Pancreatectomy - Revision history

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

2022-04-05T19:40:09Z

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

← Older revision		Revision as of 12:40, 5 April 2022
Line 4:		Line 4:
	\| airway = ETT		\| airway = ETT
	\| lines_access = PIV x2		\| lines_access = PIV x2
	~~Art~~ line		Arterial line
	\| monitors = Standard		\| monitors = Standard
	5-lead ECG		5-lead ECG

Chris.Rishel at 07:12, 5 April 2022

2022-04-05T07:12:38Z

← Older revision		Revision as of 00:12, 5 April 2022
Line 1:		Line 1:
	{{Infobox surgical procedure		{{Infobox surgical procedure
	\| anesthesia_type = ~~GA +/- epidural~~		\| anesthesia_type = General
			± Epidural
	\| airway = ETT		\| airway = ETT
	\| lines_access = 2 PIV ~~+ A-~~line		\| lines_access = PIV x2
			Art line
	\| monitors = Standard		\| monitors = Standard
	\| considerations_preoperative = Electrolyte disturbances ~~from pancreatitis common, diabetes~~ management		5-lead ECG
	\| considerations_intraoperative = Hypovolemia ~~common in pancreatitis, insulin/glucose~~ management		Temperature
			ABP
			\| considerations_preoperative = Electrolyte disturbances
			Diabetes management
			\| considerations_intraoperative = Hypovolemia
			Glucose management
	\| considerations_postoperative =		\| considerations_postoperative =
	}}		}}

	A pancreatectomy can be indicated for conditions such as pancreatic stones, cysts, benign or malignant tumors, ductal obstructions, or chronic pancreatitis. It can be classified as '''total''', where the entire organ is removed, often along with the spleen, gallbladder, local lymph nodes, the common bile duct, and portions of the small intestine and stomach, or '''partial''', where the pancreas is resected from the mesenteric vessels distally, leaving the head and uncinate process intact.		A '''pancreatectomy''' can be indicated for conditions such as pancreatic stones, cysts, benign or malignant tumors, ductal obstructions, or chronic pancreatitis. It can be classified as '''total''', where the entire organ is removed, often along with the spleen, gallbladder, local lymph nodes, the common bile duct, and portions of the small intestine and stomach, or '''partial''', where the pancreas is resected from the mesenteric vessels distally, leaving the head and uncinate process intact.

	== Preoperative management ==		== Preoperative management ==
Line 50:		Line 57:

	* CBC		* CBC
	* Electrolytes~~, especially~~ K+, serum glucose, BUN, Cr		* Electrolytes
	* ~~Coags including PT, PTT, INR~~		**Especially K+, serum glucose, BUN, Cr
			* Coagulation panel
	* LFTs		* LFTs
	* ~~urinalysis~~		* Urinalysis
	* EKG		* EKG
	* CXR		* CXR
	* ~~Echo~~ is commonly requested		* TTE is commonly requested

	=== 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. --> ===
Line 74:		Line 82:
	=== 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. --> ===

	* A-line		* Arterial line
	*2 large bore IVs		*2 large bore IVs

Line 154:		Line 162:

	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
			[[Category:General surgery]]
			[[Category:Pancreatic surgery]]

Oliviamsutton at 17:32, 14 March 2022

2022-03-14T17:32:10Z

← Older revision		Revision as of 10:32, 14 March 2022
Line 99:		Line 99:

	=== 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. --> ===

			* Endocrine and exocrine insufficiency
			* Wound infection
			* Duodenal necrosis
			* Diabetes
			* Hemorrhage

	== 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). --> ==

Oliviamsutton at 17:31, 14 March 2022

2022-03-14T17:31:26Z

← Older revision		Revision as of 10:31, 14 March 2022
Line 61:		Line 61:

	* Have insulin available for glucose management		* Have insulin available for glucose management
			*Have pressor (usually norepinephrine) available for management of hypotension

	=== 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. --> ===
Line 73:		Line 74:
	=== 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. --> ===

	*		* A-line
			*2 large bore IVs

	=== 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. --> ===

	=== 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. --> ===

			* 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. --> ===		=== 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. --> ===
Line 86:		Line 90:

