Difference between revisions of "Cholecystectomy"
From WikiAnesthesia
| Line 46: | Line 46: | ||
===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. -->=== | ||
* Consider epidural for open approach | |||
==Intraoperative management== | ==Intraoperative management== | ||
| Line 73: | Line 75: | ||
|+ | |+ | ||
! | ! | ||
! | !Open Cholecystectomy | ||
! | !Laparoscopic Cholecystectomy | ||
|- | |- | ||
|Unique considerations | |Unique considerations | ||
| | | | ||
| | | | ||
|- | |- | ||
|Position | |Position | ||
| | |Supine | ||
| | |Supine | ||
|- | |- | ||
|Surgical time | |Surgical time | ||
| | |2-4 hours | ||
| | |0.5-2 hours | ||
|- | |- | ||
|EBL | |EBL | ||
| | |250mL | ||
| | |Minimal | ||
|- | |- | ||
|Postoperative disposition | |Postoperative disposition | ||
| | |PACU | ||
| | |PACU | ||
|- | |- | ||
|Mortality | |Mortality | ||
| | | | ||
| | | | ||
|- | |- | ||
|Morbidity | |Morbidity | ||
| | | | ||
| | | | ||
|- | |- | ||
|Pain | |Pain | ||
| | |5-7 | ||
| | |3 | ||
|} | |} | ||
Revision as of 15:17, 9 February 2021
Cholecystectomy
| Anesthesia type |
General |
|---|---|
| Airway |
Endotracheal tube |
| Lines and access |
Peripheral IV |
| Monitors |
Standard ASA / 5-lead EKG |
| Primary anesthetic considerations | |
| Preoperative |
- |
| Intraoperative |
- |
| Postoperative |
- |
| Article quality | |
| Editor rating | |
| User likes | 1 |
A cholecystectomy is generally performed to treat symptomatic cholelithiasis and other gallbladder conditions. This is one of the most common procedures performed in hospitals in the United States. Of the more than 20 million people in the US with gallstones, about 30% will eventually require cholecystectomy to relieve symptoms or treat complications. A cholecystectomy can be performed laparoscopically or as an open procedure. Surgical practice has largely transitioned to the laparoscopic approach. The rate of conversion to an open operation is 2-3% for elective gallbladder surgery and ~10% for acute cholecystitis[1].
Preoperative management
Preoperative evaluation
| System | Considerations |
|---|---|
| Respiratory |
|
| Cardiovascular | |
| Renal |
|
| Gastrointestinal | |
| Hematologic |
|
Operating room preparation
Regional and neuraxial techniques
- Consider epidural for open approach
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
- Intraoperative insufflation may cause atelectasis, decrease FRC, increase PIPs, and increase CO2
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Open Cholecystectomy | Laparoscopic Cholecystectomy | |
|---|---|---|
| Unique considerations | ||
| Position | Supine | Supine |
| Surgical time | 2-4 hours | 0.5-2 hours |
| EBL | 250mL | Minimal |
| Postoperative disposition | PACU | PACU |
| Mortality | ||
| Morbidity | ||
| Pain | 5-7 | 3 |
References
- ↑ Jaffe, Richard A; Schmiesing, Clifford A; Golianu, Brenda (2014). Anesthesiologist's manual of surgical procedures. ISBN 978-1-4963-0594-7. OCLC 888551588.