Difference between revisions of "Appendectomy"
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| airway = Endotracheal tube | | airway = Endotracheal tube | ||
| lines_access = Peripheral IV | | lines_access = Peripheral IV | ||
| monitors = Standard | | monitors = Standard | ||
| considerations_preoperative = Full stomach precautions | | considerations_preoperative = Full stomach precautions | ||
| considerations_intraoperative = Rapid sequence induction | | considerations_intraoperative = Rapid sequence induction | ||
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!Considerations | !Considerations | ||
|- | |- | ||
| | |Pulmonary | ||
| | | | ||
* Acute abdominal pain can cause respiratory impairment (respiratory splinting) resulting in atelectasis | * Acute abdominal pain can cause respiratory impairment (respiratory splinting) resulting in atelectasis | ||
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*Pregnancy test (for women of child bearing age) | *Pregnancy test (for women of child bearing age) | ||
|} | |} | ||
===Operating room preparation<!-- List any special, non-standard equipment, medications, fluids, or other preparations that should be made prior to surgery. If none, this section may be removed. -->=== | ===Operating room preparation<!-- List any special, non-standard equipment, medications, fluids, or other preparations that should be made prior to surgery. If none, this section may be removed. -->=== | ||
| Line 53: | Line 52: | ||
*OG Tube (or NG if going to be left post-op) | *OG Tube (or NG if going to be left post-op) | ||
*Verify pre-incisions antibiotics required | *Verify pre-incisions antibiotics required | ||
===Regional and neuraxial techniques=== | ===Regional and neuraxial techniques=== | ||
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*Urinary catheter | *Urinary catheter | ||
*1 peripheral IV (typically 18-20 gauge) | *1 peripheral IV (typically 18-20 gauge) | ||
===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. -->=== | ||
*Pre-oxygenate with 100% FiO2 | *Pre-oxygenate with 100% FiO2 | ||
* Rapid Sequence Induction (RSI) | *Rapid Sequence Induction (RSI) | ||
*Intubation | *Intubation | ||
===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. -->=== | ||
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*Supine | *Supine | ||
*Secure or tuck the arms / Check IV | *Secure or tuck the arms / Check IV | ||
===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. -->=== | ||
| Line 112: | Line 107: | ||
*PONV | *PONV | ||
*Urinary retention (consider straight catheterization of bladder prior to emergence) | *Urinary retention (consider straight catheterization of bladder prior to emergence) | ||
==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). -->== | ||
{| class="wikitable" | {| class="wikitable" | ||
Latest revision as of 21:57, 4 April 2022
Appendectomy
| Anesthesia type |
General |
|---|---|
| Airway |
Endotracheal tube |
| Lines and access |
Peripheral IV |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative |
Full stomach precautions |
| Intraoperative |
Rapid sequence induction |
| Postoperative |
PONV |
| Article quality | |
| Editor rating | |
| User likes | 2 |
An appendectomy is generally performed as an urgent or emergent procedure to treat appendicitis. Appendicitis can occur at any age, but is more common in patients 19-25 years old. Appendicitis is common, occurring in about 7% of the population. An appendectomy can be performed laparoscopically or as an open procedure. Surgical practice has largely transitioned to the laparoscopic approach[1].
Preoperative management
Preoperative evaluation
| System | Considerations |
|---|---|
| Pulmonary |
|
| Cardiovascular |
|
| Gastrointestinal |
|
| Hematologic |
|
| Labs |
|
Operating room preparation
- OG Tube (or NG if going to be left post-op)
- Verify pre-incisions antibiotics required
Regional and neuraxial techniques
- Consider pre-incision nerve blocks
Intraoperative management
Monitoring and access
- Standard ASA monitors
- 5-lead EKG
- Urinary catheter
- 1 peripheral IV (typically 18-20 gauge)
Induction and airway management
- Pre-oxygenate with 100% FiO2
- Rapid Sequence Induction (RSI)
- Intubation
Positioning
- Supine
- Secure or tuck the arms / Check IV
Maintenance and surgical considerations
- Standard maintenance
- Consider avoiding nitrous oxide given potential for bowel dissension and increased risk of PONV
- Place OG/NG before surgical incision to decompress the stomach
- Maintain normovolemia and normothermia
Emergence
- Extubate when patient awake and able to protect airway
- PONV prophylaxis
Postoperative management
Disposition
- PACU
- Patients undergoing laparoscopic appendectomy can often be discharged home from PACU
- Encourage early post-operative ambulation
Pain management
- Oral analgesics
- Non-opioid analgesics
- Ketoralac (Toradol)
- Acetaminophen (Tylenol)
- IV narcotics for breakthrough pain
Potential complications
- PONV
- Urinary retention (consider straight catheterization of bladder prior to emergence)
Procedure variants
| Open Appendectomy | Laparoscopic Appendectomy | |
|---|---|---|
| Position | Supine | Supine |
| Surgical time | 1 hour | 30-90 mins |
| EBL | <75 mL | <75 mL |
| Postoperative disposition | PACU | PACU |
| Mortality | Perforated: 2%
Non-perforated: <0.1% |
Perforated: 2%
Non-perforated: <0.1% |
| Complications | Perforation
Abscess Fistula Hematoma Illeus |
Perforation
Abscess Fistula Hematoma Illeus Conversion to Open |
| Pain | 5-7 | 4 |
References
- ↑ Bhangu, Aneel; Søreide, Kjetil; Di Saverio, Salomone; Assarsson, Jeanette Hansson; Drake, Frederick Thurston (2015). "Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management". The Lancet. 386 (10000): 1278–1287. doi:10.1016/S0140-6736(15)00275-5.
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