WikiAnesthesia - User contributions [en]

Suspension laryngoscopy

2023-02-28T16:07:57Z

Imuller1: Created page with "Suspension Laryngoscopy is a procedure typically performed by otolaryngologists to directly visualize the larynx. {{Infobox surgical procedure | anesthesia_type = General | airway = Suspension Laryngoscopy, Jet Ventilation, Intermittent Intubation | lines_access = | monitors = | considerations_preoperative = | considerations_intraoperative = | considerations_postoperative = }} Provide a brief summary here. == Overview == === Indications<!-- List and/or describe..."

Suspension Laryngoscopy is a procedure typically performed by otolaryngologists to directly visualize the larynx.

{{Infobox surgical procedure
| anesthesia_type = General
| airway = Suspension Laryngoscopy, Jet Ventilation, Intermittent Intubation
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}

Provide a brief summary here.

== Overview ==

=== Indications ===
Suspension Laryngoscopy is used to access the pharynx, larynx, trachea, or bronchioles for various procedures (eg. microscopic surgery, tissue biopsies, removal of vocal cord polyps, dilation of tracheal stenosis).

=== Surgical procedure ===
The patient is induced under GA. The patient's teeth are protected while a rigid laryngoscope is inserted into the patient's mouth and larynx. Ventilation from this point forward is typically via Jet Ventilation. The laryngoscope is suspended in place for the duration of the procedure.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===

=== Operating room setup ===

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===

=== Positioning ===

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Indications
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]

Pancreas transplant

2023-01-06T05:24:44Z

Imuller1:

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = 2-3 PIV, 16-18 G, Arterial Line
| monitors = Standard, 5 lead ECG
| considerations_preoperative = Glucose and Hemoglobin
| considerations_intraoperative = Labile Glycemia -insulin and glucose may be needed in the same patient. Heparin should be prepared and may be sued before clamping of the iliac A or V before pancreatic anastomosis. Intraop immunosuppression should be running before Thymoglobulin or Simulect and prior to reperfusion.
| considerations_postoperative =
}}

Pancreas transplantation is performed in one of the following three settings (in decreasing order of frequency): Simultaneous pancreas and kidney transplant (SPK) Pancreas after kidney transplant (PAK) Pancreas transplant alone (PTA).

== Overview ==

== Preoperative management ==

=== Patient evaluation ===
The recipients are patients with longstanding type 1 diabetes(juvenile onset) and therefore have issues related to long term glucose intolerance.
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Incidence of difficult intubation is somewhat increased in this patient population due to limited mobility of the cervical spine or temporomandibular joint.
|-
|Neurologic
|autonomic nervous system dysfunction, systemic and peripheral neuropathy
|-
|Cardiovascular
|CAD is common in this population
|-
|Gastrointestinal
|gastroparesis
|-
|Renal
|Renal insufficiency
|-
|Endocrine
|Insulin dependence is likely in this population. Favorable peri-operative glycemic control and pre-operative glucose assessment is necessary. Pre-operative NPO status requires insulin adjustments.
|-
|Other
|
|}

=== Labs and studies ===

* CBC
* CMP

=== Operating room setup ===

* Prepare arterial line
* Have heparin in the room
* May need steroid and anti-thymocyte globulin and/or Basiliximab prepared
*Discuss Abx with surgical team: Cefazolin 2 grams and Flagyl 500 mg IV, or Clindamycin IV 600 mg and Ciprofloxacin 400 mg IV (if penicillin allergy)

=== Patient preparation and premedication ===

* Consider midazolam and Tylenol

=== Regional and neuraxial techniques ===

* Epidural or CSE may be used for postop pain management

== Intraoperative management ==

=== Monitoring and access ===

* Arterial line for blood pressure monitoring and frequent lab draws
* Many patients also have ESRD - IVs and arterial lines should avoid the side of AV fistula if present
* Nasogastric tube should be placed, secured, and position confirmed, prior to emergence

=== Positioning ===

* Supine-the operative approach is intra-abdominal via a midline laparotomy

=== Maintenance and surgical considerations ===

* Normal blood pressure is important for pancreas reperfusion and additional fluid and/or vasopressors may be needed at the time of organ reperfusion
* Significant bleeding from the pancreas graft may occur following reperfusion-It is not uncommon for patients to require transfusion with blood products (generally not more than 2 units).
* At case conclusion, the surgical team may request a low dose heparin infusion (300-400 units/hr) for vascular patency of the graft, provided hemostasis is adequate.
* Glucose management may vary from an insulin infusion to glucose infusion in the same patient

=== Emergence ===

* A Nasogastric tube should be placed, secured, and position confirmed, prior to emergence
* Most patients are candidates for extubation

== Postoperative management ==

=== Disposition ===

* A surgical ICU bed postoperatively is typically required

=== Pain management ===

=== Potential complications ===

* Significant bleeding from the pancreas graft may occur following reperfusion-It is not uncommon for patients to require transfusion with blood products (generally not more than 2 units).
* hypoglycemia

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Indications
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]

Pancreas transplant

2023-01-06T04:56:13Z

Imuller1:

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = 2-3 PIV, 16-18 G, Arterial Line
| monitors = Standard, 5 lead ECG
| considerations_preoperative =
| considerations_intraoperative = Labile Glycemia -insulin and glucose may be needed in the same patient. Heparin should be prepared and may be sued before clamping of the iliac A or V before pancreatic anastomosis. Intraop immunosuppression should be running before Thymoglobulin or Simulect and prior to reperfusion.
| considerations_postoperative =
}}

Pancreas transplantation is performed in one of the following three settings (in decreasing order of frequency): Simultaneous pancreas and kidney transplant (SPK) Pancreas after kidney transplant (PAK) Pancreas transplant alone (PTA).

== Overview ==

== Preoperative management ==

=== Patient evaluation ===
The recipients are patients with longstanding type 1 diabetes(juvenile onset) and therefore have issues related to long term glucose intolerance.
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Incidence of difficult intubation is somewhat increased in this patient population due to limited mobility of the cervical spine or temporomandibular joint.
|-
|Neurologic
|autonomic nervous system dysfunction, systemic and peripheral neuropathy
|-
|Cardiovascular
|CAD is common in this population
|-
|Gastrointestinal
|gastroparesis
|-
|Renal
|Renal insufficiency
|-
|Endocrine
|Insulin dependence is likely in this population. Favorable peri-operative glycemic control and pre-operative glucose assessment is necessary. Pre-operative NPO status requires insulin adjustments.
|-
|Other
|
|}

=== Labs and studies ===

* CBC
* CMP

=== Operating room setup ===

* Prepare arterial line
* Have heparin in the room
* May need steroid and/or anti-thymocyte globulin prepared

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===

=== Positioning ===

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Indications
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]