Myomectomy - Revision history

Rhales3: fixed spelling

2022-07-01T01:09:08Z

fixed spelling

← Older revision		Revision as of 18:09, 30 June 2022
Line 80:		Line 80:
	**Consider TIVA is high risk for PONV		**Consider TIVA is high risk for PONV
	**Maintain neuromuscular blockade if open or laparoscopy		**Maintain neuromuscular blockade if open or laparoscopy
	*~~Physiologic~~ of abdominal insufflation		*Physiology of abdominal insufflation
	**Decreased FRC		**Decreased FRC
	***May require adjustment of PEEP to prevent alveolar collapse		***May require adjustment of PEEP to prevent alveolar collapse

Chris.Rishel: Text replacement - "Art line" to "Arterial line"

2022-04-05T19:40:05Z

Text replacement - "Art line" to "Arterial line"

← Older revision		Revision as of 12:40, 5 April 2022
Line 3:		Line 3:
	\| airway = ETT, LMA, or Noninvasive O2		\| airway = ETT, LMA, or Noninvasive O2
	\| lines_access = Large bore IV		\| lines_access = Large bore IV
	± ~~Art~~ line		± Arterial line
	\| monitors = Standard		\| monitors = Standard
	5-lead ECG		5-lead ECG

Chris.Rishel at 07:41, 5 April 2022

2022-04-05T07:41:32Z

← Older revision		Revision as of 00:41, 5 April 2022
Line 112:		Line 112:
	===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. -->===

	*Pain ranges from mild to severe depending on surgical approach		*Pain ranges from mild to severe depending on surgical approach
	**Multimodal analgesia		*Multimodal analgesia
	***IV/PO acetominophen		*NSAIDs based on discussion with surgical team
	***IV/PO opioids		*Local anesthetic at trocar sites
	***IV/PO NSAIDs based on discussion with surgical team		*TAP blocks
	***IV lidocaine		*Epidural analgesia
	***IV ketamine
	***Local anesthetic at trocar sites
	***TAP blocks
	***Epidural analgesia

	===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. -->===

Chris.Rishel at 07:39, 5 April 2022

2022-04-05T07:39:15Z

← Older revision		Revision as of 00:39, 5 April 2022
Line 1:		Line 1:
	{{Infobox surgical procedure		{{Infobox surgical procedure
	\| anesthesia_type = General ~~vs Neuraxial~~		\| anesthesia_type = General or neuraxial
	\| airway = ETT vs LMA ~~vs non-invasive~~ O2		\| airway = ETT, LMA, or Noninvasive O2
	\| lines_access = ~~PIV x 1-2 (at least 1 large~~ bore)		\| lines_access = Large bore IV
	~~+/- Arterial~~ line		± Art line
	\| monitors = Standard ~~ASA monitors~~		\| monitors = Standard
	5-lead ~~EKG~~		5-lead ECG
	Temperature		Temperature
	\| considerations_preoperative = Type and screen		\| considerations_preoperative = Type and screen
	\| considerations_intraoperative = Hemorrohage~~, uterine~~ rupture~~, CO2~~ air embolism		\| considerations_intraoperative = Hemorrohage
	\| considerations_postoperative = PONV~~, hemorrhage~~/hematoma		Uterine rupture
			CO<sub>2</sub> air embolism
			\| considerations_postoperative = PONV
			Hemorrhage/hematoma
	}}A '''myomectomy''' is a surgical procedure involving the removal of uterine fibroids.		}}A '''myomectomy''' is a surgical procedure involving the removal of uterine fibroids.

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	<references />		<references />
			[[Category:Obstetric and gynecologic surgery]]

