Difference between revisions of "Pancreatectomy"

Pancreatectomy
Anesthesia type	General ± Epidural
Airway	ETT
Lines and access	PIV x2 Arterial line
Monitors	Standard 5-lead ECG Temperature ABP
	Primary anesthetic considerations
Preoperative	Electrolyte disturbances Diabetes management
Intraoperative	Hypovolemia Glucose management
Postoperative
	Article quality
Editor rating	In development
User likes	0

VisualWikitext

Latest revision as of 11:40, 5 April 2022

A pancreatectomy can be indicated for conditions such as pancreatic stones, cysts, benign or malignant tumors, ductal obstructions, or chronic pancreatitis. It can be classified as total, where the entire organ is removed, often along with the spleen, gallbladder, local lymph nodes, the common bile duct, and portions of the small intestine and stomach, or partial, where the pancreas is resected from the mesenteric vessels distally, leaving the head and uncinate process intact.

Preoperative management

Patient evaluation


System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine	Diabetes is common in these patients, glucose management should be considered
Other	Electrolyte derangements and hypovolemia common in patients with pancreatitis

Labs and studies

CBC
Electrolytes
- Especially K+, serum glucose, BUN, Cr
Coagulation panel
LFTs
Urinalysis
EKG
CXR
TTE is commonly requested

Operating room setup

Have insulin available for glucose management
Have pressor (usually norepinephrine) available for management of hypotension

Patient preparation and premedication

Regional and neuraxial techniques

Epidurals are common to manage postoperative pain
If epidural is not performed, TAP blocks can be an alternative

Intraoperative management

Monitoring and access

Arterial line
2 large bore IVs

Induction and airway management

Positioning

Supine

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Floor vs. ICU

Pain management

Epidural is common for postoperative pain management
TAP blocks are an alternative for patients who cannot receive epidurals

Potential complications

Endocrine and exocrine insufficiency
Wound infection
Duodenal necrosis
Diabetes
Hemorrhage

Procedure variants


	Total	Near-Total (Child's Procedure)	Partial (Distal)
Indications	Pancreatic stones, cysts, ductal obstruction, benign or malignant tumor, chronic pancreatitis	When underlying disease has functionally destroyed the pancreas or when lesser procedures have failed to provide adequate pain relief	Tumor or pancreatitis
Surgical procedure	Entire organ removed, usually with spleen, gallbladder, local lymph nodes, CBD, portions of SI and stomach. Remaining distal stomach is anastomosed to a portion of the SI	Removal of entire pancreas except rim of tissue along the lesser curvature of the duodenum, which makes it unnecessary to reconstruct the bile duct	Resection of the pancreas from the mesenteric vessels distally, leaving the head and uncinate process intact
Surgical time	3-6h	3-6h
EBL	300-500cc	300-500cc
Postoperative disposition
Pain management
Potential complications

References

Top contributors: Olivia Sutton and Chris Rishel

@@ Line 1: / Line 1: @@
+{{Infobox surgical procedure
+| anesthesia_type = General
+± Epidural
+| airway = ETT
+| lines_access = PIV x2
+Arterial line
+| monitors = Standard
+-lead ECG
+Temperature
+ABP
+| considerations_preoperative = Electrolyte disturbances
+Diabetes management
+| considerations_intraoperative = Hypovolemia
+Glucose management
+| considerations_postoperative =
+}}
+A '''pancreatectomy''' can be indicated for conditions such as pancreatic stones, cysts, benign or malignant tumors, ductal obstructions, or chronic pancreatitis. It can be classified as '''total''', where the entire organ is removed, often along with the spleen, gallbladder, local lymph nodes, the common bile duct, and portions of the small intestine and stomach, or '''partial''', where the pancreas is resected from the mesenteric vessels distally, leaving the head and uncinate process intact.
+== Preoperative management ==
+=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
+{| class="wikitable"
+|+
+!System
+!Considerations
+|-
+|Airway
+|
+|-
+|Neurologic
+|
+|-
+|Cardiovascular
+|
+|-
+|Pulmonary
+|
+|-
+|Gastrointestinal
+|
+|-
+|Hematologic
+|
+|-
+|Renal
+|
+|-
+|Endocrine
+|Diabetes is common in these patients, glucose management should be considered
+|-
+|Other
+|Electrolyte derangements and hypovolemia common in patients with pancreatitis
+|}
+=== 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. --> ===
+* CBC
+* Electrolytes
+**Especially K+, serum glucose, BUN, Cr
+* Coagulation panel
+* LFTs
+* Urinalysis
+* EKG
+* CXR
+* TTE is commonly requested
+=== 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. --> ===
+* Have insulin available for glucose management
+*Have pressor (usually norepinephrine) available for management of hypotension
+=== 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. --> ===
+* Epidurals are common to manage postoperative pain
+* If epidural is not performed, TAP blocks can be an alternative
+== 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. --> ===
+* Arterial line
+*2 large bore IVs
+=== 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. --> ===
+* Supine
+=== 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. --> ===
+* Floor vs. ICU
+=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
+* Epidural is common for postoperative pain management
+* TAP blocks are an alternative for patients who cannot receive epidurals
+=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
+* Endocrine and exocrine insufficiency
+* Wound infection
+* Duodenal necrosis
+* Diabetes
+* Hemorrhage
+== 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 wikitable-horizontal-scroll"
+|+
+!
+!Total
+!Near-Total (Child's Procedure)
+!Partial (Distal)
+|-
+|Indications
+|Pancreatic stones, cysts, ductal obstruction, benign or malignant tumor, chronic pancreatitis
+|When underlying disease has functionally destroyed the pancreas or when lesser procedures have failed to provide adequate pain relief
+|Tumor or pancreatitis
+|-
+|Surgical procedure
+|Entire organ removed, usually with spleen, gallbladder, local lymph nodes, CBD, portions of SI and stomach. Remaining distal stomach is anastomosed to a portion of the SI
+|Removal of entire pancreas except rim of tissue along the lesser curvature of the duodenum, which makes it unnecessary to reconstruct the bile duct
+|Resection of the pancreas from the mesenteric vessels distally, leaving the head and uncinate process intact
+|-
+|Surgical time
+|3-6h
+|3-6h
+|
+|-
+|EBL
+|300-500cc
+|300-500cc
+|
+|-
+|Postoperative disposition
+|
+|
+|
+|-
+|Pain management
+|
+|
+|
+|-
+|Potential complications
+|
+|
+|
+|}
+== References ==
+[[Category:Surgical procedures]]
+[[Category:General surgery]]
+[[Category:Pancreatic surgery]]

Anesthesia type	General ± Epidural
Airway	ETT
Lines and access	PIV x2 Arterial line
Monitors	Standard 5-lead ECG Temperature ABP
Primary anesthetic considerations
Preoperative	Electrolyte disturbances Diabetes management
Intraoperative	Hypovolemia Glucose management
Postoperative
Article quality
Editor rating	In development
User likes	0