WikiAnesthesia - User contributions [en]

Percutaneous endoscopic gastrostomy

2026-03-17T02:48:30Z

Crogers: Wrote article

{{Infobox surgical procedure
| anesthesia_type = MAC
| airway = Natural airway
| lines_access = PIV x1
| monitors = Standard
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}

A gastrostomy is a surgical procedure where a tube is placed through the abdominal wall and into the stomach. Though there are several ways to insert a gastrostomy tube, the most common technique is a percutaneous endoscopic gastrostomy (PEG). With this method, the stomach is accessed via endoscopy. The abdominal wall and stomach are then punctured under endoscopic guidance. The gastrostomy tube (G-tube) is passed through the mouth, into the stomach, and then through the stomach and abdominal wall through the puncture. The gastrostomy tube balloon in the stomach is then inflated to keep the tube in place and the retention disk on the skin side is adjusted to endure the tube remains at the correct depth.<ref>{{Cite book|last=Jaffe|first=Richard|title=Anesthesiologist's Manuel of Surgical Procedures|publisher=Wolters Kluwer|year=2014|isbn=978-1-4511-7660-5|location=Philadelphia, PA|pages=517}}</ref>

A gastrostomy tube may also be placed directly via a laparotomy as is the case in a Stam or Janeway gastrostomy. As these procedures are more technically involved and typically require general anesthesia, PEG tube placements are the preferred method for most patients.<ref>{{Cite journal|last=Rahnemai-Azar|first=Ata A.|last2=Rahnemaiazar|first2=Amir A.|last3=Naghshizadian|first3=Rozhin|last4=Kurtz|first4=Amparo|last5=Farkas|first5=Daniel T.|date=2014-06-28|title=Percutaneous endoscopic gastrostomy: indications, technique, complications and management|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC4069302/|journal=World Journal of Gastroenterology|volume=20|issue=24|pages=7739–7751|doi=10.3748/wjg.v20.i24.7739|issn=2219-2840|pmc=4069302|pmid=24976711}}</ref>

G-tubes are typically placed for permanent or temporary gastric access that is needed for greater than 30 day, making a nasogastric tube unsustainable. A G-tube is usually placed for enteral access for nutrition and medication or, less often, gastric decompression. Long-term enteral access is needed when there is a neurologic impairment or mechanical impediment that prevents patients from managing oral secretions or increases aspiration risk. These conditions can include, but are not limited to dysphagia from stoke or neurologic disorders, head and neck cancers, trauma, and failure to thrive. In the case of gastric decompression, a patient may have an chronic ileus, poor bowel motility, or obstruction causing nausea, vomiting, or abdominal discomfort.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Aspiration risk
|-
|Neurologic
|Ability to cooperate with MAC sedation
|-
|Cardiovascular
|Hypovolemia due to N/V or poor PO intake
|-
|Pulmonary
|
|-
|Gastrointestinal
|Nutritional status
|-
|Hematologic
|
|-
|Renal
|Electrolyte abnormalities due to GI fluid loss
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===

* CMP
* Other labs per H&P

=== Operating room setup ===
Endoscope

=== Patient preparation and premedication ===
Patient dependent. Consider IV acetaminophen for pre-operative pain control

== Intraoperative management ==

=== Monitoring and access ===
Standard monitoring

PIV x1

=== Induction and airway management ===
Typically done under MAC sedation

=== Positioning ===
Supine

=== Maintenance and surgical considerations ===
For MAC, titrate sedatives (propofol infusion), and analgesics (fentanyl) for appropriate depth of anesthesia

=== Emergence ===
If GETA used, ensure return of laryngeal reflexes prior to extubation.

