Difference between revisions of "Breast lumpectomy"
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Ashwini Bhat (talk | contribs) m (added minor addition on considering TIVA) |
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{{Infobox surgical case reference | {{Infobox surgical case reference | ||
| anesthesia_type = | | anesthesia_type = MAC or General | ||
| airway = | | airway = LMA/ETT if GA | ||
| lines_access = | | lines_access = PIV | ||
| monitors = | | monitors = Standard | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = | ||
| considerations_postoperative = | | considerations_postoperative = PONV | ||
}}A lumpectomy is the removal of a discrete portion or “lump” of breast tissue. | }}A '''breast lumpectomy''' is the removal of a discrete portion or “lump” of breast tissue. This procedure is sometimes referred to as a '''partial mastectomy'''. | ||
Sometimes the procedure is performed with wire localization, where a radiologist inserts the tip of a wire into the target tissue under fluoroscopic guidance preoperatively. This enables the surgeon to more precisely localize the lesion, and is more commonly performed for deeper lesions. | |||
== Preoperative management == | == Preoperative management == | ||
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| | | | ||
|- | |- | ||
| | |Pulmonary | ||
| | | | ||
|- | |- | ||
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| | | | ||
|} | |} | ||
=== Labs and studies | === Labs and studies === | ||
=== 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. --> === | ||
=== 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. --> === | ||
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== Intraoperative management == | == 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. --> === | === Monitoring and access <!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
* PIV x 1 | |||
* Place BP cuff off the surgical field | |||
* Make sure EKG leads are not near the sterile field | |||
=== 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 | |||
* Arms out | |||
=== 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. --> === | ||
* Consider TIVA or partial TIVA, due to higher risk of PONV (patient population tends to be older females, who are at higher risk of PONV) and faster emergence. | |||
=== 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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|+ | |+ | ||
! | ! | ||
! | !Superficial | ||
! | !Deep | ||
|- | |- | ||
|Unique considerations | |Unique considerations | ||
| | |More likely MAC | ||
| | |More likely GA | ||
|- | |- | ||
|Position | |Position | ||
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|- | |- | ||
|Surgical time | |Surgical time | ||
| | |15-45 mins | ||
| | |30-60 mins | ||
|- | |- | ||
|EBL | |EBL | ||
| | |5-10cc | ||
| | |5-10cc | ||
|- | |- | ||
|Postoperative disposition | |Postoperative disposition | ||
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[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
[[Category:General surgery]] | |||
[[Category:Breast surgery]] | |||
Latest revision as of 17:07, 7 August 2022
Breast lumpectomy
| Anesthesia type |
MAC or General |
|---|---|
| Airway |
LMA/ETT if GA |
| Lines and access |
PIV |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative |
PONV |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A breast lumpectomy is the removal of a discrete portion or “lump” of breast tissue. This procedure is sometimes referred to as a partial mastectomy.
Sometimes the procedure is performed with wire localization, where a radiologist inserts the tip of a wire into the target tissue under fluoroscopic guidance preoperatively. This enables the surgeon to more precisely localize the lesion, and is more commonly performed for deeper lesions.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| 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
- PIV x 1
- Place BP cuff off the surgical field
- Make sure EKG leads are not near the sterile field
Induction and airway management
Positioning
- Supine
- Arms out
Maintenance and surgical considerations
- Consider TIVA or partial TIVA, due to higher risk of PONV (patient population tends to be older females, who are at higher risk of PONV) and faster emergence.
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Superficial | Deep | |
|---|---|---|
| Unique considerations | More likely MAC | More likely GA |
| Position | ||
| Surgical time | 15-45 mins | 30-60 mins |
| EBL | 5-10cc | 5-10cc |
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Barrett Larson, Chris Rishel, Tony Wang and Ashwini Bhat