WikiAnesthesia at 13:23, 29 March 2022

2022-03-29T13:23:21Z

Show changes

Cornel.Chiu at 03:01, 20 January 2022

2022-01-20T03:01:14Z

← Older revision		Revision as of 20:01, 19 January 2022
Line 9:		Line 9:
	}}		}}

	Myomectomy is a surgical procedure involving the removal of fibroids ~~of the uterus~~ in patients who have not completed childbearing. Indications include abnormal bleeding, infertility, ureteral compression, hydroureter/hydronephrosis and pain<ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>. There are several approaches to the surgery that is dictated by the size, number and location of the fibroids. The procedure begins with Pfannenstiel (open), low midline abdominal laparoscopic incision(laparoscopic) with placement of trocars, or with hysteroscopy. For the laparoscopic approach, abdomen is insufflated. For the vaginal approach, the uterus is infused with fluids. In order to minimize bleeding, ~~vasoconstrictor~~ such as epinephrine or vasopressin is injected to the myometrium or a tourniquet can be used to minimize uterine blood flow. Fibroids are removed and defects are sutured and closed.		Myomectomy is a surgical procedure involving the removal of uterine fibroids in patients who have not completed childbearing. Indications include abnormal bleeding, infertility, ureteral compression, hydroureter/hydronephrosis, and pain<ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>. There are several approaches to the surgery that is dictated by the size, number, and location of the fibroids. The procedure begins with Pfannenstiel (open), low midline abdominal laparoscopic incision (laparoscopic) with placement of trocars, or with hysteroscopy. For the laparoscopic approach, the abdomen is insufflated. For the vaginal approach, the uterus is infused with fluids. In order to minimize bleeding, vasoconstrictors such as epinephrine or vasopressin are injected into the myometrium or a tourniquet can be used to minimize uterine blood flow. Fibroids are removed and defects are sutured and closed.

	== Preoperative management ==		== Preoperative management ==
Line 33:		Line 33:

	* IV midazolam for anxiety		* IV midazolam for anxiety
	* PO ~~Acetaminophen~~ for pain		* PO acetaminophen for pain
	* PO gabapentin		* PO gabapentin
	* PO celecoxib		* PO celecoxib

Cornel.Chiu at 20:57, 19 January 2022

2022-01-19T20:57:59Z

← Older revision		Revision as of 13:57, 19 January 2022
Line 9:		Line 9:
	}}		}}

	Myomectomy is a surgical procedure involving the removal of fibroids of the uterus in patients who have not completed childbearing. Indications include abnormal bleeding, infertility, ureteral compression, hydroureter/hydronephrosis and pain<ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>. There are several approaches to the surgery that is dictated by the size, number and location of the fibroids. The procedure begins with Pfannenstiel (open), low midline abdominal laparoscopic incision(laparoscopic) with placement of trocars, or with hysteroscopy. For laparoscopic approach, abdomen is ~~insufflation~~. For vaginal approach, the uterus is infused with fluids. In order to minimize bleeding, vasoconstrictor such as epinephrine or vasopressin is injected to the myometrium or a tourniquet can be used to minimize uterine blood flow. Fibroids are removed and defects are sutured and closed.		Myomectomy is a surgical procedure involving the removal of fibroids of the uterus in patients who have not completed childbearing. Indications include abnormal bleeding, infertility, ureteral compression, hydroureter/hydronephrosis and pain<ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>. There are several approaches to the surgery that is dictated by the size, number and location of the fibroids. The procedure begins with Pfannenstiel (open), low midline abdominal laparoscopic incision(laparoscopic) with placement of trocars, or with hysteroscopy. For the laparoscopic approach, abdomen is insufflated. For the vaginal approach, the uterus is infused with fluids. In order to minimize bleeding, vasoconstrictor such as epinephrine or vasopressin is injected to the myometrium or a tourniquet can be used to minimize uterine blood flow. Fibroids are removed and defects are sutured and closed.

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

Cornel.Chiu at 20:56, 19 January 2022

2022-01-19T20:56:15Z

← Older revision		Revision as of 13:56, 19 January 2022
Line 2:		Line 2:
	\| anesthesia_type = General vs Neuraxial		\| anesthesia_type = General vs Neuraxial
	\| airway = ETT vs LMA vs non-invasive O2		\| airway = ETT vs LMA vs non-invasive O2
	\| lines_access = PIV x 2 (at least 1 large bore), +/- arterial line		\| lines_access = PIV x 1-2 (at least 1 large bore), +/- arterial line
	\| monitors = Standard, 5-lead EKG, temperature		\| monitors = Standard, 5-lead EKG, temperature
	\| considerations_preoperative = Type and screen		\| considerations_preoperative = Type and screen
Line 50:		Line 50:
	* +/- arterial depending size/location/approach of myomectomy		* +/- arterial depending size/location/approach of myomectomy
	* OG/NGT to decompress stomach prior to trocar placement to decrease risk of injury		* OG/NGT to decompress stomach prior to trocar placement to decrease risk of injury
	* PIV x 2 ( at least 1 large bore for open)		* PIV x 1-2 (at least 1 large bore for open or laparoscopic)

