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<big>A splenectomy is the surgical removal of the spleen. This is achieved through a midline abdominal or left subcostal incision or laparoscopically. The spleen is mobilized by dividing the lateral peritoneal attachments while the spleen is retracted medially. The splenic artery is ligated, the splenic vein is tied; the ligaments supporting the spleen are detached and the spleen removed. The spleen can be removed in pieces or as a whole.</big>


<big>Indications: trauma with uncontrolled bleeding; hematologic disorders, tumors, cysts, idiopathic thrombocytopenic purpura, hemolytic anemia, thrombosis of the splenic blood vessels, an accessory spleen is possible and is searched for, splenomegaly (spleen greater than 20 centimeters longitudinally), and staging of Hodgkin’s and non- Hodgkin’s disease</big>{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = 2 large bore PIVs; +/- arterial line
| monitors = Standard; 5-lead ECG
| considerations_preoperative =
| considerations_intraoperative = Consider RSI if pt has abdominal distention
| considerations_postoperative = PONV
}}
== Overview ==
== 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
|Patients with systemic disease requiring splenectomy may be chronically ill and have ↓ cardiovascular reserve
|-
|Pulmonary
|Patients who have splenomegaly may have a degree of left lower lobe atelectasis and compromised ventilation 2° intraabdominal pathology: ↓ FRC → ↑ A-a gradi- ent + ↓ PaO2
|-
|Gastrointestinal
|
|-
|Hematologic
|Cytopenia is very common → Preop replacement of platelets should be considered in patients with severe thrombocytopenia. Myelosuppression should be anticipated in all patients receiving active chemotherapy.
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}
=== 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. --> ===
* CXR, EKG may all be needed
* Lab tests should include a CBC, electrolytes, PT/PTT/INR, platelet count, BUN and creatinine, blood glucose, type and screen
* Check coagulation studies and platelet levels if patient is taking anticoagulants (i.e.: Plavix) before planning a spinal for neuraxial anesthesia
=== 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. --> ===
Usually type and screen; prepare 2 units PRBCs
=== 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. --> ===
Epidural for post op pain management (not commonly used)
== 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. --> ===
=== 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. --> ===
=== Pain management<!-- 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. --> ===
== 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"
|+
!
!Open
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|Supine
|
|-
|Surgical time
|2-4 hrs
|
|-
|EBL
|50-100 ml
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}
== References ==
Jaffe, R. A., Schmiesing, C., & Golianu, B. (2009). Anesthesiologist's manual of surgical procedures (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
Macksey, Lynn Fitzgerald. (2012). Surgical procedures and anesthetic implications : a handbook for nurse anesthesia practice. Sudbury, MA :Jones & Bartlett Learning
[[Category:Surgical procedures]]

Latest revision as of 17:43, 27 April 2022

A splenectomy is the surgical removal of the spleen. This is achieved through a midline abdominal or left subcostal incision or laparoscopically. The spleen is mobilized by dividing the lateral peritoneal attachments while the spleen is retracted medially. The splenic artery is ligated, the splenic vein is tied; the ligaments supporting the spleen are detached and the spleen removed. The spleen can be removed in pieces or as a whole.

Indications: trauma with uncontrolled bleeding; hematologic disorders, tumors, cysts, idiopathic thrombocytopenic purpura, hemolytic anemia, thrombosis of the splenic blood vessels, an accessory spleen is possible and is searched for, splenomegaly (spleen greater than 20 centimeters longitudinally), and staging of Hodgkin’s and non- Hodgkin’s disease

Splenectomy
Anesthesia type

General

Airway

ETT

Lines and access

2 large bore PIVs; +/- arterial line

Monitors

Standard; 5-lead ECG

Primary anesthetic considerations
Preoperative
Intraoperative

Consider RSI if pt has abdominal distention

Postoperative

PONV

Article quality
Editor rating
In development
User likes
1

Overview

Preoperative management

Patient evaluation

System Considerations
Airway
Neurologic
Cardiovascular Patients with systemic disease requiring splenectomy may be chronically ill and have ↓ cardiovascular reserve
Pulmonary Patients who have splenomegaly may have a degree of left lower lobe atelectasis and compromised ventilation 2° intraabdominal pathology: ↓ FRC → ↑ A-a gradi- ent + ↓ PaO2
Gastrointestinal
Hematologic Cytopenia is very common → Preop replacement of platelets should be considered in patients with severe thrombocytopenia. Myelosuppression should be anticipated in all patients receiving active chemotherapy.
Renal
Endocrine
Other

Labs and studies

  • CXR, EKG may all be needed
  • Lab tests should include a CBC, electrolytes, PT/PTT/INR, platelet count, BUN and creatinine, blood glucose, type and screen
  • Check coagulation studies and platelet levels if patient is taking anticoagulants (i.e.: Plavix) before planning a spinal for neuraxial anesthesia

Operating room setup

Patient preparation and premedication

Usually type and screen; prepare 2 units PRBCs

Regional and neuraxial techniques

Epidural for post op pain management (not commonly used)

Intraoperative management

Monitoring and access

Induction and airway management

Positioning

Supine

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

Open Variant 2
Unique considerations
Position Supine
Surgical time 2-4 hrs
EBL 50-100 ml
Postoperative disposition
Pain management
Potential complications

References

Jaffe, R. A., Schmiesing, C., & Golianu, B. (2009). Anesthesiologist's manual of surgical procedures (4th ed.). Philadelphia: Lippincott Williams & Wilkins.

Macksey, Lynn Fitzgerald. (2012). Surgical procedures and anesthetic implications : a handbook for nurse anesthesia practice. Sudbury, MA :Jones & Bartlett Learning

Top contributors: Jessica Milin

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