Difference between revisions of "Bone marrow procurement"
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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. | |||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
| Line 49: | Line 53: | ||
===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. -->=== | ===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. -->=== | ===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=== | ||
Avoid pre-op Tylenol, can give at the end of the case. Everything (Tylenol, steroids) transfers from bone marrow donor to recipient.<!-- 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. | |||
Alternatively, patients are good candidates for deep QL (truncal) block. This is more easily accomplished after patient proned. | |||
==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=== | ||
PIV x1-2 (at least one good IV for resuscitation). Avoid antecubital due to patient positioning.<!-- 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. --> | ===Induction and airway management=== | ||
Standard induction as patients are generally healthy.<!-- 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. -->=== | ||
Prone. Arms Superman/above head and accessible. | |||
===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 | |||
*Alternatively consider methadone 0.15 mg/kg (Ideal Body Weight) on induction | |||
* 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 88: | ||
==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=== | ||
Long acting opioids as above.<!-- 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. -->=== | ===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->=== | ||
Latest revision as of 06:44, 6 May 2025
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
Avoid pre-op Tylenol, can give at the end of the case. Everything (Tylenol, steroids) transfers from bone marrow donor to recipient.
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.
Alternatively, patients are good candidates for deep QL (truncal) block. This is more easily accomplished after patient proned.
Intraoperative management
Monitoring and access
PIV x1-2 (at least one good IV for resuscitation). Avoid antecubital due to patient positioning.
Induction and airway management
Standard induction as patients are generally healthy.
Positioning
Prone. Arms Superman/above head and accessible.
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
- Alternatively consider methadone 0.15 mg/kg (Ideal Body Weight) on induction
- Pretty emetogenic, consider TIVA, scopolamine patch, etc
- Usually harvest 850cc to 1.5L (depends on cell count)
Emergence
Postoperative management
Disposition
PACU
Pain management
Long acting opioids as above.
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 and BRANDON ETHAN Sumida