	=== 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. --> ===
Line 150:		Line 150:
	\|-		\|-
	\|Surgical time		\|Surgical time
	\|		\|Up to 4 hours
	\|1-4 hours		\|1-4 hours
	\|1-4 hours		\|1-4 hours
	\|-		\|-
	\|EBL		\|EBL
	\|1~~-1.5~~ L		\|Up to 1 L
	\|100-600 mL		\|100-600 mL
	\|0-100 mL		\|0-100 mL

Cornel.Chiu at 20:35, 19 January 2022

2022-01-19T20:35:37Z

← Older revision		Revision as of 13:35, 19 January 2022
Line 6:		Line 6:
	\| considerations_preoperative = Type and screen		\| considerations_preoperative = Type and screen
	\| considerations_intraoperative = Hemorrohage, uterine rupture, CO2 air embolism		\| considerations_intraoperative = Hemorrohage, uterine rupture, CO2 air embolism
	\| considerations_postoperative = PONV		\| considerations_postoperative = PONV, hemorrhage/hematoma
	}}		}}

	Myomectomy is a surgical procedure involving the removal of fibroids of the uterus in patients who have not completed childbearing. Indications include abnormal bleeding, infertility, ureteral compression, hydroureter/hydronephrosis and pain<ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>. There are several approaches to the surgery that is dictated by the size, number and location of the fibroids. The procedure begins with Pfannenstiel (open), low midline abdominal laparoscopic incision(laparoscopic) with placement of trocars, or with hysteroscopy. In order to minimize bleeding, vasoconstrictor such as epinephrine or vasopressin is injected to the myometrium or a tourniquet can be used to minimize uterine blood flow. Fibroids are removed and defects are sutured and closed.		Myomectomy is a surgical procedure involving the removal of fibroids of the uterus in patients who have not completed childbearing. Indications include abnormal bleeding, infertility, ureteral compression, hydroureter/hydronephrosis and pain<ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>. There are several approaches to the surgery that is dictated by the size, number and location of the fibroids. The procedure begins with Pfannenstiel (open), low midline abdominal laparoscopic incision(laparoscopic) with placement of trocars, or with hysteroscopy. For laparoscopic approach, abdomen is insufflation. For vaginal approach, the uterus is infused with fluids. In order to minimize bleeding, vasoconstrictor such as epinephrine or vasopressin is injected to the myometrium or a tourniquet can be used to minimize uterine blood flow. Fibroids are removed and defects are sutured and closed.

	== Preoperative management ==		== Preoperative management ==
Line 18:		Line 18:
	!System		!System
	!Considerations		!Considerations
	\|-
	~~\|Respiratory~~
	\|
	\|-
	~~\|Gastrointestinal~~
	\|
	\|-		\|-
	\|Hematologic		\|Hematologic
Line 30:		Line 24:
	\|Renal		\|Renal
	\|Assess for volume status as abdominal insufflation decreases preload		\|Assess for volume status as abdominal insufflation decreases preload
	\|-
	~~\|Other~~
	\|
	\|}		\|}

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	=== 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. --> ===

	* Spinal and/or epidural		* Spinal and/or epidural mainly for vaginal approach or for supplementation of analgesia with general for open approach

	== Intraoperative management ==		== Intraoperative management ==
Line 57:		Line 48:
	* Standard ASA monitors		* Standard ASA monitors
	* 5-lead EKG		* 5-lead EKG
	* +/- arterial depending size/~~extent~~ of myomectomy		* +/- arterial depending size/location/approach of myomectomy
	* OG/NGT to decompress stomach prior to trocar placement to decrease risk of injury		* OG/NGT to decompress stomach prior to trocar placement to decrease risk of injury
	* PIV x 2 ( at least 1 large bore)		* PIV x 2 ( at least 1 large bore for open)

	=== 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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	=== 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. --> ===

	* Maintenance with volatile anesthetic supplemented with opioid analgesic		* Maintenance with volatile anesthetic supplemented with opioid or neuraxial for analgesic
	** Consider TIVA is high risk for PONV		** Consider TIVA is high risk for PONV
	** Maintain neuromuscular blockade if open or laparoscopy		** Maintain neuromuscular blockade if open or laparoscopy
Line 94:		Line 85:
	* Uterine rupture		* Uterine rupture
	* Bowel/bladder injury		* Bowel/bladder injury
			* Monitored fluid infused and fluid retrieved and assess for fluid shifts and electrolytes imbalance if vaginal approach