	=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===		=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===

			* Floor vs. ICU

	=== 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. --> ===

			* Epidural is common for postoperative pain management
			* TAP blocks are an alternative for patients who cannot receive epidurals

	=== 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. --> ===
Line 96:		Line 105:
	\|+		\|+
	!		!
	!~~Variant 1~~		!Total
	!~~Variant 2~~		!Near-Total (Child's Procedure)
			!Partial (Distal)
	\|-		\|-
	\|~~Unique considerations~~		\|Indications
	\|		\|Pancreatic stones, cysts, ductal obstruction, benign or malignant tumor, chronic pancreatitis
	\|		\|When underlying disease has functionally destroyed the pancreas or when lesser procedures have failed to provide adequate pain relief
			\|Tumor or pancreatitis
	\|-		\|-
	\|~~Position~~		\|Surgical procedure
	\|		\|Entire organ removed, usually with spleen, gallbladder, local lymph nodes, CBD, portions of SI and stomach. Remaining distal stomach is anastomosed to a portion of the SI
	\|		\|Removal of entire pancreas except rim of tissue along the lesser curvature of the duodenum, which makes it unnecessary to reconstruct the bile duct
			\|Resection of the pancreas from the mesenteric vessels distally, leaving the head and uncinate process intact
	\|-		\|-
	\|Surgical time		\|Surgical time
	\|		\|3-6h
			\|3-6h
	\|		\|
	\|-		\|-
	\|EBL		\|EBL
	\|		\|300-500cc
			\|300-500cc
	\|		\|
	\|-		\|-
	\|Postoperative disposition		\|Postoperative disposition
			\|
	\|		\|
	\|		\|
	\|-		\|-
	\|Pain management		\|Pain management
			\|
	\|		\|
	\|		\|
	\|-		\|-
	\|Potential complications		\|Potential complications
			\|
	\|		\|
	\|		\|

Oliviamsutton at 17:19, 14 March 2022

2022-03-14T17:19:12Z

← Older revision		Revision as of 10:19, 14 March 2022
Line 41:		Line 41:
	\|-		\|-
	\|Endocrine		\|Endocrine
	\|		\|Diabetes is common in these patients, glucose management should be considered
	\|-		\|-
	\|Other		\|Other
	\|		\|Electrolyte derangements and hypovolemia common in patients with pancreatitis
	\|}		\|}

Oliviamsutton at 17:17, 14 March 2022

2022-03-14T17:17:03Z

← Older revision	Revision as of 10:17, 14 March 2022
Line 1:	Line 1:
		{{Infobox surgical procedure
		\| anesthesia_type = GA +/- epidural
		\| airway = ETT
		\| lines_access = 2 PIV + A-line
		\| monitors = Standard
		\| considerations_preoperative = Electrolyte disturbances from pancreatitis common, diabetes management
		\| considerations_intraoperative = Hypovolemia common in pancreatitis, insulin/glucose management
		\| considerations_postoperative =
		}}

		A pancreatectomy can be indicated for conditions such as pancreatic stones, cysts, benign or malignant tumors, ductal obstructions, or chronic pancreatitis. It can be classified as '''total''', where the entire organ is removed, often along with the spleen, gallbladder, local lymph nodes, the common bile duct, and portions of the small intestine and stomach, or '''partial''', where the pancreas is resected from the mesenteric vessels distally, leaving the head and uncinate process intact.

		== 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
		\|
		\|-
		\|Pulmonary
		\|
		\|-
		\|Gastrointestinal
		\|
		\|-
		\|Hematologic
		\|
		\|-
		\|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. --> ===

		* CBC
		* Electrolytes, especially K+, serum glucose, BUN, Cr
		* Coags including PT, PTT, INR
		* LFTs
		* urinalysis
		* EKG
		* CXR
		* Echo is commonly requested

		=== 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. --> ===

		* Have insulin available for glucose management

		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. 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. --> ===

		* Epidurals are common to manage postoperative pain
		* If epidural is not performed, TAP blocks can be an alternative

		== 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. --> ===

		=== 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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