Difference between revisions of "Adrenalectomy"

Adrenalectomy
Anesthesia type	General
Airway	ETT
Lines and access	2 PIVs, +/- Arterial line
Monitors	standard
	Primary anesthetic considerations
Preoperative	Electrolytes
Intraoperative	Rapid hemodynamic changes
Postoperative	Tumor withdrawal requiring steroid replacement
	Article quality
Editor rating	In development
User likes	0

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Latest revision as of 02:46, 26 April 2023

An adrenalectomy is a surgical procedure to remove one or both adrenal glands, and is typically performed to remove a hormone-secreting tumor. The anesthetic approach to this procedure varies depending on the hormones produced by the tumor. If the tumor is a pheochromocytoma, unique considerations for preoperative optimization and perioperative management are required (see excision of pheochromocytoma).

Preoperative management

Patient evaluation

Key in the preoperative workup is determining if the mass is functional and/or if it is malignant. Functional tumors could produce cushings syndrome, hyper aldosteronism, or a pheochromocytoma


System	Considerations
Neurologic	Investigate headaches, fatigue, syncope
Cardiovascular	HTN, cardiac remodeling, HLD,
Pulmonary
Gastrointestinal
Hematologic
Renal	Hypernatremia, hypokalemia
Endocrine
Other	Obesity/cushingoid

Labs and studies

Electrocardiogram to investigate potential arrhythmias or signs of electrolyte changes
Consider ECHO if clinical suspicion of cardiac remodeling/heart failure, long standing HTN, functional changes
CBC
CMP especially important for electrolyte evaluation
(typically preformed preop in adrenal mass workup) dexamethasone suppression test
Plasma metanephrines (Normetanephrine, Norepinephrine, Epinephrine , Dopamine) if concern for pheo

Operating room setup

If the mass is small and nonfunctional, the surgical procedure can be straight foreword with minimal disruptions expected to the endocrine system. However if the mass is functional, tumor manipulation can precipitate large changes in glucose, electrolytes (potassium/sodium), blood pressure and HR.

Patient preparation and premedication

Regional and neuraxial techniques

Consider TAP block or epidural depending on extent of resection

Intraoperative management

Monitoring and access

2 peripheral IVs

Arterial line for monitoring rapid hemodynamic changes and possibly frequent blood draws if functional tumor. If nonfunctional, typically no arterial line required

Induction and airway management

Standard

Positioning

Lateral with surgical side up

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

PACU, typically, however can require ICU depending on extent of resection and changes in endocrine system

Pain management

PCA for IV opiate therapy

Consider regional such as TAP block vs Epidural if larger resection expected

Potential complications

Procedure variants


	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

Top contributors: Chris Rishel, Mitchel DeVita and tyler murphy

@@ Line 1: / Line 1: @@
+{{Infobox surgical case reference
+| anesthesia_type = General
+| airway = ETT
+| lines_access = 2 PIVs, +/- Arterial line
+| monitors = standard
+| considerations_preoperative = Electrolytes
+| considerations_intraoperative = Rapid hemodynamic changes
+| considerations_postoperative = Tumor withdrawal requiring steroid replacement
+}}
+An '''adrenalectomy''' is a surgical procedure to remove one or both adrenal glands, and is typically performed to remove a hormone-secreting tumor. The anesthetic approach to this procedure varies depending on the hormones produced by the tumor. If the tumor is a [[pheochromocytoma]], unique considerations for preoperative optimization and perioperative management are required (see [[excision of pheochromocytoma]]).
+== Preoperative management ==
+=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
+Key in the preoperative workup is determining if the mass is functional and/or if it is malignant. Functional tumors could produce cushings syndrome, hyper aldosteronism, or a pheochromocytoma
+{| class="wikitable"
+|+
+!System
+!Considerations
+|-
+|Neurologic
+|Investigate headaches, fatigue, syncope
+|-
+|Cardiovascular
+|HTN, cardiac remodeling, HLD,
+|-
+|Pulmonary
+|
+|-
+|Gastrointestinal
+|
+|-
+|Hematologic
+|
+|-
+|Renal
+|Hypernatremia, hypokalemia
+|-
+|Endocrine
+|
+|-
+|Other
+|Obesity/cushingoid
+|}
+=== 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. --> ===
+* Electrocardiogram to investigate potential arrhythmias or signs of electrolyte changes
+* Consider ECHO if clinical suspicion of cardiac remodeling/heart failure, long standing HTN, functional changes
+* CBC
+* CMP especially important for electrolyte evaluation
+* (typically preformed preop in adrenal mass workup) dexamethasone suppression test
+* Plasma metanephrines (Normetanephrine, Norepinephrine, Epinephrine , Dopamine) if concern for pheo
+=== 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. --> ===
+If the mass is small and nonfunctional, the surgical procedure can be straight foreword with minimal disruptions expected to the endocrine system. However if the mass is functional, tumor manipulation can precipitate large changes in glucose, electrolytes (potassium/sodium), blood pressure and HR.
+=== 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. --> ===
+Consider TAP block or epidural depending on extent of resection
+== 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. --> ===
+peripheral IVs
+Arterial line for monitoring rapid hemodynamic changes and possibly frequent blood draws if functional tumor. If nonfunctional, typically no arterial line required
+=== 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. --> ===
+Standard
+=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
+Lateral with surgical side up
+=== 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. --> ===
+PACU, typically, however can require ICU depending on extent of resection and changes in endocrine system
+=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
+PCA for IV opiate therapy
+Consider regional such as TAP block vs Epidural if larger resection expected
+=== 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"
+|+
+!
+!Variant 1
+!Variant 2
+|-
+|Unique considerations
+|
+|
+|-
+|Position
+|
+|
+|-
+|Surgical time
+|
+|
+|-
+|EBL
+|
+|
+|-
+|Postoperative disposition
+|
+|
+|-
+|Pain management
+|
+|
+|-
+|Potential complications
+|
+|
+|}
+== References ==
+[[Category:Surgical procedures]]