	=== 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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	* PACU		* PACU
	* ~~Usually discharged home~~		* Home likely for laparoscopic or vaginal approach
			* Most likely floor for open approach

	=== 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. --> ===

	* Pain is mild to severe depending on surgical approach		* Pain ranges from mild to severe depending on surgical approach
	** Multimodal analgesia		** Multimodal analgesia
	*** IV/PO acetominophen		*** IV/PO acetominophen
	*** IV/PO opioids		*** IV/PO opioids
	*** IV/PO NSAIDs ~~pending~~ surgical team ~~approval~~		*** IV/PO NSAIDs based on discussion with surgical team
	*** IV lidocaine		*** IV lidocaine
	*** IV ketamine		*** IV ketamine
Line 128:		Line 121:
	* Fistula formation		* Fistula formation
	* Pulmonary embolism		* Pulmonary embolism
			* Pulmonary edema
			* Electrolyte imbalances

	== 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). --> ==
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	!		!
	!Open myomectomy		!Open myomectomy
	!~~Laparscopic~~ myomectomy		!Laparoscopic myomectomy
	!Vaginal myomectomy		!Vaginal myomectomy
	\|-		\|-
	\|Unique considerations		\|Unique considerations
	\|		\|
	\|Minimizes blood lost		* Increased bleeding risk
			\|
			* Minimizes blood lost
			* May require mini-laparotomy or posterior culdotomy to retrieve fibroids

	\|		\|
			* Requires hysteroscopy
			* Fluid shifts
	\|-		\|-
	\|Position		\|Position
	\|Supine		\|Supine
	\|Steep Trendelenburg		\|Steep Trendelenburg +/- lithotomy
	\|Lithotomy		\|Lithotomy
	\|-		\|-
Line 156:		Line 157:
	\|1-1.5 L		\|1-1.5 L
	\|100-600 mL		\|100-600 mL
	\|		\|0-100 mL
	\|-		\|-
	\|Postoperative disposition		\|Postoperative disposition
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	\|Potential complications		\|Potential complications
	\|Bowel/bladder injury, bleeding		\|Bowel/bladder injury, bleeding
	\|Bowel/bladder injury		\|Bowel/bladder injury, complications of abdominal CO2 insufflation
	\|Uterine rupture		\|Uterine rupture, pulmonary edema, electrolyte abnormalities
	\|}		\|}

Cornel.Chiu: most sections

2022-01-19T19:22:49Z

most sections

← Older revision		Revision as of 12:22, 19 January 2022
Line 4:		Line 4:
	\| lines_access = PIV x 2 (at least 1 large bore), +/- arterial line		\| lines_access = PIV x 2 (at least 1 large bore), +/- arterial line
	\| monitors = Standard, 5-lead EKG, temperature		\| monitors = Standard, 5-lead EKG, temperature
	\| considerations_preoperative =		\| considerations_preoperative = Type and screen
	\| considerations_intraoperative = Hemorrohage, uterine rupture		\| considerations_intraoperative = Hemorrohage, uterine rupture, CO2 air embolism
	\| considerations_postoperative = PONV		\| considerations_postoperative = PONV
	}}		}}

	Myomectomy is a surgical procedure involving the removal of ~~parts of the muscular layers~~ of the uterus. Indications include abnormal bleeding, infertility, and pain<ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>		Myomectomy is a surgical procedure involving the removal of fibroids of the uterus in patients who have not completed childbearing. Indications include abnormal bleeding, infertility, ureteral compression, hydroureter/hydronephrosis and pain<ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>. There are several approaches to the surgery that is dictated by the size, number and location of the fibroids. The procedure begins with Pfannenstiel (open), low midline abdominal laparoscopic incision(laparoscopic) with placement of trocars, or with hysteroscopy. In order to minimize bleeding, vasoconstrictor such as epinephrine or vasopressin is injected to the myometrium or a tourniquet can be used to minimize uterine blood flow. Fibroids are removed and defects are sutured and closed.