== Postoperative management ==

=== Disposition ===
PACU

=== Pain management ===
IV Tylenol, NSAIDS, opiates as indicated

=== Potential complications ===

* Leakage of gastric contents around tube
* Tube dislodgement
* Clogged tube
* Periosteal wound infection

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
|-
|Unique considerations
|Previous gastric procedures can affect difficulty
|-
|Position
|Supine
|-
|Surgical time
|30-60 minutes
|-
|EBL
|Minimal
|-
|Postoperative disposition
|PACU
|-
|Pain management
|IV pain medication
|-
|Potential complications
|Periostimal leakage, local skin infection
|}

== References ==

[[Category:Surgical procedures]]

Repair of ruptured of lacerated globe

2026-03-17T02:20:53Z

Crogers: Wrote article

{{Infobox surgical procedure
| anesthesia_type =
| airway =
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}

Repair of a globe rupture, laceration, penetration, or perforation is an urgent surgery to repair the corneal or scleral layers of the eye cause by blunt, penetrating, or perforating trauma. This often includes, but is not limited to, replacement of extruded intraocular contents, closure of open defects, and removal of foreign bodies. Anterior injuries are more readily identified and closed. If a posterior injury is suspected, further surgical intervention may be necessary including extraocular muscle removal to fully inspect the scleral surface.<ref>{{Cite book|last=Jaffe|first=Richard|title=Anesthesiologist's Manual of Surgical Procedures|publisher=Wolters Kluwer|year=2014|isbn=798-1-4511-7660-5|location=Philadelphia, PA|pages=162-164}}</ref>

An ophthalmic examination is performed preoperatively, and imaging is occasionally used as an adjunct to aid in identification of the specifics of the defect.<ref name=":0">{{Cite web|title=Ruptured Globe - EyeWiki|url=https://eyewiki.org/Ruptured_Globe#cite_note-37|access-date=2026-03-17|website=eyewiki.org|language=en}}</ref>

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Potential concomitant airway trauma
|-
|Neurologic
|AMS 2/2 trauma
|-
|Cardiovascular
|CHF, CAD, cardiovascular stability
|-
|Pulmonary
|Potential lung injuries, smoking hx, asthma hx
|-
|Gastrointestinal
|NPO status, recent N/V
|-
|Hematologic
|Potential bleeding
|}

=== Labs and studies ===
CBC, CMP

Maxillofacial CT per ophthalmology

=== Operating room setup ===
Avoid circumstances that can increase IOP

* Consider anxiolytics such as benzodiazepines anxiety, crying, struggling, straining
* Consider pain medication, but avoid opioids due to concern for increased nausea and vomiting
* Consider antiemetics (ondansetron, Phenergan, ect) to prevent nausea and vomiting

Patient will most likely not have appropriate NPO status and will be considered a full stomach

* Consider metoclopramide and antacids prior to surgery to prevent aspiration pneumonitis
*

In patients with a smoking history, or asthma, consider pre-treating with albuterol to control coughing and improve oxygenation and ventilation after intubation.

=== Patient preparation and premedication ===
Regional anesthesia such as retrobulbar blocks are contraindicated as this can potentially increase IOP, worsening globe injury and surgical outcomes.<ref>{{Citation|last=Blair|first=Kyle|title=Globe Rupture|date=2026|url=http://www.ncbi.nlm.nih.gov/books/NBK551637/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=31869101|access-date=2026-03-17|last2=Alhadi|first2=Sameir A.|last3=Czyz|first3=Craig N.}}</ref>

== Intraoperative management ==

=== Monitoring and access ===
Standard monitoring

PIV x1

=== Induction and airway management ===
A smooth induction and intubation are crucial to prevent increasing IOP. Rapid sequence is required both due to NPO status and inability to mask ventilate to prevent increased IOP.

General endotracheal anesthesia

Standard induction

* IV opioid (fentanyl, dilaudid)
* Lidocaine
* Propofol
** Avoid ketamine as this may potentially increase IOP
* Paralytic
** Avoid succinylcholine as it may potentially increase IOP

=== Positioning ===
Supine

Table turned 90-180 degrees depending on surgeon preference

=== Maintenance and surgical considerations ===
Volatile anesthesia and TIVA are appropriate for this case. Avoid nitrous oxide due to concern for trapped air expansion in globe.<ref name=":0" />

Maintain muscle relaxation until eye is surgically closed

Avoid hypercarbia as this can increase IOP

=== Emergence ===
Goal of smooth emergence and extubation to prevent increased IOP

== Postoperative management ==

=== Disposition ===
PACU, floor bed

=== Pain management ===
Tylenol and ibuprofen if not contraindicated by patient comorbidities

Can consider IV or PO opiates, but consider risk of nausea.

