Difference between revisions of "Colectomy"
From WikiAnesthesia
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=== 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. --> === | ||
* 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<!-- 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. --> === | ||
* RSI if bowel obstruction or distended abdomen | |||
=== 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. --> === | ||
Revision as of 20:45, 12 May 2021
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 | |
| 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
- 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
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