Difference between revisions of "Transurethral resection of bladder tumor"
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| monitors = Standard | | monitors = Standard | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = Muscle relaxation may be requested by surgeon | ||
| considerations_postoperative = | | considerations_postoperative = | ||
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A transurethral resection of bladder tumor (TURBT) is an endoscopic procedure used to diagnose, stage, and treat early tumors of the bladder. A resectoscope is passed into the bladder via the urethra and used to remove visible tumor. | A '''transurethral resection of bladder tumor''' ('''TURBT''') is an endoscopic procedure used to diagnose, stage, and treat early tumors of the bladder. A resectoscope is passed into the bladder via the urethra and used to remove visible tumor. | ||
== Preoperative management == | == Preoperative management == | ||
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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. --> === | ||
* Can be performed under spinal anesthesia | |||
** Spinal anesthesia will not eliminate | |||
== 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. --> === | ||
* PIV x1 | |||
=== 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. --> === | ||
* If GA, ETT vs. LMA | |||
** Surgeon may request sustained muscle relaxation to limit movement from obturator nerve stimulation | |||
=== 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. --> === | ||
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=== 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. --> === | ||
* Stimulation of the obturator nerve | * Stimulation of the obturator nerve can cause significant movement, which creates risk of bladder perforation | ||
**Risk increased if tumor involves lateral wall of the bladder | |||
**To avoid this reflex, muscle relaxation is often used | |||
*However, studies have shown that TIVA with LMA is a safe, reliable, and controllable method for maintenance of anesthesia with blunting of the obturator reflex<ref>{{Cite journal|date=2007-08-01|title=Total intravenous general anesthesia with laryngeal mask airway for transurethral resection of bladder tumor|url=https://www.sciencedirect.com/science/article/abs/pii/S1000194807600471|journal=Journal of Medical Colleges of PLA|language=en|volume=22|issue=4|pages=234–237|doi=10.1016/S1000-1948(07)60047-1|issn=1000-1948}}</ref> | |||
=== 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. --> === | ||
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* Bleeding | * Bleeding | ||
* Reabsorption | * Reabsorption | ||
== References == | == References == | ||
Latest revision as of 07:22, 9 April 2024
Transurethral resection of bladder tumor
| Anesthesia type |
GA or Neuraxial |
|---|---|
| Airway |
ETT/LMA (if GA) |
| Lines and access |
PIV x 1 |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
Muscle relaxation may be requested by surgeon |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A transurethral resection of bladder tumor (TURBT) is an endoscopic procedure used to diagnose, stage, and treat early tumors of the bladder. A resectoscope is passed into the bladder via the urethra and used to remove visible tumor.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
- Can be performed under spinal anesthesia
- Spinal anesthesia will not eliminate
Intraoperative management
Monitoring and access
- PIV x1
Induction and airway management
- If GA, ETT vs. LMA
- Surgeon may request sustained muscle relaxation to limit movement from obturator nerve stimulation
Positioning
- Lithotomy
Maintenance and surgical considerations
- Stimulation of the obturator nerve can cause significant movement, which creates risk of bladder perforation
- Risk increased if tumor involves lateral wall of the bladder
- To avoid this reflex, muscle relaxation is often used
- However, studies have shown that TIVA with LMA is a safe, reliable, and controllable method for maintenance of anesthesia with blunting of the obturator reflex[1]
Emergence
Postoperative management
Disposition
- PACU
Pain management
Potential complications
- Bladder perforation (most serious complication)
- Urethral rupture or false passage
- Bleeding
- Reabsorption
References
- ↑ "Total intravenous general anesthesia with laryngeal mask airway for transurethral resection of bladder tumor". Journal of Medical Colleges of PLA. 22 (4): 234–237. 2007-08-01. doi:10.1016/S1000-1948(07)60047-1. ISSN 1000-1948.
Top contributors: Barrett Larson, Chris Rishel and Tony Wang