=== Potential complications ===

* Permanent blindness
* Endophthalmitis
* Retinal detachment
* Hemorrhagic retinopathy
* Sympathetic ophthalmia

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
|-
|Unique considerations
|Avoid medications or procedure that would increase intraocular pressure
|-
|Position
|Supine, table turned 90-180 degrees
|-
|Surgical time
|1-2 hours
|-
|EBL
|Minimal
|-
|Postoperative disposition
|PACU
|-
|Pain management
|Tylenol, ibuprofen, opiates
|-
|Potential complications
|Endophthalmitis, retinal detachment, corneal abrasion, permanent blindness
|}

== References ==

[[Category:Surgical procedures]]

Laser treatment for burn scar

2026-03-17T01:04:39Z

Crogers:

{{Infobox surgical procedure
| anesthesia_type = MAC orGeneral
| airway = LMA or Natural Airway
| lines_access = PIV x1
| monitors = Standard
| considerations_preoperative =
| considerations_intraoperative = Intraoperative laser
| considerations_postoperative = Pain control
}}

== Overview ==
CO2 lasers resurfacing is a surgical procedure used to improve the appearance of hypertrophic scars from burns or other trauma. The CO2 lasers help to remodel and redistribute dermal collagen fibers, flattening and softening them to reduce scar thickness and improve functionality. It is often combined with local 5-Flurouracil injections and steroid injections for further collogen breakdown and fibroblast inhibition.<ref>{{Cite journal|last=Klifto|first=Kevin M.|last2=Asif|first2=Mohammed|last3=Hultman|first3=C. Scott|date=2020|title=Laser management of hypertrophic burn scars: a comprehensive review|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC7175764/|journal=Burns & Trauma|volume=8|pages=tkz002|doi=10.1093/burnst/tkz002|issn=2321-3868|pmc=7175764|pmid=32346540}}</ref><ref>{{Cite book|last=Jaffe|first=Richard|title=Anesthesiologist's Manual of Surgical Procedures|publisher=Wolters Kluwer|year=2014|isbn=978-1-4511-7660-5|location=Philadelphia, PA|pages=1104-1106}}</ref>

Laser treatments for scars usually take 3-8 sessions spaced 4-8 weeks apart for optimal scar and mobility improvements.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Airway evaluation, consideration for natural airway vs. LMA vs. ETT
|-
|Neurologic
|Outpatient pain medication
|-
|Cardiovascular
|CAD, CHF
|-
|Pulmonary
|Smoking hx
|-
|Gastrointestinal
|GERD
|-
|Other
|Skin infections
|}

=== Labs and studies ===
Labs and studies should be aimed at patient comorbidities

=== Operating room setup ===
Ensure proper laser-approved eye-protection for both patient and physician

=== Patient preparation and premedication ===
Premedication with Tylenol for pain is recommended for patients with good hepatic function

As this is an outpatient procedure, premedication with benzodiazepines are discouraged to ensure appropriately timed PACU course. However, lorazepam PO can be taken prior to the procedure for severely anxious patients.

== Intraoperative management ==

=== Monitoring and access ===
Standard Monitoring

PIV x1

=== Induction and airway management ===
Procedure can be done under MAC or general anesthesia. General anesthesia can be done with a natural airway, LMA, or ETT with consideration to airway patency.

Maintain spontaneous ventilation if using natural airway or LMA

=== Positioning ===
Supine

=== Maintenance and surgical considerations ===

* Propofol infusion
* IV opioids

=== Emergence ===
Natural airway: cessation of maintenance anesthetic

LMA: able to remove LMA in deep plane of anesthesia if patient is breathing spontaneously and ventilating/oxygenating appropriately

== Postoperative management ==

=== Disposition ===
PACU to home

=== Pain management ===

* Acetaminophen
* Ibuprofen
* Oral opioids

=== Potential complications ===
Laser fire (more likely with facial procedures)

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
|-
|Unique considerations
|Eye protection for laser use
|-
|Indications
|Hypertrophic scar reduction
|-
|Position
|Supine
|-
|Surgical time
|30-60 minutes
|-
|EBL
|Minimal
|-
|Postoperative disposition
|Outpatient
|-
|Pain management
|Tylenol, ibuprofen
|-
|Potential complications
|Laser fire
|}

