Difference between revisions of "Nuss Bar Insertion"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General | ||
| airway = | | airway = ETT | ||
| lines_access = | | lines_access = 2 PIVs, atleast one should be a Large bore IV (16G or lower). | ||
| monitors = | | monitors = Standard | ||
| considerations_preoperative = | | considerations_preoperative = Administer Valium for muscle spasm | ||
| considerations_intraoperative = | | considerations_intraoperative = Erector spinae block for analgesia. Potential for massive hemorrhage due to injury to heart or major vessels. Consider neuromoscular blockade as movement during important surgical events can lead to inadvertent damage to great vessels. | ||
| considerations_postoperative = | | considerations_postoperative = Significant post-op pain, consider valium administration for spasms. | ||
}} | }} | ||
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|- | |- | ||
|Airway | |Airway | ||
| | | | ||
|- | |- | ||
|Neurologic | |Neurologic | ||
| | | | ||
|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
|Potential for injury to heart and great vessels during placement of Bar. | |Potential for injury to heart and great vessels during placement of Bar. Patient will have a pre-op echo to look at effect on cardiac function. | ||
|- | |- | ||
|Pulmonary | |Pulmonary | ||
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|- | |- | ||
|Hematologic | |Hematologic | ||
| | | | ||
|- | |- | ||
|Renal | |Renal | ||
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=== 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. --> === | === 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. --> === | ||
Check CBC and order Type and Screen | |||
=== 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. --> === | === 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. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
Diazepam is often administered as it helps with muscle spasm after surgery | |||
=== 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. --> === | ||
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=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
Two large bore IVs preferred. | |||
=== 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. --> === | ||
=== 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. --> === | ||
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. --> === | === 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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=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
Valium for post-op muscle spasm. Consider Ketorolac | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
Need for mass transfusion due to injury to great vessels | |||
== 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). --> == | ||
Latest revision as of 19:48, 30 July 2022
Nuss Bar Insertion
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
2 PIVs, atleast one should be a Large bore IV (16G or lower). |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative |
Administer Valium for muscle spasm |
| Intraoperative |
Erector spinae block for analgesia. Potential for massive hemorrhage due to injury to heart or major vessels. Consider neuromoscular blockade as movement during important surgical events can lead to inadvertent damage to great vessels. |
| Postoperative |
Significant post-op pain, consider valium administration for spasms. |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Provide a brief summary here.
Overview
Indications
Pectus Excavatum
Surgical procedure
Nuss Bar insertion
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | Potential for injury to heart and great vessels during placement of Bar. Patient will have a pre-op echo to look at effect on cardiac function. |
| Pulmonary | Patients usually have a Pulmpnary function test or "CPET". Results often provide useful information on amount of restrictive disease |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Check CBC and order Type and Screen
Operating room setup
Patient preparation and premedication
Diazepam is often administered as it helps with muscle spasm after surgery
Regional and neuraxial techniques
Erector Spinae Block
Intraoperative management
Monitoring and access
Two large bore IVs preferred.
Induction and airway management
Positioning
Supine
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Patient will be admitted inpatient post surgery
Pain management
Valium for post-op muscle spasm. Consider Ketorolac
Potential complications
Need for mass transfusion due to injury to great vessels
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Ashwini Bhat and Tony Wang