Appendectomy
Anesthesia type |
General |
---|---|
Airway |
Endotracheal tube |
Lines and access |
Peripheral IV |
Monitors |
Standard ASA / 5-Lead EKG |
Primary anesthetic considerations | |
Preoperative |
Full stomach precautions |
Intraoperative |
Rapid sequence induction |
Postoperative |
PONV |
Article quality | |
Editor rating | |
User likes | 2 |
An appendectomy is generally performed as an urgent or emergent procedure to treat appendicitis. Appendicitis can occur at any age, but is more common in patients 19-25 years old. Appendicitis is common, occurring in about 7% of the population. An appendectomy can be performed laparoscopically or as an open procedure. Surgical practice has largely transitioned to the laparoscopic approach[1].
Preoperative management
Preoperative evaluation
System | Considerations |
---|---|
Respiratory |
|
Cardiovascular |
|
Gastrointestinal |
|
Hematologic |
|
Labs |
|
Operating room preparation
- NG Tube
- Verify pre-incisions antibiotics required
Regional and neuraxial techniques
- Consider pre-incision nerve blocks
Intraoperative management
Monitoring and access
- Standard ASA monitors
- 5-lead EKG
- Urinary catheter
- 1 peripheral IV (typically 16-18 gauge)
Induction and airway management
- Pre-oxygenate with 100% FiO2
- Rapid Sequence Induction (RSI)
- Intubation
Positioning
- Supine
- Secure or tuck the arms
Maintenance and surgical considerations
- Standard maintenance
- Consider avoiding nitrous oxide given potential for bowel dissension and increased risk of PONV
- Place OG/NG before surgical incision to decompress the stomach
- Maintain norovolemia and normothermia
Emergence
- Extubate when patient awake and able to protect airway
- PONV prophylaxis
Postoperative management
Disposition
- PACU
- Patients undergoing laparoscopic appendectomy can often be discharged home from PACU
- Encourage early post-operative ambulation
Pain management
- Oral analgesics
- Non-opioid analgesics
- Ketoralac (Toradol)
- Acetaminophen (Tylenol)
- IV narcotics for breakthrough pain
Potential complications
- PONV
- Urinary retention (consider straight catheterization of bladder prior to emergence)
Procedure variants
Open Appendectomy | Laparoscopic Appendectomy | |
---|---|---|
Position | Supine | Supine |
Surgical time | 1 hour | 30-90 mins |
EBL | <75 mL | <75 mL |
Postoperative disposition | PACU | PACU |
Mortality | Perforated: 2%
Non-perforated: <0.1% |
Perforated: 2%
Non-perforated: <0.1% |
Complications | Perforation
Abscess Fistula Hematoma Illeus |
Perforation
Abscess Fistula Hematoma Illeus Conversion to Open |
Pain | 5-7 | 4 |
References
- ↑ Bhangu, Aneel; Søreide, Kjetil; Di Saverio, Salomone; Assarsson, Jeanette Hansson; Drake, Frederick Thurston (2015). "Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management". The Lancet. 386 (10000): 1278–1287. doi:10.1016/S0140-6736(15)00275-5.
Top contributors: Barrett Larson, Chris Rishel, Tony Wang and Olivia Sutton