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	May have DVT in the upper extremity affected and may be on anticoagulation
Renal
Endocrine
Other

Labs and studies

Generally not necessary as most patients are young and healthy

Operating room setup

• If the surgeon wants to have neuro-monitoring to avoid injury to the brachaial plexus, you will need to avoid paralysis
  • TIVA with succinylcholine for induction would be ideal
• Can set up for GA with paralysis if no need for neuro-monitoring

Patient preparation and premedication

• Anxiolysis as needed

Regional and neuraxial techniques

• Paravertebral Block may help with post-op pain control

Intraoperative management

Induction and airway management

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

Positioning

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

Maintenance and surgical considerations

Avoid any IVs or BP cuff on the surgical side as that arm will be prepped and in the surgical field.

Procedure variants

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