Difference between revisions of "Circumcision"
From WikiAnesthesia
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* Set OR temperature to 70<sup>o</sup> to 75<sup>o</sup> | * Set OR temperature to 70<sup>o</sup> to 75<sup>o</sup> | ||
* Underbody | * Underbody bear hugger preheated | ||
=== 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. --> === | ||
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=== 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. --> === | ||
* Caudal epidural, penile block, or dorsal ring block for analgesia supplemented with general <ref name=":0" /><ref name=":1" />' | * Caudal epidural, penile block, pudendal nerve block, or dorsal ring block for analgesia supplemented with general <ref name=":0" /><ref name=":1" /><ref>{{Cite journal|last=Boisvert-Moreau|first=Frédérique|last2=Turcotte|first2=Bruno|last3=Albert|first3=Natalie|last4=Singbo|first4=Narcisse|last5=Moore|first5=Katherine|last6=Boivin|first6=Ariane|date=2022-11-17|title=Randomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcision|url=https://rapm.bmj.com/content/early/2022/11/16/rapm-2022-103785|journal=Regional Anesthesia & Pain Medicine|language=en|doi=10.1136/rapm-2022-103785|issn=1098-7339|pmid=36396298}}</ref>' | ||
*Caudal: 0.25% Bupivacaine 1cc/kg | *Caudal: 0.25% Bupivacaine 1cc/kg OR 0.2% ropivacaine | ||
== Intraoperative management == | == Intraoperative management == | ||
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*** IV/PO opioids | *** IV/PO opioids | ||
*** Topical local anesthetic | *** Topical local anesthetic | ||
*** Regional block | *** Regional block (penile block, can be performed by surgeon or anesthesia) | ||
*** Caudal epidural | *** Caudal epidural | ||
Latest revision as of 10:10, 2 August 2024
Circumcision
| Anesthesia type |
General, Caudal Epidural |
|---|---|
| Airway |
ETT vs LMA |
| Lines and access |
PIV x 1 |
| Monitors |
Standard, Temperature |
| Primary anesthetic considerations | |
| Preoperative |
OR and table pre-warmed |
| Intraoperative |
Temperature |
| Postoperative |
Emergence delirium |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Circumcision is a procedure involving the foreskin removal of the penis exposing the glans penis. Indication includes family reasons, phimosis or recurrent balanitis [1][2]. Most circumcisions occur in the newborn nursery performed by pediatrician or obstetrician with different clamps when patients are neonates[1][3]. However, if circumcision is performed in the operating room, the procedure begins with two incisions to remove the penile skin surrounding and covering the glans penis which is the most common method in the operating room[3].
Preoperative management
Operating room setup
- Set OR temperature to 70o to 75o
- Underbody bear hugger preheated
Patient preparation and premedication
- PO midazolam for anxiety in children experiencing separation anxiety
- PO acetaminophen for pain
Regional and neuraxial techniques
- Caudal epidural, penile block, pudendal nerve block, or dorsal ring block for analgesia supplemented with general [1][2][4]'
- Caudal: 0.25% Bupivacaine 1cc/kg OR 0.2% ropivacaine
Intraoperative management
Monitoring and access
- Standard ASA monitors
- Temperature
- PIV x 1
Induction and airway management
- Mask induction with sevoflurane +/- N2O
- ETT vs LMA
- IV induction for patients > 10 years old
Positioning
- Supine
Maintenance and surgical considerations
- Maintenance with volatile anesthetics, IV anesthetic or a combination
- Monitor temperature and ensure large surface areas are covered with warm blankets
Emergence
- Emergence delirium
Postoperative management
Disposition
- PACU
- Usually discharged home
Pain management
- Pain is mild
- Multimodal
- PO/PR/IV acetaminophen
- IV/PO NSAIDs
- IV/PO opioids
- Topical local anesthetic
- Regional block (penile block, can be performed by surgeon or anesthesia)
- Caudal epidural
- Multimodal
Potential complications
- Infection
- Hematoma
Procedure variants
| Circumcision | |
|---|---|
| Position | Supine |
| Surgical time | 30 minutes |
| EBL | Minimal |
| Postoperative disposition | Home |
| Pain management | Mild , multimodal |
| Potential complications | Infection, hematoma |
References
- ↑ 1.0 1.1 1.2 Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Sixth edition ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404.
|edition=has extra text (help)CS1 maint: others (link) - ↑ 2.0 2.1 A guide to pediatric anesthesia. Craig Sims, Dana Weber, Chris Johnson (2nd ed ed.). Cham. 2020. ISBN 978-3-030-19246-4. OCLC 1117280100.
|edition=has extra text (help)CS1 maint: others (link) - ↑ 3.0 3.1 Gregory's pediatric anesthesia. Dean B. Andropoulos, George A. Gregory (Sixth edition ed.). Hoboken, NJ. 2020. ISBN 978-1-119-37151-9. OCLC 1137179895.
|edition=has extra text (help)CS1 maint: others (link) - ↑ Boisvert-Moreau, Frédérique; Turcotte, Bruno; Albert, Natalie; Singbo, Narcisse; Moore, Katherine; Boivin, Ariane (2022-11-17). "Randomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcision". Regional Anesthesia & Pain Medicine. doi:10.1136/rapm-2022-103785. ISSN 1098-7339. PMID 36396298 Check
|pmid=value (help).