Difference between revisions of "Cholecystectomy"
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Chris Rishel (talk | contribs) Tag: 2017 source edit |
(Preop and intraop management changes) |
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|Cardiovascular | |Cardiovascular | ||
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* Sepsis can result in hypotension, tachycardia | |||
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|Renal | |Renal | ||
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|Hematologic | |Hematologic | ||
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* Sepsis can result in | * Sepsis can result in leukocytosis/leucopenia | ||
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|Endocrine | |Endocrine | ||
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=== Labs and studies === | === Labs and studies === | ||
* CBC | |||
* Chemistry Panel | |||
* | * | ||
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==Intraoperative management== | ==Intraoperative management== | ||
===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. -->=== | ||
* Standard ASA monitors | |||
* 5-lead EKG | |||
* 1-2 peripheral IVs | |||
* In unstable patients, consider arterial line and central access | |||
===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. -->=== | ||
* Standard induction | |||
* In unstable patients, consider etomidate (BP control) and rapid sequence intubation (RSI) | |||
===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 | |||
* Secure and tuck arms | |||
===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. -->=== | ||
* Intraoperative insufflation may cause atelectasis, decrease FRC, increase PIPs, and increase CO2 | * Intraoperative insufflation may cause | ||
** Resp: atelectasis, decrease FRC, increase PIPs, and increase CO2 | |||
** GI: gastric content regurgitation | |||
** Cardiac: decreased cardiac output | |||
===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->=== | ===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->=== | ||
* PONV prophylaxis | |||
==Postoperative management== | ==Postoperative management== | ||
Revision as of 21:39, 10 March 2021
Cholecystectomy
| Anesthesia type |
General |
|---|---|
| Airway |
Endotracheal tube |
| Lines and access |
Peripheral IV |
| Monitors |
Standard ASA |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 1 |
A cholecystectomy is generally performed to treat symptomatic cholelithiasis and other gallbladder conditions. This is one of the most common procedures performed in hospitals in the United States. Of the more than 20 million people in the US with gallstones, about 30% will eventually require cholecystectomy to relieve symptoms or treat complications. A cholecystectomy can be performed laparoscopically or as an open procedure. Surgical practice has largely transitioned to the laparoscopic approach. The rate of conversion to an open operation is 2-3% for elective gallbladder surgery and ~10% for acute cholecystitis[1].
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Respiratory |
|
| Cardiovascular |
|
| Renal |
|
| Gastrointestinal | |
| Hematologic |
|
| Endocrine | |
| Other |
Labs and studies
- CBC
- Chemistry Panel
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
- Consider epidural for open approach
Intraoperative management
Monitoring and access
- Standard ASA monitors
- 5-lead EKG
- 1-2 peripheral IVs
- In unstable patients, consider arterial line and central access
Induction and airway management
- Standard induction
- In unstable patients, consider etomidate (BP control) and rapid sequence intubation (RSI)
Positioning
- Supine
- Secure and tuck arms
Maintenance and surgical considerations
- Intraoperative insufflation may cause
- Resp: atelectasis, decrease FRC, increase PIPs, and increase CO2
- GI: gastric content regurgitation
- Cardiac: decreased cardiac output
Emergence
- PONV prophylaxis
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Open Cholecystectomy | Laparoscopic Cholecystectomy | |
|---|---|---|
| Unique considerations | ||
| Position | Supine | Supine |
| Surgical time | 2-4 hours | 0.5-2 hours |
| EBL | 250mL | Minimal |
| Postoperative disposition | PACU | PACU |
| Mortality | ||
| Morbidity | ||
| Pain | 5-7 | 3 |
References
- ↑ Jaffe, Richard A; Schmiesing, Clifford A; Golianu, Brenda (2014). Anesthesiologist's manual of surgical procedures. ISBN 978-1-4963-0594-7. OCLC 888551588.