VisualWikitext
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Tag: 2017 source edit
 
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| airway = Endotracheal tube
| airway = Endotracheal tube
| lines_access = Peripheral IV
| lines_access = Peripheral IV
| monitors = Standard ASA  /  5-Lead EKG
| monitors = Standard
| considerations_preoperative = Full stomach precautions
| considerations_preoperative = Full stomach precautions
| considerations_intraoperative = Rapid sequence induction
| considerations_intraoperative = Rapid sequence induction
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*Pregnancy test (for women of child bearing age)
*Pregnancy test (for women of child bearing age)
|}
|}
*


===Operating room preparation<!-- List any special, non-standard equipment, medications, fluids, or other preparations that should be made prior to surgery. If none, this section may be removed. -->===
===Operating room preparation<!-- List any special, non-standard equipment, medications, fluids, or other preparations that should be made prior to surgery. If none, this section may be removed. -->===
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*OG Tube (or NG if going to be left post-op)
*OG Tube (or NG if going to be left post-op)
*Verify pre-incisions antibiotics required
*Verify pre-incisions antibiotics required
*


===Regional and neuraxial techniques===
===Regional and neuraxial techniques===
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*Urinary catheter
*Urinary catheter
*1 peripheral IV (typically 18-20 gauge)
*1 peripheral IV (typically 18-20 gauge)
*


===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. -->===


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


===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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*Supine
*Supine
*Secure or tuck the arms / Check IV
*Secure or tuck the arms / Check IV
*


===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. -->===
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*PONV
*PONV
*Urinary retention (consider straight catheterization of bladder prior to emergence)
*Urinary retention (consider straight catheterization of bladder prior to emergence)
*


==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). -->==
==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"
{| class="wikitable"

Latest revision as of 21:57, 4 April 2022

Appendectomy
Anesthesia type

General

Airway

Endotracheal tube

Lines and access

Peripheral IV

Monitors

Standard

Primary anesthetic considerations
Preoperative

Full stomach precautions

Intraoperative

Rapid sequence induction

Postoperative

PONV

Article quality
Editor rating
Certified
User likes
2

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
Pulmonary
  • 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

  • OG Tube (or NG if going to be left post-op)
  • 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 18-20 gauge)

Induction and airway management

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

Positioning

  • Supine
  • Secure or tuck the arms / Check IV

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 normovolemia 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

  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.

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

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