Pericardial Window - Revision history

Zining2023: References section completed

2026-02-22T23:37:26Z

References section completed

← Older revision		Revision as of 16:37, 22 February 2026
Line 40:		Line 40:
	* Lower recurrence rates		* Lower recurrence rates
	* Ability to obtain pericardial biopsy		* Ability to obtain pericardial biopsy
	* Direct visualization of bleeding or loculations		* Direct visualization of bleeding or loculations<ref>{{Cite journal\|last=Adler\|first=Yehuda\|last2=Charron\|first2=Philippe\|last3=Imazio\|first3=Massimo\|last4=Badano\|first4=Luigi\|last5=Barón-Esquivias\|first5=Gonzalo\|last6=Bogaert\|first6=Jan\|last7=Brucato\|first7=Antonio\|last8=Gueret\|first8=Pascal\|last9=Klingel\|first9=Karin\|last10=Lionis\|first10=Christos\|last11=Maisch\|first11=Bernhard\|date=2015-11-07\|title=2015 ESC Guidelines for the diagnosis and management of pericardial diseases\|url=https://academic.oup.com/eurheartj/article/36/42/2921/2293375\|journal=European Heart Journal\|language=en\|volume=36\|issue=42\|pages=2921–2964\|doi=10.1093/eurheartj/ehv318\|issn=0195-668X\|pmc=7539677\|pmid=26320112}}</ref>

	=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> ===		=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> ===
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	{\| class="wikitable wikitable-horizontal-scroll"		{\| class="wikitable wikitable-horizontal-scroll"
	\|+		\|+<ref>{{Cite book\|title=Kaplan's cardiac anesthesia: perioperative and critical care\|date=2024\|publisher=Elsevier\|isbn=978-0-323-82924-3\|editor-last=Kaplan\|editor-first=Joel A.\|edition=8th edition\|location=Philadelphia, PA\|editor-last2=Augoustides\|editor-first2=John G. T.\|editor-last3=Gutsche\|editor-first3=Jacob T.}}</ref><ref>{{Cite book\|title=Hensley's practical approach to cardiothoracic anesthesia\|date=2025\|publisher=Wolters Kluwer Health\|isbn=978-1-9752-0910-0\|editor-last=Bartels\|editor-first=Karsten\|edition=Seventh edition\|location=Philadelphia\|editor-last2=Shaw\|editor-first2=Andrew D.\|editor-last3=Fox\|editor-first3=Amanda\|editor-last4=Thiel\|editor-first4=Robert H.\|editor-last5=Howard-Quijano\|editor-first5=Kimberly}}</ref>
	!		!
	!Subxiphoid		!Subxiphoid

Zining2023: Finished procedural variants section

2026-02-22T23:30:57Z

Finished procedural variants section

← Older revision		Revision as of 16:30, 22 February 2026
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	\|+		\|+
	!		!
	!~~Variant 1~~		!Subxiphoid
	!~~Variant 2~~		!Thoracotomy
			!VATS
			!Post-cardiac
			surgery
			!Pericardioperitoneal
	\|-		\|-
	\|Unique considerations		\|Unique considerations
	\|		\|Tamponade
	\|		Maintain spontaneous ventilation
			\|OLV
			\|OLV
			\|Adhesions
			Graft injury risk
			\|Drain into abdomen
	\|-		\|-
	\|~~Indications~~		\|Timing
	\|		\|Emergent/Urgent
	\|		\|Urgent/Elective
	\|-		\|Elective
	~~\|Position~~		\|Urgent
	\|		\|Elective
	\|
	\|-
	~~\|Surgical time~~
	\|
	\|
	\|-		\|-
	\|EBL		\|EBL
	\|		\|Low
	\|		\|Moderate
	\|-		\|Low
	~~\|Postoperative disposition~~		\|High
	\|		\|Low
	\|
	\|-
	~~\|Pain management~~
	\|
	\|
	\|-		\|-
	\|Potential complications		\|Potential complications
	\|		\|Incomplete drainage
	\|		\|Pain, PTX
			\|Conversion to open
			\|Bleeding
			\|Abdominal complications
	\|}		\|}

