Difference between revisions of "Pancreaticoduodenectomy"
| Line 26: | Line 26: | ||
|- | |- | ||
|Pulmonary | |Pulmonary | ||
| | |Many pancreatic cancer patients have been heavy smokers, increased risk of pulmonary complications | ||
|- | |- | ||
|Gastrointestinal | |Gastrointestinal | ||
| | |Check if patient has had a bowel prep, they may be dry | ||
|- | |- | ||
|Hematologic | |Hematologic | ||
| | |Assess for anticoagulation and possible contraindications to an epidural. DVTs/PEs are major common complications of pancreatic cancer patients | ||
|- | |- | ||
|Renal | |Renal | ||
| Line 38: | Line 38: | ||
|- | |- | ||
|Endocrine | |Endocrine | ||
| | |80% have either diabetes or impaired glucose tolerance. Diabetics are at increased risk of MI, CVA, renal infarction | ||
|- | |- | ||
|Other | |Other | ||
| | |Pancreatitis patients tend to be hypotensive and hypovolemic | ||
More than 80% of pancreatic cancers are diagnosed in patients >65y/o with comorbidities. | |||
|} | |} | ||
| Line 48: | Line 49: | ||
* CBC, BMP, LFTs, coags | * CBC, BMP, LFTs, coags | ||
* EKG in any patient with risk factors for CAD | * EKG in any patient with risk factors for CAD | ||
*Type and Screen, have 2 units of pRBC on hold | |||
=== 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. --> === | ||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. 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. --> === | === 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. --> === | ||
* Preoperative epidural placement is common | |||
== Intraoperative management == | == Intraoperative management == | ||
| Line 80: | Line 86: | ||
|+ | |+ | ||
! | ! | ||
! | !Standard Whipple | ||
! | !Pylorus Preserving Whipple | ||
|- | |- | ||
| | |Procedure | ||
| | |Resection of head of pancreas, gallbladder, part of duodenum, pylorus of the stomach, and lymph nodes near the pancreatic head. | ||
| | Surgeon reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the SI during digestion | ||
|The pylorus is not resected | |||
|- | |- | ||
|Position | |Position | ||
Revision as of 07:10, 14 March 2022
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV x 2 |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative |
Mechanical bowel prep |
| Intraoperative |
Combined general + epidural |
| Postoperative |
PONV |
| Article quality | |
| Editor rating | |
| User likes | 1 |
The Pancreaticoduodenectomy is also known as the Whipple Procedure, after Dr. Allen Whipple. This is the most commonly performed surgery to remove pancreatic tumors, and is typically done for patients who have tumors located in the head of the pancreas or adjacent regions. The procedure is anatomically complicated, and there may be anatomical variations among the various involved blood vessels and ducts in the area. Even after pancreatic resection, the 5-year survival rate is only 15-20% (compared with 5% without surgery).
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Pulmonary | Many pancreatic cancer patients have been heavy smokers, increased risk of pulmonary complications |
| Gastrointestinal | Check if patient has had a bowel prep, they may be dry |
| Hematologic | Assess for anticoagulation and possible contraindications to an epidural. DVTs/PEs are major common complications of pancreatic cancer patients |
| Renal | |
| Endocrine | 80% have either diabetes or impaired glucose tolerance. Diabetics are at increased risk of MI, CVA, renal infarction |
| Other | Pancreatitis patients tend to be hypotensive and hypovolemic
More than 80% of pancreatic cancers are diagnosed in patients >65y/o with comorbidities. |
Labs and studies
- CBC, BMP, LFTs, coags
- EKG in any patient with risk factors for CAD
- Type and Screen, have 2 units of pRBC on hold
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
- Preoperative epidural placement is common
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Standard Whipple | Pylorus Preserving Whipple | |
|---|---|---|
| Procedure | Resection of head of pancreas, gallbladder, part of duodenum, pylorus of the stomach, and lymph nodes near the pancreatic head.
Surgeon reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the SI during digestion |
The pylorus is not resected |
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Barrett Larson, Olivia Sutton, Tony Wang and Chris Rishel