== References ==

[[Category:Surgical procedures]]

Laser treatment for burn scar

2026-03-17T00:10:43Z

Crogers: Wrote article

{{Infobox surgical procedure
| anesthesia_type = MAC orGeneral
| airway = LMA or Natural Airway
| lines_access = PIV x1
| monitors = Standard
| considerations_preoperative =
| considerations_intraoperative = Intraoperative laser
| considerations_postoperative = Pain control
}}

== Overview ==
CO2 lasers resurfacing is a surgical procedure used to improve the appearance of hypertrophic scars from burns or other trauma. The CO2 lasers help to remodel and redistribute dermal collagen fibers, flattening and softening them to reduce scar thickness and improve functionality. It is often combined with local 5-Flurouracil injections and steroid injections for further collogen breakdown and fibroblast inhibition.

Laser treatments for scars usually take 3-8 sessions spaced 4-8 weeks apart for optimal scar and mobility improvements.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Airway evaluation, consideration for natural airway vs. LMA vs. ETT
|-
|Neurologic
|Outpatient pain medication
|-
|Cardiovascular
|CAD, CHF
|-
|Pulmonary
|Smoking hx
|-
|Gastrointestinal
|GERD
|-
|Other
|Skin infections
|}

=== Labs and studies ===
Labs and studies should be aimed at patient comorbidities

=== Operating room setup ===
Ensure proper laser-approved eye-protection for both patient and physician

=== Patient preparation and premedication ===
Premedication with Tylenol for pain is recommended for patients with good hepatic function

As this is an outpatient procedure, premedication with benzodiazepines are discouraged to ensure appropriately timed PACU course. However, lorazepam PO can be taken prior to the procedure for severely anxious patients.

== Intraoperative management ==

=== Monitoring and access ===
Standard Monitoring

PIV x1

=== Induction and airway management ===
Procedure can be done under MAC or general anesthesia. General anesthesia can be done with a natural airway, LMA, or ETT with consideration to airway patency.

Maintain spontaneous ventilation if using natural airway or LMA

=== Positioning ===
Supine

=== Maintenance and surgical considerations ===

* Propofol infusion
* IV opioids

=== Emergence ===
Natural airway: cessation of maintenance anesthetic

LMA: able to remove LMA in deep plane of anesthesia if patient is breathing spontaneously and ventilating/oxygenating appropriately

== Postoperative management ==

=== Disposition ===
PACU to home

=== Pain management ===

* Acetaminophen
* Ibuprofen
* Oral opioids

=== Potential complications ===
Laser fire (more likely with facial procedures)

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
|-
|Unique considerations
|Eye protection for laser use
|-
|Indications
|Hypertrophic scar reduction
|-
|Position
|Supine
|-
|Surgical time
|30-60 minutes
|-
|EBL
|Minimal
|-
|Postoperative disposition
|Outpatient
|-
|Pain management
|Tylenol, ibuprofen
|-
|Potential complications
|Laser fire
|}

== References ==

[[Category:Surgical procedures]]

Laser treatment for burn scar

2026-03-16T23:13:32Z

Crogers:

{{Infobox surgical procedure
| anesthesia_type =
| airway =
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}

== Overview ==
CO2 lasers resurfacing is a surgical procedure used to improve the appearance of hypertrophic scars from burns or other trauma. The CO2 lasers help to remodel and redistribute dermal collagen fibers, flattening and softening them to reduce scar thickness and improve functionality. It is often combined with local 5-Flurouracil injections and steroid injections for further collogen breakdown and fibroblast inhibition.

