Difference between revisions of "Ivor Lewis esophagectomy"

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* Arterial line +/- flowtrack (ideally on left arm)
* Arterial line +/- flowtrack (ideally on left arm)
* Fluid warmer
* Fluid warmer
* Double-lumen tube (left)
* Double-lumen tube (left) / bronchial blocker with SLT


=== 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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* May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage
* May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage
* Left sided double lumen tube
* Left sided double lumen tube or single lumen ETT with bronchial blocker


=== 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. --> ===
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=== 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. --> ===
==== Abdominal Dissection ====
* Pt is placed supine and peritoneal cavity is examined for metastatic disease
* Lower portion of the stomach is mobilized
* Gastric conduit formed
* A cervical anastamosis is performed and esophogus and stomach returned to mediastinum


=== 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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|Position
|Position
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|Supine then left
 
lateral decubitus
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|-
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|Postoperative disposition
|Postoperative disposition
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|ICU
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|ICU or ERAS
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|ICU or ERAS
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|-
|Pain management
|Pain management
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|Thoracic Epidural
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|Thoracic Epidural
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|Thoracic Epidural
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|Potential complications
|Potential complications
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|Anastamotic leak (4.3%)
 
Vocal cord paresis (0.9%)
 
Mortality (1.68%)<ref>{{Cite journal|last=Luketich|first=James D.|last2=Pennathur|first2=Arjun|last3=Awais|first3=Omar|last4=Levy|first4=Ryan M.|last5=Keeley|first5=Samuel|last6=Shende|first6=Manisha|last7=Christie|first7=Neil A.|last8=Weksler|first8=Benny|last9=Landreneau|first9=Rodney J.|last10=Abbas|first10=Ghulam|last11=Schuchert|first11=Matthew J.|date=2012-07|title=Outcomes after minimally invasive esophagectomy: review of over 1000 patients|url=https://pubmed.ncbi.nlm.nih.gov/22668811|journal=Annals of Surgery|volume=256|issue=1|pages=95–103|doi=10.1097/SLA.0b013e3182590603|issn=1528-1140|pmc=4103614|pmid=22668811}}</ref>
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Revision as of 20:21, 1 September 2021

Ivor Lewis esophagectomy
Anesthesia type

General

Airway

DLT

Lines and access

Large PIV, arterial line, NG tube

Monitors

Standard, arterial line

Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
Article quality
Editor rating
In development
User likes
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Provide a brief summary of this surgical procedure and its indications here.

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Respiratory
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

  • Arterial line +/- flowtrack (ideally on left arm)
  • Fluid warmer
  • Double-lumen tube (left) / bronchial blocker with SLT

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

  • Invasive hemodynamic monitoring
  • Large bore IV access

Induction and airway management

  • May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage
  • Left sided double lumen tube or single lumen ETT with bronchial blocker

Positioning

  • Start in supine position if EGD is used
  • Patient will be later positioned to left lateral decubitus

Maintenance and surgical considerations

Abdominal Dissection

  • Pt is placed supine and peritoneal cavity is examined for metastatic disease
  • Lower portion of the stomach is mobilized
  • Gastric conduit formed
  • A cervical anastamosis is performed and esophogus and stomach returned to mediastinum


Emergence

Postoperative management

Disposition

  • Post-op ICU

Pain management

  • Epidural

Potential complications

Procedure variants

Open Laparoscopic Robotic
Unique considerations
Position Supine then left

lateral decubitus

Surgical time
EBL
Postoperative disposition ICU ICU or ERAS ICU or ERAS
Pain management Thoracic Epidural Thoracic Epidural Thoracic Epidural
Potential complications Anastamotic leak (4.3%)

Vocal cord paresis (0.9%)

Mortality (1.68%)[1]

References

  1. ↑ Luketich, James D.; Pennathur, Arjun; Awais, Omar; Levy, Ryan M.; Keeley, Samuel; Shende, Manisha; Christie, Neil A.; Weksler, Benny; Landreneau, Rodney J.; Abbas, Ghulam; Schuchert, Matthew J. (2012-07). "Outcomes after minimally invasive esophagectomy: review of over 1000 patients". Annals of Surgery. 256 (1): 95–103. doi:10.1097/SLA.0b013e3182590603. ISSN 1528-1140. PMC 4103614. PMID 22668811. Check date values in: |date= (help)

Top contributors: Nirav Kamdar and Olivia Sutton

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