Splenectomy - Revision history

Jessica.Milin at 01:43, 28 April 2022

2022-04-28T01:43:53Z

← Older revision		Revision as of 18:43, 27 April 2022
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	== References ==		== References ==
			Jaffe, R. A., Schmiesing, C., & Golianu, B. (2009). Anesthesiologist's manual of surgical procedures (4th ed.). Philadelphia: Lippincott Williams & Wilkins.

			Macksey, Lynn Fitzgerald. (2012). Surgical procedures and anesthetic implications : a handbook for nurse anesthesia practice. Sudbury, MA :Jones & Bartlett Learning

	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]

Jessica.Milin at 00:49, 28 April 2022

2022-04-28T00:49:41Z

← Older revision		Revision as of 17:49, 27 April 2022
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	\|+		\|+
	!		!
	!~~Variant 1~~		!Open
	!Variant 2		!Variant 2
	\|-		\|-
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	\|-		\|-
	\|Position		\|Position
	\|		\|Supine
	\|		\|
	\|-		\|-
	\|Surgical time		\|Surgical time
	\|		\|2-4 hrs
	\|		\|
	\|-		\|-
	\|EBL		\|EBL
	\|		\|50-100 ml
	\|		\|
	\|-		\|-

Jessica.Milin at 00:49, 28 April 2022

2022-04-28T00:49:03Z

← Older revision		Revision as of 17:49, 27 April 2022
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	{{Infobox surgical procedure		<big>A splenectomy is the surgical removal of the spleen. This is achieved through a midline abdominal or left subcostal incision or laparoscopically. The spleen is mobilized by dividing the lateral peritoneal attachments while the spleen is retracted medially. The splenic artery is ligated, the splenic vein is tied; the ligaments supporting the spleen are detached and the spleen removed. The spleen can be removed in pieces or as a whole.</big>

			<big>Indications: trauma with uncontrolled bleeding; hematologic disorders, tumors, cysts, idiopathic thrombocytopenic purpura, hemolytic anemia, thrombosis of the splenic blood vessels, an accessory spleen is possible and is searched for, splenomegaly (spleen greater than 20 centimeters longitudinally), and staging of Hodgkin’s and non- Hodgkin’s disease</big>{{Infobox surgical procedure
	\| anesthesia_type = General		\| anesthesia_type = General
	\| airway = ETT		\| airway = ETT
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	== Overview ==		== Overview ==


	<big>A splenectomy is the surgical removal of the spleen. This is achieved through a midline abdominal or left subcostal incision or laparoscopically. The spleen is mobilized by dividing the lateral peritoneal attachments while the spleen is retracted medially. The splenic artery is ligated, the splenic vein is tied; the ligaments supporting the spleen are detached and the spleen removed. The spleen can be removed in pieces or as a whole.</big>

	<big>Indications: trauma with uncontrolled bleeding; hematologic disorders, tumors, cysts, idiopathic thrombocytopenic purpura, hemolytic anemia, thrombosis of the splenic blood vessels, an accessory spleen is possible and is searched for, splenomegaly (spleen greater than 20 centimeters longitudinally), and staging of Hodgkin’s and non- Hodgkin’s disease.</big>

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

Jessica.Milin at 00:48, 28 April 2022

2022-04-28T00:48:23Z

← Older revision	Revision as of 17:48, 27 April 2022
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		{{Infobox surgical procedure
		\| anesthesia_type = General
		\| airway = ETT
		\| lines_access = 2 large bore PIVs; +/- arterial line
		\| monitors = Standard; 5-lead ECG
		\| considerations_preoperative =
		\| considerations_intraoperative = Consider RSI if pt has abdominal distention
		\| considerations_postoperative = PONV
		}}

		== Overview ==


		<big>A splenectomy is the surgical removal of the spleen. This is achieved through a midline abdominal or left subcostal incision or laparoscopically. The spleen is mobilized by dividing the lateral peritoneal attachments while the spleen is retracted medially. The splenic artery is ligated, the splenic vein is tied; the ligaments supporting the spleen are detached and the spleen removed. The spleen can be removed in pieces or as a whole.</big>

		<big>Indications: trauma with uncontrolled bleeding; hematologic disorders, tumors, cysts, idiopathic thrombocytopenic purpura, hemolytic anemia, thrombosis of the splenic blood vessels, an accessory spleen is possible and is searched for, splenomegaly (spleen greater than 20 centimeters longitudinally), and staging of Hodgkin’s and non- Hodgkin’s disease.</big>

		== 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
		\|
		\|-
		\|Cardiovascular
		\|Patients with systemic disease requiring splenectomy may be chronically ill and have ↓ cardiovascular reserve
		\|-
		\|Pulmonary
		\|Patients who have splenomegaly may have a degree of left lower lobe atelectasis and compromised ventilation 2° intraabdominal pathology: ↓ FRC → ↑ A-a gradi- ent + ↓ PaO2
		\|-
		\|Gastrointestinal
		\|
		\|-
		\|Hematologic
		\|Cytopenia is very common → Preop replacement of platelets should be considered in patients with severe thrombocytopenia. Myelosuppression should be anticipated in all patients receiving active chemotherapy.
		\|-
		\|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. --> ===

		* CXR, EKG may all be needed
		* Lab tests should include a CBC, electrolytes, PT/PTT/INR, platelet count, BUN and creatinine, blood glucose, type and screen
		* Check coagulation studies and platelet levels if patient is taking anticoagulants (i.e.: Plavix) before planning a spinal for neuraxial anesthesia

		=== 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. --> ===
		Usually type and screen; prepare 2 units PRBCs

		=== 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. --> ===
		Epidural for post op pain management (not commonly used)

		== 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. --> ===
		Supine

		=== 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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