Difference between revisions of "Splenectomy"
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{{Infobox surgical procedure | <big>A splenectomy is the surgical removal of the spleen. This is achieved through a midline abdominal or left subcostal incision or laparoscopically. The spleen is mobilized by dividing the lateral peritoneal attachments while the spleen is retracted medially. The splenic artery is ligated, the splenic vein is tied; the ligaments supporting the spleen are detached and the spleen removed. The spleen can be removed in pieces or as a whole.</big> | ||
<big>Indications: trauma with uncontrolled bleeding; hematologic disorders, tumors, cysts, idiopathic thrombocytopenic purpura, hemolytic anemia, thrombosis of the splenic blood vessels, an accessory spleen is possible and is searched for, splenomegaly (spleen greater than 20 centimeters longitudinally), and staging of Hodgkin’s and non- Hodgkin’s disease</big>{{Infobox surgical procedure | |||
| anesthesia_type = General | | anesthesia_type = General | ||
| airway = ETT | | airway = ETT | ||
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== Overview == | == Overview == | ||
== Preoperative management == | == Preoperative management == | ||
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|+ | |+ | ||
! | ! | ||
! | !Open | ||
!Variant 2 | !Variant 2 | ||
|- | |- | ||
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|- | |- | ||
|Position | |Position | ||
| | |Supine | ||
| | | | ||
|- | |- | ||
|Surgical time | |Surgical time | ||
| | |2-4 hrs | ||
| | | | ||
|- | |- | ||
|EBL | |EBL | ||
| | |50-100 ml | ||
| | | | ||
|- | |- | ||
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== References == | == References == | ||
Jaffe, R. A., Schmiesing, C., & Golianu, B. (2009). Anesthesiologist's manual of surgical procedures (4th ed.). Philadelphia: Lippincott Williams & Wilkins. | |||
Macksey, Lynn Fitzgerald. (2012). Surgical procedures and anesthetic implications : a handbook for nurse anesthesia practice. Sudbury, MA :Jones & Bartlett Learning | |||
[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
Latest revision as of 17:43, 27 April 2022
A splenectomy is the surgical removal of the spleen. This is achieved through a midline abdominal or left subcostal incision or laparoscopically. The spleen is mobilized by dividing the lateral peritoneal attachments while the spleen is retracted medially. The splenic artery is ligated, the splenic vein is tied; the ligaments supporting the spleen are detached and the spleen removed. The spleen can be removed in pieces or as a whole.
Indications: trauma with uncontrolled bleeding; hematologic disorders, tumors, cysts, idiopathic thrombocytopenic purpura, hemolytic anemia, thrombosis of the splenic blood vessels, an accessory spleen is possible and is searched for, splenomegaly (spleen greater than 20 centimeters longitudinally), and staging of Hodgkin’s and non- Hodgkin’s disease
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
2 large bore PIVs; +/- arterial line |
| Monitors |
Standard; 5-lead ECG |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
Consider RSI if pt has abdominal distention |
| Postoperative |
PONV |
| Article quality | |
| Editor rating | |
| User likes | 1 |
Overview
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | Patients with systemic disease requiring splenectomy may be chronically ill and have ↓ cardiovascular reserve |
| Pulmonary | Patients who have splenomegaly may have a degree of left lower lobe atelectasis and compromised ventilation 2° intraabdominal pathology: ↓ FRC → ↑ A-a gradi- ent + ↓ PaO2 |
| Gastrointestinal | |
| Hematologic | Cytopenia is very common → Preop replacement of platelets should be considered in patients with severe thrombocytopenia. Myelosuppression should be anticipated in all patients receiving active chemotherapy. |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
- CXR, EKG may all be needed
- Lab tests should include a CBC, electrolytes, PT/PTT/INR, platelet count, BUN and creatinine, blood glucose, type and screen
- Check coagulation studies and platelet levels if patient is taking anticoagulants (i.e.: Plavix) before planning a spinal for neuraxial anesthesia
Operating room setup
Patient preparation and premedication
Usually type and screen; prepare 2 units PRBCs
Regional and neuraxial techniques
Epidural for post op pain management (not commonly used)
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Supine
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Open | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | Supine | |
| Surgical time | 2-4 hrs | |
| EBL | 50-100 ml | |
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Jaffe, R. A., Schmiesing, C., & Golianu, B. (2009). Anesthesiologist's manual of surgical procedures (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
Macksey, Lynn Fitzgerald. (2012). Surgical procedures and anesthetic implications : a handbook for nurse anesthesia practice. Sudbury, MA :Jones & Bartlett Learning