Incision and drainage of perianal abscess
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Incision and drainage of perianal abscess
Anesthesia type |
MAC, General, spinal |
---|---|
Airway | |
Lines and access |
PIV |
Monitors |
Standard |
Primary anesthetic considerations | |
Preoperative |
Airway and respiratory evaluation if considering prone position |
Intraoperative |
Prone position |
Postoperative | |
Article quality | |
Editor rating | |
User likes | 0 |
Incision and drainage (I&D) of perianal abscess is a procedure for treatment of abscesses at and around the anal verge. Patients typically have co-morbidities such as inflammatory bowel disease, malignancy, or traumatic injury leading to perianal abscesses. Many patients often have repeated I&Ds before resolution of their abscesses. These patients tend to be males in their 40-50s but can across all patient populations.
Preoperative management
Patient evaluation
System | Considerations |
---|---|
Airway | Standard evaluation
May be prone positioning so concern for airway difficulty may change anesthetic technique |
Neurologic | |
Cardiovascular | Standard evaluation |
Pulmonary | Evaluate for any signs/symptoms or co-morbidities that would signal decreased respiratory reserve, as patient positioning may be affected (lithotomy vs prone) |
Gastrointestinal | |
Hematologic | Blood loss from I&D of perianal abscesses is rare |
Renal | |
Endocrine | |
Other | Check with surgeon for ERAS protocol |
kLabs and studies
- CBC
- BMP
Regional and neuraxial techniques
- Spinal can be used if MAC/general anesthesia is contraindicated
- Epidurals can often spare the anal region.
Intraoperative management
Monitoring and access
- Standard monitors
- PIV
Induction and airway management
- If MAC: standard induction, face mask
- If general: prone position requires ETT over LMA. Standard induction unless concerned about aspiration
- If spinal: aim for L1-L2 level of analgesia, face mask for airway
Positioning
- Prone preferred
- If concerned about respiratory reserve, can consider lithotomy after discussion with surgeon
Maintenance and surgical considerations
- Standard Maintenance
- Pain is usually greatest with initial incision, requiring up front analgesia
Emergence
- Standard emergence
- Standard PONV prophylaxis
Postoperative management
Disposition
Typically outpatient procedure
Pain management
- Pain usually greatest intra-op, can be treated with rapid acting analgesics such as fentanyl, ketamine, or remifentanil given duration of procedure is short
- Post-op pain usually improved compared to pre-op, consider multi-modal adjuncts to long acting opioids if needed
Potential complications
- Sepsis
- Positioning can lead to axillary nerve damage or peroneal nerve damage (if lithotomy)
- Conversion from MAC to general
Procedure variants
Variant 1 | Variant 2 | |
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Unique considerations | ||
Position | ||
Surgical time | ||
EBL | ||
Postoperative disposition | ||
Pain management | ||
Potential complications |
References
- ↑ Jaffe, Richard (2022). Anesthesiologist's Manual of Surgical Procedures. Wolters Kluwer. pp. 618–620. ISBN 1496371259.
- ↑ Sigmon, David F.; Emmanuel, Bishoy; Tuma, Faiz (2024), "Perianal Abscess", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 29083652, retrieved 2024-02-13
Top contributors: Mitchel DeVita, Sean Liu and Chris Rishel