Difference between revisions of "Mastectomy"
From WikiAnesthesia
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A total '''mastectomy''' refers to the complete removal of breast tissue. A modified radical mastectomy refers to the removal of the breast and the corresponding axillary lymph nodes. | A total '''mastectomy''' (simple mastectomy) refers to the complete removal of breast tissue. A modified radical mastectomy refers to the removal of the breast and the corresponding axillary lymph nodes. | ||
== Preoperative management == | == Preoperative management == | ||
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|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
| | |Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible. Use of trastuzamab can cause reversible decrease in LV function. | ||
|- | |- | ||
|Respiratory | |Respiratory | ||
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|- | |- | ||
|Hematologic | |Hematologic | ||
| | |Chemotherapy can cause anemia and thrombocytopenia. | ||
|- | |- | ||
|Renal | |Renal | ||
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | === Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | ||
* CBC with diff and platelet count | |||
=== 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. --> === | ||
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=== 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 Paravertebral Blocks | |||
== Intraoperative management == | == Intraoperative management == | ||
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* Ipsilateral arm may be prepped into field | * Ipsilateral arm may be prepped into field | ||
* Repositioning may be required | * Repositioning may be required | ||
* Avoid brachial plexus stretch | |||
=== 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. --> === | ||
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=== 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 | |||
* Lymphedema | |||
* Seroma | |||
* Pneumothorax | |||
== 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 06:48, 18 May 2021
Mastectomy
| Anesthesia type |
General |
|---|---|
| Airway |
ETT vs. LMA |
| Lines and access |
PIV |
| Monitors |
Standard monitors |
| Primary anesthetic considerations | |
| Preoperative |
Place IV in non-operative extremity |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A total mastectomy (simple mastectomy) refers to the complete removal of breast tissue. A modified radical mastectomy refers to the removal of the breast and the corresponding axillary lymph nodes.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible. Use of trastuzamab can cause reversible decrease in LV function. |
| Respiratory | |
| Gastrointestinal | |
| Hematologic | Chemotherapy can cause anemia and thrombocytopenia. |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
- CBC with diff and platelet count
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
- Consider Paravertebral Blocks
Intraoperative management
Monitoring and access
- 20g PIV (non-operative extremity)
- Place BP cuff on non-operative extremity
Induction and airway management
Positioning
- Supine
- Ipsilateral arm may be prepped into field
- Repositioning may be required
- Avoid brachial plexus stretch
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
- PACU
Pain management
Potential complications
- PONV
- Lymphedema
- Seroma
- Pneumothorax
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |