Sentinel lymph node biopsy

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Sentinel lymph node biopsy
Anesthesia type

GA, local with sedation

Airway

LMA

Lines and access

PIV sufficient

Monitors

standard

Primary anesthetic considerations
Preoperative

Cancer considerations. Radioisotope tagging beforehand means that cancelling "elective" cases is discouraged once they have been tagged.

Intraoperative

avoid BP cuff on ipsilateral arm.

Postoperative

PONV (breast surgery). With local infilitration, pain is usually minimal.

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Provide a brief summary here.

Overview

Indications

  • The sentinel lymph node is the first node or group of lymph nodes that drains from the primary cancer. Thus, it is used to check for metastastic breast cancer.

Surgical procedure

  • Carried out in conjunction with radioisotope tagging beforehand. The nodes with the highest degree of activity are removed.
  • Involves incision in axilla to excise corresponding nodes.

Preoperative management

Patient evaluation

System Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

  • Standard monitors
  • PIV sufficient

Induction and airway management

  • If GA - standard induction. Usually a fairly healthy population.
  • If MAC - propofol infusion +/- narcotic prn

Positioning

  • Supine. Arms out

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

  • Day procedure

Pain management

  • Usually small incision. Local infilitration +/- prn narcotic, multimodals sufficient.

Potential complications

Procedure variants

Variant 1 Variant 2
Unique considerations
Indications
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References