Difference between revisions of "Appendectomy"

Appendectomy
Anesthesia type	General
Airway	Endotracheal tube
Lines and access	Peripheral IV
Monitors	Standard ASA / 5-Lead EKG
	Primary anesthetic considerations
Preoperative	Full stomach precautions
Intraoperative	Rapid sequence induction
Postoperative	PONV
	Article quality
Editor rating	Certified
User likes	2

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Revision as of 16:59, 3 March 2021

An appendectomy is generally performed as an urgent or emergent procedure to treat appendicitis. Appendicitis can occur at any age, but is more common in patients 19-25 years old. Appendicitis is common, occurring in about 7% of the population. An appendectomy can be performed laparoscopically or as an open procedure. Surgical practice has largely transitioned to the laparoscopic approach^[1]

Preoperative management

Preoperative evaluation


System	Considerations
Respiratory	Acute abdominal pain can cause respiratory impairment (respiratory splinting) resulting in atelectasis
Cardiovascular	May be dehydrated due to fever, emesis, and reduced oral intake Assess volume status by checking vital signs, mucus membranes, skin turgor. IV hydration before anesthetic induction
Gastrointestinal	Patients typically present with nausea and vomiting. Patients with acute abdomen should be treated as if they have full stomachs. Muscular resistance to palpation (muscle guarding) can correlate with severity of the inflammatory process.
Hematologic	Patients typically have moderate leukocytosis with left shift Expect hemoconcentration if patient dehydrated
Labs	CBC Chemistry Panel Pregnancy test (for women of child bearing age)

Operating room preparation

NG Tube
Verify pre-incisions antibiotics required

Regional and neuraxial techniques

Consider pre-incision nerve blocks

Intraoperative management

Monitoring and access

Standard ASA monitors
5-lead EKG
Urinary catheter
1 peripheral IV (typically 16-18 gauge)

Induction and airway management

Pre-oxygenate with 100% FiO2
Rapid Sequence Induction (RSI)
Intubation

Positioning

Supine
Secure or tuck the arms

Maintenance and surgical considerations

Standard maintenance
- Consider avoiding nitrous oxide given potential for bowel dissension and increased risk of PONV
Place OG/NG before surgical incision to decompress the stomach
Maintain norovolemia and normothermia

Emergence

Extubate when patient awake and able to protect airway
PONV prophylaxis

Postoperative management

Disposition

PACU
- Patients undergoing laparoscopic appendectomy can often be discharged home from PACU
Encourage early post-operative ambulation

Pain management

Oral analgesics
Non-opioid analgesics
- Ketoralac (Toradol)
- Acetaminophen (Tylenol)
IV narcotics for breakthrough pain

Potential complications

PONV
Urinary retention (consider straight catheterization of bladder prior to emergence)

Procedure variants


	Open Appendectomy	Laparoscopic Appendectomy
Position	Supine	Supine
Surgical time	1 hour	30-90 mins
EBL	<75 mL	<75 mL
Postoperative disposition	PACU	PACU
Mortality	Perforated: 2% Non-perforated: <0.1%	Perforated: 2% Non-perforated: <0.1%
Complications	Perforation Abscess Fistula Hematoma Illeus	Perforation Abscess Fistula Hematoma Illeus Conversion to Open
Pain	5-7	4

References

↑ Bhangu, Aneel; Søreide, Kjetil; Di Saverio, Salomone; Assarsson, Jeanette Hansson; Drake, Frederick Thurston (2015). "Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management". The Lancet. 386 (10000): 1278–1287. doi:10.1016/S0140-6736(15)00275-5.

Top contributors: Barrett Larson, Chris Rishel, Tony Wang and Olivia Sutton

[1] Bhangu, Aneel; Søreide, Kjetil; Di Saverio, Salomone; Assarsson, Jeanette Hansson; Drake, Frederick Thurston (2015). "Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management". The Lancet. 386 (10000): 1278–1287. doi:10.1016/S0140-6736(15)00275-5.

[1]

@@ Line 8: / Line 8: @@
 | considerations_postoperative = PONV
 | image_file =
-}}An appendectomy is generally performed as an urgent or emergent procedure to treat appendicitis.  Appendicitis can occur at any age, but is more common in patients 19-25 years old.  Appendicitis is common, occurring in about 7% of the population.  An appendectomy can be performed laparoscopically or as an open procedure.  Surgical practice has largely transitioned to the laparoscopic approach<ref>{{Cite journal|last=Bhangu|first=Aneel|last2=Søreide|first2=Kjetil|last3=Di Saverio|first3=Salomone|last4=Assarsson|first4=Jeanette Hansson|last5=Drake|first5=Frederick Thurston|date=2015|title=Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management|url=https://linkinghub.elsevier.com/retrieve/pii/S0140673615002755|journal=The Lancet|language=en|volume=386|issue=10000|pages=1278–1287|doi=10.1016/S0140-6736(15)00275-5|via=}}</ref>.
+}}An appendectomy is generally performed as an urgent or emergent procedure to treat appendicitis.  Appendicitis can occur at any age, but is more common in patients 19-25 years old.  Appendicitis is common, occurring in about 7% of the population.  An appendectomy can be performed laparoscopically or as an open procedure.  Surgical practice has largely transitioned to the laparoscopic approach<ref>{{Cite journal|last=Bhangu|first=Aneel|last2=Søreide|first2=Kjetil|last3=Di Saverio|first3=Salomone|last4=Assarsson|first4=Jeanette Hansson|last5=Drake|first5=Frederick Thurston|date=2015|title=Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management|url=https://linkinghub.elsevier.com/retrieve/pii/S0140673615002755|journal=The Lancet|language=en|volume=386|issue=10000|pages=1278–1287|doi=10.1016/S0140-6736(15)00275-5|via=}}</ref>
 ==Preoperative management==
 ===Preoperative evaluation<!-- Provide a brief overview of the preoperative evaluation and optimization of patients for this case. Also list relevant labs, studies, or physical exam findings. If none, this section may be removed. -->===