Difference between revisions of "Cholecystectomy"

From WikiAnesthesia
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 tachycardia, tachypnea, hyperthermia, and leukocytosis/leucopenia
* 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 22:39, 10 March 2021

Cholecystectomy
Anesthesia type

General

Airway

Endotracheal tube

Lines and access

Peripheral IV

Monitors

Standard ASA
5-lead EKG

Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
Article quality
Editor rating
Certified
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
  • Acute abdominal pain can cause respiratory impairment (respiratory splinting) resulting in atelectasis
Cardiovascular
  • Sepsis can result in hypotension, tachycardia
Renal
Gastrointestinal
Hematologic
  • Sepsis can result in leukocytosis/leucopenia
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

  1. Jaffe, Richard A; Schmiesing, Clifford A; Golianu, Brenda (2014). Anesthesiologist's manual of surgical procedures. ISBN 978-1-4963-0594-7. OCLC 888551588.