Colectomy

Colectomy

Anesthesia type	General +/- Epidural
Airway	ETT
Lines and access	PIV (1 or 2)
Monitors	Standard ASA 5-Lead EKG Urine output +/- Art line
Primary anesthetic considerations
Preoperative	Full stomach precautions if acute abdomen
Intraoperative
Postoperative
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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 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	Bowel obstruction increases risk for aspiration. Consider NG tube to decompress stomach.
Hematologic	Anemia can result from cancer, chronic inflammation and GI blood loss. Dehydration can cause hemoconcentration and mask anemia. GI malabsorption can impair coagulation system.
Renal	If oral intake reduced or there's been vomiting, there may be electrolyte abnormalities. Potential for metabolic acidosis in patients with diarrhea or having a bowel prep.
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
• Presurgical ERAS protocol
• Consider preop acetaminophen / gabapentin / celcoxib

Regional and neuraxial techniques

• Consider thoracic epidural (for open procedures)

Intraoperative management

Monitoring and access

• Typically only 1 PIV for laparoscopic and 2 for open cases
  • Upgraded access if anticipate more significant blood loss or fluid shifts

Induction and airway management

• RSI if bowel obstruction or distended abdomen

Positioning

• Supine
• May need steep Trendelenburg if laparoscopic

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications