Jashvin at 18:54, 30 March 2023

2023-03-30T18:54:09Z

← Older revision		Revision as of 11:54, 30 March 2023
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	\| anesthesia_type = General		\| anesthesia_type = General
	\| airway = ETT		\| airway = ETT
	\| lines_access = PIV, +/0 A-line		\| lines_access = PIV, +/- A-line
	\| monitors = Standard, +/- A-line		\| monitors = Standard, +/- A-line, +/- BIS/Massimo if TIVA
	\| considerations_preoperative =		\| considerations_preoperative =
	\| considerations_intraoperative = Intraoperative electrophysiological monitoring if at level of spinal cord, Prone positioning		\| considerations_intraoperative = Intraoperative electrophysiological monitoring if at level of spinal cord, Prone positioning
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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, Coags

	=== 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. --> ===
			TIVA if neurophysiological monitoring

	=== 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. --> ===
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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. --> ===
	Large bore IV access. Potential for large volume blood loss.		Large bore IV access. Potential for large volume blood loss during exposure

	=== 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. --> ===
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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. --> ===
			Prone positioning

			* Minimize large volume of crystalloid
			** Ischemic neuropathy
			** Airway edema
			** Consider blood or albumin for intravascular expansion
			* Pad pressure points
			** Check eyes and ears
			** Foam pillow with cutouts for eyes, nose mouth,
			** Typically arms abducted & limit flexion to <90*
			** Pad elbows knees, feet, arms

	== 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). --> ==

Jashvin: New page for Lumbar lami

2023-03-30T18:47:54Z

New page for Lumbar lami

New page

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = PIV, +/0 A-line
| monitors = Standard, +/- A-line
| considerations_preoperative =
| considerations_intraoperative = Intraoperative electrophysiological monitoring if at level of spinal cord, Prone positioning
| considerations_postoperative = Pain control
}}

Lunar laminectomy is a complete removal of lamina, which is use for to decompress the neural elements of the lumbar spine, usually via a posterior approach in the prone position.

== Overview ==

=== Indications ===
Lumbar radiculopathy 2° degenerative disc disease from herniated disks, congenital stenosis, neoplasm, and, occasionally, trauma. Lumbar laminectomy is also used to gain access to the spinal canal for dealing with intradural tumors, arteriovenous malformations (AVMs), and other spinal cord lesions.

=== Surgical 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 ===
Large bore IV access. Potential for large volume blood loss.

=== Induction and airway management ===
Standard induction

Avoid long acting paralytic if neurophysiological monitoring. Consider succinylcholine or remifentanil bolus (1.5mg/kg)

=== Positioning ===
Prone positioning

=== Maintenance and surgical considerations ===
1-2 hour for single level

+0.5-1hr per additional level

TIVA if neurophysiological monitoring (Propofol, Remi, phenylephrine to support BP)

BIS or Massimo to monitor depth of anesthesia if using TIVA

Avoid large volume resuscitation given prone positioning

=== 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]]

Lumbar Laminectomy - Revision history

Jashvin at 18:54, 30 March 2023

Jashvin: New page for Lumbar lami