Difference between revisions of "Colectomy"
From WikiAnesthesia
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A '''colectomy''' is a surgical procedure to remove all or part of the colon. A partial colectomy (also known a segmental or hemi-colectomy) involves removing a portion of the colon, followed by the creation of an anastomosis or stoma. With more advanced disease, the entire large intestine is removed (total colectomy). Colectomies are often done | A '''colectomy''' is a surgical procedure to remove all or part of the colon. A partial colectomy (also known a segmental or hemi-colectomy) involves removing a portion of the colon, followed by the creation of an anastomosis or stoma. With more advanced disease, the entire large intestine is removed (total colectomy). Colectomies are often done laparoscopically. Common indications for the procedure include cancer, bowel obstruction, colitis, or diverticulitis. | ||
== Preoperative management == | == Preoperative management == | ||
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* BMP / Electrolytes | * BMP / Electrolytes | ||
* Coags | * Coags | ||
* Consider T&S or T&C | * Consider T&S or T&C, particularly if open | ||
* | * | ||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
* NGT/OGT | |||
* Warming blanket | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
* Patients often have bowel prep | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
* Consider thoracic epidural if open | |||
== Intraoperative management == | == Intraoperative management == | ||
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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 | |||
* May need steep Trendelenburg if laparoscopic | |||
=== 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. --> === | ||
Revision as of 20:33, 12 May 2021
Colectomy
| Anesthesia type |
General +/- Epidural |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV x 1 |
| Monitors |
Standard ASA 5-Lead EKG Urine output +/- Art line |
| Primary anesthetic considerations | |
| Preoperative |
Full stomach precautions if acute abdomen |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A colectomy is a surgical procedure to remove all or part of the colon. A partial colectomy (also known a segmental or hemi-colectomy) involves removing a portion of the colon, followed by the creation of an anastomosis or stoma. With more advanced disease, the entire large intestine is removed (total colectomy). Colectomies are often done laparoscopically. Common indications for the procedure include cancer, bowel obstruction, colitis, or diverticulitis.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | Bowel rupture can cause sepsis or septic shock and hemodynamic instability. |
| Respiratory | If bowel obstruction and abdominal dissension, there may be impaired diaphragmatic excursion, which could negatively impact FRC and result in more rapid desaturations. Ensure adequate preoxygenation |
| Gastrointestinal | |
| Hematologic | |
| Renal | If oral intake reduced or there's been vomiting, there may be electrolyte abnormalities. |
| Endocrine | |
| Other |
Labs and studies
- CBC
- BMP / Electrolytes
- Coags
- Consider T&S or T&C, particularly if open
Operating room setup
- NGT/OGT
- Warming blanket
Patient preparation and premedication
- Patients often have bowel prep
Regional and neuraxial techniques
- Consider thoracic epidural if open
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
- Supine
- May need steep Trendelenburg if laparoscopic
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Barrett Larson, Tony Wang and Chris Rishel