Laser treatments for scars usually take 3-8 sessions spaced 4-8 weeks apart for optimal scar and mobility improvements.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Airway evaluation, consideration for natural airway vs. LMA vs. ETT
|-
|Neurologic
|Outpatient pain medication
|-
|Cardiovascular
|CAD, CHF
|-
|Pulmonary
|Smoking hx
|-
|Gastrointestinal
|GERD
|-
|Other
|Skin infections
|}

=== Labs and studies ===
Labs and studies should be aimed at patient comorbidities

=== Operating room setup ===
Ensure proper laser-approved eye-protection for both patient and physician

=== Patient preparation and premedication ===
Premedication with Tylenol for pain is recommended for patients with good hepatic function

As this is an outpatient procedure, premedication with benzodiazepines are discouraged to ensure appropriately timed PACU course. However, lorazepam PO can be taken prior to the procedure for severely anxious patients.

== Intraoperative management ==

=== Monitoring and access ===
Standard Monitoring

PIV x1

=== Induction and airway management ===
Procedure can be done under MAC or general anesthesia. General anesthesia can be done with a natural airway, LMA, or ETT with consideration to airway patency.

Maintain spontaneous ventilation if using natural airway or LMA

=== Positioning ===
Supine

=== Maintenance and surgical considerations ===

* Propofol infusion
* IV opioids

=== Emergence ===
Natural airway: cessation of maintenance anesthetic

LMA: able to remove LMA in deep plane of anesthesia if patient is breathing spontaneously and ventilating/oxygenating appropriately

== Postoperative management ==

=== Disposition ===
PACU to home

=== Pain management ===

* Acetaminophen
* Ibuprofen
* Oral opioids

=== Potential complications ===
Laser fire (more likely with facial procedures)

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
|-
|Unique considerations
|Eye protection for laser use
|-
|Indications
|Hypertrophic scar reduction
|-
|Position
|Supine
|-
|Surgical time
|30-60 minutes
|-
|EBL
|Minimal
|-
|Postoperative disposition
|Outpatient
|-
|Pain management
|Tylenol, ibuprofen
|-
|Potential complications
|Laser fire
|}

== References ==

[[Category:Surgical procedures]]

Pelvic exenteration

2026-03-11T02:30:11Z

Crogers: Wrote most of the article

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = 2-3 Large bore IVs, Arterial line
| monitors = Standard
| considerations_preoperative =
| considerations_intraoperative = Volume shifts and bleeding
| considerations_postoperative =
}}

A pelvic exenteration is a radical procedure in which multiple organs are removed from the pelvis as a curative or palliative measure for recurrent or locally advanced locally invasive pelvic cancers (vaginal, uterine, cervical, vulvar, rectal, urethral, prostate). A total pelvic exenteration includes a en-bloc resection of the reproductive organs as well as the pelvic sections of the gastrointestinal tract and genitourinary tract. These include the sigmoid colon, rectum, anus, bladder, and urethra. In males, reproductive organs include the prostate and seminal vesicles. In females, this includes the uterus, fallopian tubes, ovaries, cervix, vagina, and possibly the vulva.<ref>{{Cite book|last=Jaffe|first=Richard|title=Anesthesiologist's Manual of Surgical Procedures|publisher=Wolters Kluwer|year=2015|isbn=978-1-4511-7660-5|location=Philadelphia, PA|pages=781-786}}</ref>

In female patients a pelvic exenteration can be anterior (removal of reproductive organs and urinary tract, sparing the rectum) or posterior (removal of reproductive organs and gastrointestinal tract, sparing the urinary system).<ref>{{Citation|last=Grimes|first=W. R.|title=Pelvic Exenteration|date=2026|url=http://www.ncbi.nlm.nih.gov/books/NBK563269/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=33085416|access-date=2026-03-11|last2=Dunton|first2=Charles J.|last3=Stratton|first3=Michael}}</ref>

This procedure often results in an end colostomy (to descending colon to anus anastomosis is sometimes possible), a continent or incontinent urinary diversion, and a muscle flap for perineal and/or vaginal reconstruction.<ref>{{Cite web|title=UpToDate|url=https://www.uptodate.com/contents/exenteration-for-gynecologic-cancer?search=pelvic%20exenteration&source=search_result&selectedTitle=1~18&usage_type=default&display_rank=1|access-date=2026-03-11|website=www.uptodate.com}}</ref>