	== Preoperative management ==		== Preoperative management ==
Line 26:		Line 26:
	\|-		\|-
	\|Hematologic		\|Hematologic
	\|Assess for anemia secondary to menorrhagia		\|Assess for anemia secondary to menorrhagia or menometrorrhagia
	\|-		\|-
	\|Renal		\|Renal
	\|		\|Assess for volume status as abdominal insufflation decreases preload
	\|-
	~~\|Endocrine~~
	\|
	\|-		\|-
	\|Other		\|Other
Line 46:		Line 43:
	* IV midazolam for anxiety		* IV midazolam for anxiety
	* PO Acetaminophen for pain		* PO Acetaminophen for pain
			* PO gabapentin
			* PO celecoxib
	* Scopolamine patch for PONV		* Scopolamine patch for PONV

Line 59:		Line 58:
	* 5-lead EKG		* 5-lead EKG
	* +/- arterial depending size/extent of myomectomy		* +/- arterial depending size/extent of myomectomy
			* OG/NGT to decompress stomach prior to trocar placement to decrease risk of injury
	* PIV x 2 ( at least 1 large bore)		* PIV x 2 ( at least 1 large bore)

Line 69:		Line 69:
	=== 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. --> ===

	* Lithotomy (vaginal approach)		* Lithotomy (laparoscopic, vaginal approach)
	* Supine (open approach)		* Supine (open approach)
	* Steep Trendelenburg (laparoscopic approach)		* Steep Trendelenburg (laparoscopic approach)
Line 77:		Line 77:
	* Maintenance with volatile anesthetic supplemented with opioid analgesic		* Maintenance with volatile anesthetic supplemented with opioid analgesic
	** Consider TIVA is high risk for PONV		** Consider TIVA is high risk for PONV
	** Maintain neuromuscular blockade if laparoscopy		** Maintain neuromuscular blockade if open or laparoscopy
			* Physiologic of abdominal insufflation
			** Decreased FRC
			*** May require adjustment of PEEP to prevent alveolar collapse
			** CO2 retention
			*** May require adjustment of MV to decrease absorbed CO2 from insufflation
			** Increase HR, MAP, PVR and SVR
			** Decreased venous return from IVC collapsed, preload, and cardiac output
			** Bradycardia and systole
			*** May need to decompress abdomen from insufflation, and proceed abdominal insufflation slowly
			*** Treat with atropine or glycopyrrolate
	* Monitor blood loss, transfuse if needed		* Monitor blood loss, transfuse if needed
			** Vascular injury
			* CO2 air embolism
			* Subcutaneous/mediastinal emphysema
			* Uterine rupture
			* Bowel/bladder injury

	=== 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. --> ===
Line 95:		Line 110:
	* Pain is mild to severe depending on surgical approach		* Pain is mild to severe depending on surgical approach
	** Multimodal analgesia		** Multimodal analgesia
	*** IV/PO acetominophen		*** IV/PO acetominophen
	*** IV/PO opioids		*** IV/PO opioids
	*** Local anesthetic at trocar sites		*** IV/PO NSAIDs pending surgical team approval
	*** TAP blocks		*** IV lidocaine
	*** Epidural analgesia		*** IV ketamine
			*** Local anesthetic at trocar sites
			*** TAP blocks
			*** Epidural analgesia

	=== 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/hematoma
	* ~~Uterine rupture~~		* Pregnancy complications
	* ~~Bowel/bladder injury~~		* Infections
			* Peroneal nerve damage
			* Adhesion formation
			* Fistula formation
			* Pulmonary embolism

	== 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). --> ==
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	\|Unique considerations		\|Unique considerations
	\|		\|
	\|		\|Minimizes blood lost
	\|		\|
	\|-		\|-
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	\|Surgical time		\|Surgical time
	\|		\|
	\|		\|1-4 hours
	\|		\|1-4 hours
	\|-		\|-
	\|EBL		\|EBL
	\|		\|1-1.5 L
	\|		\|100-600 mL
	\|		\|
	\|-		\|-
	\|Postoperative disposition		\|Postoperative disposition
	\|Floor		\|Floor
	\|		\|PACU and usually discharged home
	\|		\|PACU and usually discharged home
	\|-		\|-
	\|Pain management		\|Pain management
	\|Severe, multimodal, consider epidural		\|Severe, multimodal, consider epidural
	\|~~Mild to moderate~~, multimodal		\|Moderate, multimodal
	\|Mild to moderate, multimodal		\|Mild to moderate, multimodal
	\|-		\|-