Thoracic outlet syndrome surgery

Thoracic outlet syndrome surgery

Anesthesia type	General
Airway	ETT
Lines and access	PIV
Monitors	Standard
Primary anesthetic considerations
Preoperative	Generally young healthy females
Intraoperative
Postoperative	PONV
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Thoracic outlet syndrome surgery includes procedures such as first rib resection and scalenectomy. Symptoms include pain, tingling, or weakness in the upper extremity, with vascular involvement including venous swelling, arterial flow disruption, and deep vein thrombosis.

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic	May have numbness/tingling in affected upper extremity
Cardiovascular	May have vascular involvement (venous swelling, DVT, arterial compression)
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Generally not necessary as most patients are young and healthy

Operating room setup

• Standard GETA w/ paralysis setup

Patient preparation and premedication

• Anxiolysis as needed

Intraoperative management

Induction and airway management

Standard induction for GETA, paralysis okay as no nerve monitoring needed

Positioning

Left or right lateral decubitus, with affected upper extremity in operative field facing up. Generally with shoulder roll.

Procedure variants

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