Difference between revisions of "Bone marrow procurement"
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(Created page with "{{Infobox surgical procedure | anesthesia_type = | airway = | lines_access = | monitors = | considerations_preoperative = | considerations_intraoperative = | considerations_postoperative = }}Provide a brief summary here. ==Overview== ===Indications<!-- List and/or describe the indications for this surgical procedure. -->=== ===Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. -->=== ==Preoperative management== ===Patient evaluat...") |
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = GA vs spinal | ||
| airway = | | airway = ETT (if GA) vs natural airway (if spinal) | ||
| lines_access = | | lines_access = 1 PIV | ||
| monitors = | | monitors = Standard ASA monitors | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = Very aggressive fluids. | ||
| considerations_postoperative = | | considerations_postoperative = PONV and postop pain are common | ||
}} | }}Bone marrow procurement is performed on generally healthy patients who are donating to someone with leukemia. Procurement is typically done on the hip bones (e.g. iliac crest). | ||
==Overview== | ==Overview== | ||
===Indications<!-- List and/or describe the indications for this surgical procedure. -->=== | ===Indications<!-- List and/or describe the indications for this surgical procedure. -->=== | ||
Bone marrow donation | |||
===Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. -->=== | ===Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. -->=== | ||
Long ports are inserted into bone marrow and syringes are used to aspirate. Typically done on hip bones in the prone position. | |||
==Preoperative management== | ==Preoperative management== | ||
===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->=== | ===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->=== | ||
Donors are typically relatively healthy. | |||
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===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. -->=== | ||
===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. -->=== | ||
Can be done with spinal, though because of prone positioning, lots of movement, and occasionally lengthy procedure, this is relatively uncomfortable for the patient. Using GA with ETT is generally preferred for this reason. | |||
==Intraoperative management== | ==Intraoperative management== | ||
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===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. -->=== | ||
Prone | |||
===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. -->=== | ||
* Generally no antibiotics needed | |||
* Avoid nitrous oxide (myelosuppression) | |||
* Avoid steroids (immunosuppression) | |||
* Aggressive fluid repletion, generally ~3:1 repletion with crystalloid. Albumin is often used as well. | |||
** Can do the case with 1 20G PIV, but easier to keep up with fluid repletion if it is 18G or greater or if have a second IV | |||
* Procedure can be quite painful, consider Dilaudid for postop | |||
* Pretty emetogenic, consider TIVA, scopolamine patch, etc | |||
* Usually harvest 850cc to 1.5L (depends on cell count) | |||
===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 65: | Line 81: | ||
==Postoperative management== | ==Postoperative management== | ||
===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. -->=== | ||
PACU | |||
===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. -->=== | ||
Latest revision as of 07:12, 13 June 2024
Bone marrow procurement
| Anesthesia type |
GA vs spinal |
|---|---|
| Airway |
ETT (if GA) vs natural airway (if spinal) |
| Lines and access |
1 PIV |
| Monitors |
Standard ASA monitors |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
Very aggressive fluids. |
| Postoperative |
PONV and postop pain are common |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Bone marrow procurement is performed on generally healthy patients who are donating to someone with leukemia. Procurement is typically done on the hip bones (e.g. iliac crest).
Overview
Indications
Bone marrow donation
Surgical procedure
Long ports are inserted into bone marrow and syringes are used to aspirate. Typically done on hip bones in the prone position.
Preoperative management
Patient evaluation
Donors are typically relatively healthy.
| 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
Can be done with spinal, though because of prone positioning, lots of movement, and occasionally lengthy procedure, this is relatively uncomfortable for the patient. Using GA with ETT is generally preferred for this reason.
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Prone
Maintenance and surgical considerations
- Generally no antibiotics needed
- Avoid nitrous oxide (myelosuppression)
- Avoid steroids (immunosuppression)
- Aggressive fluid repletion, generally ~3:1 repletion with crystalloid. Albumin is often used as well.
- Can do the case with 1 20G PIV, but easier to keep up with fluid repletion if it is 18G or greater or if have a second IV
- Procedure can be quite painful, consider Dilaudid for postop
- Pretty emetogenic, consider TIVA, scopolamine patch, etc
- Usually harvest 850cc to 1.5L (depends on cell count)
Emergence
Postoperative management
Disposition
PACU
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Indications | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Tony Wang