Difference between revisions of "Cholecystectomy"
From WikiAnesthesia
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| monitors = Standard ASA<br /> | | monitors = Standard ASA<br /> | ||
5-lead EKG | 5-lead EKG | ||
| considerations_preoperative = | | considerations_preoperative = NG Tube | ||
| considerations_intraoperative = | | considerations_intraoperative = Rapid sequence intubation | ||
| considerations_postoperative = | | considerations_postoperative = PONV | ||
}}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<ref>{{Cite book|last=Jaffe|first=Richard A|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805|title=Anesthesiologist's manual of surgical procedures|last2=Schmiesing|first2=Clifford A|last3=Golianu|first3=Brenda|date=2014|isbn=978-1-4963-0594-7|language=English|oclc=888551588}}</ref>. | }}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<ref>{{Cite book|last=Jaffe|first=Richard A|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805|title=Anesthesiologist's manual of surgical procedures|last2=Schmiesing|first2=Clifford A|last3=Golianu|first3=Brenda|date=2014|isbn=978-1-4963-0594-7|language=English|oclc=888551588}}</ref>. | ||
==Preoperative management== | ==Preoperative management== | ||
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* Standard ASA monitors | * Standard ASA monitors | ||
* 5-lead EKG | * 5-lead EKG | ||
* 1-2 peripheral IVs | * Urinary catheter | ||
* In unstable patients, consider arterial line and central access | * NG tube | ||
* 1-2 peripheral IVs (16-18 gauge) | |||
* In unstable patients or if open cholecystectomy, 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. -->=== | ||
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===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 | * Supine, Trendelenburg | ||
* Secure and tuck arms | * Secure and tuck arms | ||
| Line 86: | Line 88: | ||
* Intraoperative insufflation may cause | * Intraoperative insufflation may cause | ||
** Resp: atelectasis, decrease FRC, increase PIPs, and increase CO2 | ** Resp: atelectasis, decrease FRC, increase PIPs, and increase CO2. May also cause endobronchial intubation | ||
** GI: gastric content regurgitation | ** GI: gastric content regurgitation | ||
** Cardiac: decreased cardiac output | ** Cardiac: decreased cardiac output | ||
| Line 98: | Line 100: | ||
===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ||
* NSAIDs and acetaminophen for mild pain | |||
* Opioids for breakthrough pain. Consider PCA for open cases | |||
===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->=== | ===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->=== | ||
* PONV | |||
* Subcutaneous emphysema (from insufflation) | |||
* Bowel injury | |||
==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). -->== | ||
Revision as of 22:05, 10 March 2021
Cholecystectomy
| Anesthesia type |
General |
|---|---|
| Airway |
Endotracheal tube |
| Lines and access |
Peripheral IV |
| Monitors |
Standard ASA |
| Primary anesthetic considerations | |
| Preoperative |
NG Tube |
| Intraoperative |
Rapid sequence intubation |
| Postoperative |
PONV |
| 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
- NG tube
Patient preparation and premedication
- Midazolam
Regional and neuraxial techniques
- Consider epidural for open approach
Intraoperative management
Monitoring and access
- Standard ASA monitors
- 5-lead EKG
- Urinary catheter
- NG tube
- 1-2 peripheral IVs (16-18 gauge)
- In unstable patients or if open cholecystectomy, 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, Trendelenburg
- Secure and tuck arms
Maintenance and surgical considerations
- Intraoperative insufflation may cause
- Resp: atelectasis, decrease FRC, increase PIPs, and increase CO2. May also cause endobronchial intubation
- GI: gastric content regurgitation
- Cardiac: decreased cardiac output
Emergence
- PONV prophylaxis
Postoperative management
Disposition
Pain management
- NSAIDs and acetaminophen for mild pain
- Opioids for breakthrough pain. Consider PCA for open cases
Potential complications
- PONV
- Subcutaneous emphysema (from insufflation)
- Bowel injury
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.