inabnet\|first5=William B.\|last6=Billington\|first6=Charles J.\|last7=Thomas\|first7=Avis J.\|last8=Leslie\|first8=Daniel B.\|last9=Chong\|first9=Keong\|last10=Jeffery\|first10=Robert W.\|last11=Ahmed\|first11=Leaque\|date=2013-06-05\|title=Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial\|url=https://pubmed.ncbi.nlm.nih.gov/23736733\|journal=JAMA\|volume=309\|issue=21\|pages=2240–2249\|doi=10.1001/jama.2013.5835\|issn=1538-3598\|pmc=3954742\|pmid=23736733}}</ref>.

	==Preoperative management==		==Preoperative management==
Line 107:		Line 107:
	*Aspiration		*Aspiration
	*Backwall suture of anastamosis		*Backwall suture of anastamosis
			*Mortality is 0.2-0.3% with a laparoscopic approach<ref>{{Citation\|last=O'Brien\|first=Paul\|title=Surgical Treatment of Obesity\|date=2000\|url=http://www.ncbi.nlm.nih.gov/books/NBK279090/\|work=Endotext\|editor-last=Feingold\|editor-first=Kenneth R.\|place=South Dartmouth (MA)\|publisher=MDText.com, Inc.\|pmid=25905316\|access-date=2021-06-05\|editor2-last=Anawalt\|editor2-first=Bradley\|editor3-last=Boyce\|editor3-first=Alison\|editor4-last=Chrousos\|editor4-first=George}}</ref>
			*25% of patients require revision of their procedures after 10 years of follow-up<ref>{{Citation\|last=O'Brien\|first=Paul\|title=Surgical Treatment of Obesity\|date=2000\|url=http://www.ncbi.nlm.nih.gov/books/NBK279090/\|work=Endotext\|editor-last=Feingold\|editor-first=Kenneth R.\|place=South Dartmouth (MA)\|publisher=MDText.com, Inc.\|pmid=25905316\|access-date=2021-06-05\|editor2-last=Anawalt\|editor2-first=Bradley\|editor3-last=Boyce\|editor3-first=Alison\|editor4-last=Chrousos\|editor4-first=George}}</ref>

	==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). -->==

Jessica.Leung at 20:34, 17 May 2021

2021-05-17T20:34:09Z

← Older revision		Revision as of 13:34, 17 May 2021
Line 5:		Line 5:
	OG tube		OG tube
	\| monitors = Standard, nasal temp		\| monitors = Standard, nasal temp
	\| considerations_preoperative = Potential difficult airway ~~and ventilation~~		\| considerations_preoperative = Potential difficult ventilation and airway management
	\| considerations_intraoperative = Rapid sequence, ramped position		\| considerations_intraoperative = Rapid sequence, ramped position
	\| considerations_postoperative = PONV, IV tylenol		\| considerations_postoperative = PONV, IV tylenol
	}}		}}

	A procedural variant for gastric partitioning for morbid obesity where the stomach is partitioned into a proximal and distal pouch with an ~~anastamosis~~ to the jejunum to drain the proximal pouch.		A procedural variant for gastric partitioning for morbid obesity where the stomach is partitioned into a proximal and distal pouch with an anastomosis to the jejunum to drain the proximal pouch.

	==Preoperative management==		==Preoperative management==
Line 57:		Line 57:
	*Consider video laryngoscopy		*Consider video laryngoscopy
	*OG tube		*OG tube
			*Methylene Blue and 60mL syringe

	===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. -->===
Line 63:		Line 64:

	===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 post-operative TAP block

	==Intraoperative management==		==Intraoperative management==
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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. -->===

	*OG tube is advanced through the surgical ~~anastamosis~~ to prevent backwall suturing of ~~anastamosis~~		*OG tube is advanced through the surgical anastomosis to prevent backwall suturing of anastomosis
	**Surgical and anesthesia communication and coordination is important to guide OGT through ~~anastamosis~~		**Surgical and anesthesia communication and coordination is important to guide OGT through anastomosis
			*Methylene blue 60mL used at the end of the case to pressurize the proximal pouch and look for leaks across the staple line of the anastomosis.

	===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. -->===

Jessica.Leung: started the page. Added patient evaluation. Edited pre-operative and intraoperative management.

2021-05-17T20:09:32Z

started the page. Added patient evaluation. Edited pre-operative and intraoperative management.

← Older revision		Revision as of 13:09, 17 May 2021
Line 10:		Line 10:
	}}		}}

	~~Provide~~ a ~~brief summary of this surgical procedure~~ and ~~its indications here~~.		A procedural variant for gastric partitioning for morbid obesity where the stomach is partitioned into a proximal and distal pouch with an anastamosis to the jejunum to drain the proximal pouch.

	==Preoperative management==		==Preoperative management==
Line 50:		Line 50:
	===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. -->===

	* ~~sleep~~ study (AHI score if available) for OSA		*Sleep study (AHI score if available) for OSA

	===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. -->===

	* Consider ramp for airway management		*Consider ramp for airway management
	* Consider video laryngoscopy		*Consider video laryngoscopy
	* OG tube		*OG tube

	===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. -->===

	* Minimize perioperative sedation		*Minimize perioperative sedation

	===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 68:		Line 68:
	===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. -->===

	* Standard ASA monitors		*Standard ASA monitors

	===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. -->===

	* Consider rapid sequence induction		*Consider rapid sequence induction
	* Video laryngoscopy can be helpful for anticipated difficult airways		*Video laryngoscopy can be helpful for anticipated difficult airways

	===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. -->===

	* Supine		*Supine
	* Extreme reverse Trendelenburg (place baseboard by feet)		*Extreme reverse Trendelenburg (place baseboard by feet)

	===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. -->===

	* OG tube is advanced through the surgical anastamosis to prevent backwall suturing of anastamosis		*OG tube is advanced through the surgical anastamosis to prevent backwall suturing of anastamosis
	** Surgical and anesthesia communication and coordination is important to guide OGT through anastamosis		**Surgical and anesthesia communication and coordination is important to guide OGT through anastamosis

	===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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	===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		*PACU

	===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. -->===

	* Moderate pain: IV and oral narcotics		*Moderate pain: IV and oral narcotics

	===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. -->===

	* Bleeding		*Bleeding
	* Thromboemobolic events		*Thromboemobolic events
	* Aspiration		*Aspiration
	* Backwall suture of anastamosis		*Backwall suture of anastamosis

	==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). -->==

Jessica.Leung: started the page. Added patient evaluation. Edited pre-operative and intraoperative management.

2021-05-17T19:39:47Z

started the page. Added patient evaluation. Edited pre-operative and intraoperative management.

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