As the aim of this procedure is curative, the procedure may be aborted if the initial exploratory laparotomy finds the tumor burden to be too extensive for resection, or if positive lymph nodes are found.<ref name=":0">{{Cite journal|last=Carvalho|first=Filipe|last2=Qiu|first2=Shengyang|last3=Panagi|first3=Vasia|last4=Hardy|first4=Katy|last5=Tutcher|first5=Hannah|last6=Machado|first6=Marta|last7=Silva|first7=Francisca|last8=Dinen|first8=Caroline|last9=Lane|first9=Carol|last10=Jonroy|first10=Alleh|last11=Knox|first11=Jon|date=2023-01-01|title=Total Pelvic Exenteration surgery - Considerations for healthcare professionals|url=https://www.sciencedirect.com/science/article/pii/S0748798322006187|journal=European Journal of Surgical Oncology|volume=49|issue=1|pages=225–236|doi=10.1016/j.ejso.2022.08.011|issn=0748-7983}}</ref>

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Prior intubations, airway evaluation
|-
|Neurologic
|Hx of stroke, carotid artery disease, seizures
|-
|Cardiovascular
|Exercise tolerance, CAD, CHF, prior cardiotoxic chemotherapy
|-
|Pulmonary
|Hx of smoking, lung disease, sleep apnea, prior chemotherapy
|-
|Gastrointestinal
|Nutritional status
|-
|Hematologic
|Anemia of chronic disease
|-
|Renal
|Urinary continence, CKD
|-
|Endocrine
|Diabetes, steroid use
|}

=== Labs and studies ===

* CBC
* CMP
* Type and Cross
* Cancer marker if relevant
* EKG or TTE if cardiac concern
* CXR if concern for pulmonary disease
* CT for evaluation of extent of tumor burden, vascular involvement of masses

=== Operating room setup ===

* Arterial line pressure bag and tubing
* Ultrasound for arterial line and IVs (optional)
* Videoscope for potentially challenging airway or history of cervical spine procedures
* Blood transfusion tubing and warmer

Procedure may be done open, laparoscopically, or robot assisted. Confirm approach with surgical team.

Procedure involves several surgical teams including gynecological oncology, colorectal, and urology

=== Patient preparation and premedication ===
Midazolam 2 mg IV

- Consider holding for patients >75 years of age

Tylenol 1g for patients without renal impairment

=== Regional and neuraxial techniques ===
Consider pre-operative lumbar epidural placement for intra-operative and post-operative pain management

== Intraoperative management ==

=== Monitoring and access ===

* Standard monitors
* Arterial line
* Two large bore peripheral IVs
* Nasogastric tube

=== Induction and airway management ===
General endotracheal anesthesia

Standard induction

* IV opioid (fentanyl, dilaudid, methadone)
* Lidocaine
* Propofol
* Paralytic

Consider ketamine for pain adjunct

=== Positioning ===
Modified lithotomy

=== Maintenance and surgical considerations ===
Antibiotics: Ancef, metronidazole (if anticipating gastrointestinal resection)

Anesthetic maintenance: Preferentially use TIVA, particularly in female patients due to increased risk of PONV

=== Emergence ===
Plan for emergence if patient is hemodynamically stable has good oxygenation and ventilation status and is appropriately responsive.

Consider leaving patient intubated if they are:

* Hemodynamically unstable
* Requiring a high FiO2
* Hypercarbic

== Postoperative management ==

=== Disposition ===
ICU

=== Pain management ===
IV opiates

* Fentanyl
* Dilaudid
* Methadone

Lumbar epidural

=== Potential complications<ref name=":0" /> ===

* Bleeding
* PONV
* Bowel obstruction
* Ileus
* Stoma breakdown
* Vaginal fistula
* Ureteral stricture
* Infection
* Venous thrombosis
* PE
* Positional nerve damage
* Hypotension due to fluid shifts

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
|-
|Unique considerations
|Case may be aborted tumor burden is considered irresectable on initial inspection
|-
|Position
|Modified lithotomy
|-
|Surgical time
|8-12 hours
|-
|EBL
|1200-4000 ml
|-
|Postoperative disposition
|ICU
|-
|Pain management
|IV opiates, epidural anesthesia
|-
|Potential complications
|bleeding, infection, dehiscence, ileus, bowel obstruction, fistula
|}

== References ==

[[Category:Surgical procedures]]