Difference between revisions of "Mastectomy"
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{{Infobox surgical case reference | {{Infobox surgical case reference | ||
| anesthesia_type = General | | anesthesia_type = General | ||
| airway = ETT | | airway = ETT | ||
| lines_access = PIV | LMA | ||
| monitors = Standard | | lines_access = PIV x1-2 | ||
| considerations_preoperative = | | monitors = Standard | ||
| considerations_preoperative = PIV in non-operative arm | |||
| considerations_intraoperative = | | considerations_intraoperative = | ||
| considerations_postoperative = | | considerations_postoperative = PONV | ||
}} | }} | ||
| Line 23: | Line 24: | ||
|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
|Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible. Use of trastuzamab can cause reversible decrease in LV function. | |Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible. | ||
Use of trastuzamab can cause reversible decrease in LV function. | |||
|- | |- | ||
|Pulmonary | |Pulmonary | ||
Latest revision as of 22:23, 4 April 2022
Mastectomy
| Anesthesia type |
General |
|---|---|
| Airway |
ETT LMA |
| Lines and access |
PIV x1-2 |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative |
PIV in non-operative arm |
| Intraoperative | |
| Postoperative |
PONV |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A total mastectomy (simple mastectomy) refers to the complete removal of breast tissue. A modified radical mastectomy refers to the removal of the breast and the corresponding axillary lymph nodes.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible.
Use of trastuzamab can cause reversible decrease in LV function. |
| Pulmonary | Patients receiving radiation therapy to the chest/thorax can have respiratory compromise |
| Gastrointestinal | |
| Hematologic | Chemotherapy can cause anemia and thrombocytopenia. |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
- CBC with diff and platelet count
- May have anemia or thrombocytopenia due to chemo
- EKG
- Consider echo
- May have cardiomyopathy due to chemotherapy
Operating room setup
Patient preparation and premedication
- Consider acetaminophen, gabapentin and/or celecoxib
- Anxiolysis, as needed
- ERAS protocol
Regional and neuraxial techniques
- Consider paravertebral blocks, transversus abdomens plane (TAP) block, or thoracic epidural
- Studies have shown a trend towards increasing utilization of peripheral nerve blocks (PNB) for mastectomy. As of 2018, ~13% of cases involved a PNB according to the National Anesthesia Clinical Outcomes Registry[1].
Intraoperative management
Monitoring and access
- PIV x 1-2 (non-operative extremity)
- Place BP cuff on non-operative extremity
Induction and airway management
- Standard induction
Positioning
- Supine
- Ipsilateral arm may be prepped into field
- Repositioning may be required
- Avoid brachial plexus stretch
- Repositioning may be required if reconstruction is also being done (i.e. latissimus doors flap)
Maintenance and surgical considerations
- Standard maintenance
- Surgeon may prefer no paralytic for the axillary direction
- Maintain normovolemia -goal-directed fluid management
- Maintain normothermia - warming blanket
- Avoid anemia and blood transfusions
- Watch out for potential pneumothorax with deep surgical exploration
Emergence
- PONV prophylaxis (females are more susceptible to PONV)
Postoperative management
Disposition
- PACU
Pain management
- Emphasize multimodal pain management
Potential complications
- PONV
- Lymphedema
- Seroma
- Pneumothorax
Procedure variants
| Total mastectomy | Modified radical mastectomy | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
- ↑ Lam, Stephanie; Qu, Helena; Hannum, Margaret; Tan, Kay See; Afonso, Anoushka; Tokita, Hanae K.; McCormick, Patrick J. (2021-05-24). "Trends in Peripheral Nerve Block Usage in Mastectomy and Lumpectomy: Analysis of a National Database From 2010 to 2018". Anesthesia & Analgesia: 10.1213/ANE.0000000000005368. doi:10.1213/ANE.0000000000005368. ISSN 0003-2999.