Zining2023: Finished intraop section

2026-02-22T23:19:14Z

Finished intraop section

@@ Line 23: / Line 23: @@
 }}A pericardial window creates a surgical communication between the pericardial space and pleural or peritoneal cavity to allow continuous drainage of pericardial fluid. It is indicated for symptomatic effusions, cardiac tamponade, purulent pericarditis, recurrent malignant effusions, and failed percutaneous drainage.
-From an anesthesia standpoint, the central issue is tamponade physiology, not the incision itself.
+From an anesthesia standpoint, the central issue is tamponade physiology, not the surgical incision itself.
 == Overview ==
@@ Line 157: / Line 157: @@
 === 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. --> ===
+* Surgeon prepped and ready before induction
 === 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 ==
@@ Line 182: / Line 232: @@
 Subxiphoid approach - mild to moderate pain comparable to laparoscopic upper abdominal incision
-* acetaminophen, low dose opioid, consider NSAIDs
+* Acetaminophen, low dose opioid, consider NSAIDs
 Thoracotomy/VATS approach - moderate to severe pain, especially with chest tube placement

Zining2023: Finished postop disposition, pain, complications

2026-02-22T16:38:48Z

Finished postop disposition, pain, complications

@@ Line 169: / Line 169: @@
 === 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). --> ==

Zining2023: Finished preop considerations table

2026-02-22T16:29:48Z

Finished preop considerations table

← Older revision		Revision as of 09:29, 22 February 2026
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	\|-		\|-
	\|Airway		\|Airway
	\|		\| -Prior mediastinal radiation or malignancy (difficult airway, limited neck mobility)
			-Orthopnea (tamponade may not tolerate supine positioning)
	\|-		\|-
	\|Neurologic		\|Neurologic
	\|		\| -Altered mental status from low cardiac output
			-Syncope or presyncope (suggests severe tamponade physiology)
	\|-		\|-
	\|Cardiovascular		\|Cardiovascular
	\|		\| -Assess tamponade physiology (Beck's triad, tachycardia, narrow pulse pressure, pulsus paradoxus, electrical alternans)
			-Echo findings (RA systolic collapse, RV diastolic collapse, dilated IVC with minimal variation, large effusion with swinging heart)

			-Assess underlying cardiomyopathy or recent cardiac surgery
	\|-		\|-
	\|Pulmonary		\|Pulmonary
	\|		\| -Dyspnea at rest, orthopnea
			-Pleural effusion
	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
	\|		\| -NPO status uncertain in urgent cases
			-Hepatic congestion or ascites
	\|-		\|-
	\|Hematologic		\|Hematologic
	\|		\| -Anticoagulation usage
			-Thrombocytopenia (malignancy, chemotherapy)

			-Coagulopathy
	\|-		\|-
	\|Renal		\|Renal
	\|		\| -Uremia?
			-AKI from low cardiac output
	\|-		\|-
	\|Endocrine		\|Endocrine
	\|		\| -hypothyroidism can cause pericardial effusion
	\|-		\|-
	\|Other		\|Other
	\|		\| -etiologies include TB, autoimmune diseases
	\|}		\|}

Zining2023: Finished preop management, except patient eval

2026-02-22T16:09:20Z

Finished preop management, except patient eval

@@ Line 84: / Line 84: @@
 === 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. --> ===
 === 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. --> ===
 === 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. --> ===
 == Intraoperative management ==

Zining2023: Overview section completed

2026-02-22T15:46:54Z

Overview section completed

@@ Line 28: / Line 28: @@
 === Indications<!-- List and/or describe the indications for this surgical procedure. --> ===
 === Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> ===
 == Preoperative management ==

Zining2023: Created page. Completed basic description and infobox

2026-02-22T15:35:53Z

Created page. Completed basic description and infobox

New page

{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = PIV x2
Arterial line (if tamponade physiology or instability)
Central line only if necessary (do not delay drainage)
| monitors = Standard ASA
Invasive arterial BP
+/- CVP
TEE
| considerations_preoperative = -Determine presence and severity of tamponade physiology
-Identify etiology (malignancy, uremia, infection, post-cardiac surgery, trauma)
-Assess degree of sympathetic compensation
-Evaluate anticoagulation
| considerations_intraoperative = -Avoid loss of sympathetic tone
-Avoid reductions in preload
-Avoid sudden increases in intrathoracic pressure
-Surgeon scrubbed and ready before induction if unstable
| considerations_postoperative = -Hemodynamic instability after decompression
-Acute RV failure
-Re-expansion pulmonary edema
-Reaccumulation of effusion
}}A pericardial window creates a surgical communication between the pericardial space and pleural or peritoneal cavity to allow continuous drainage of pericardial fluid. It is indicated for symptomatic effusions, cardiac tamponade, purulent pericarditis, recurrent malignant effusions, and failed percutaneous drainage.

From an anesthesia standpoint, the central issue is tamponade physiology, not the incision itself.

== Overview ==

=== Indications ===

=== 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 ===

=== 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]]