Laparoscopic colectomy

Laparoscopic colectomy

Anesthesia type	General
Airway	ETT
Lines and access	PIV
Monitors	Standard, usually no A line needed
Primary anesthetic considerations
Preoperative	NPO status, volume status
Intraoperative	hypercapnia, decreased preload
Postoperative	PONV
Article quality
Editor rating	In development
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Laparoscopy approach to surgery requires insufflation of gas, most commonly carbon dioxide (CO2), to allow for visualization through laparoscopic instruments. A colectomy is a surgical procedure to remove all or part of the colon. A partial colectomy (also known a segmental or hemi-colectomy) involves removing a portion of the colon, followed by the creation of an anastomosis or stoma.

Compared to open surgery, laparoscopic approaches generate multiple different physiologic effects. Most concerning are increased intra-abdominal pressure and its hemodynamic effects as well as hypercapnia from CO2 absorption. Laparoscopic procedures also tend to require increased time vs an open procedure.

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Regional and neuraxial techniques

While laparoscopic procedures have been successfully preformed under neuraxial, this is less commonly done. Abdominal insufflation is generally less well tolerated in an awake patient and positioning (trendelenburg vs reverse trendelenburg) can also limit this technique. If done, usually a T4-T6 level is required.

Post induction or pre emergence truncal blocks, such as a transversus abdominis plane (TAP) block or quadratus lumborum (QL) block can help reduce post operative pain.

Intraoperative management

Induction and airway management

Generally an endotracheal tube is required as it allows for the optimal control of ventilation as well as aspiration protection.

Natural airway should be avoided given the increased intra abdominal pressure and concern for aspiration.

Supraglottic airway devices such as the laryngeal mask airway (LMA) are also typically avoided. Increased airway pressures are required to overcome the increased intra abdominal pressures generated by insufflation. Second generation LMA devices theoretically can hols a seal at these elevated pressures, however they do not protect against aspiration.

Procedure variants

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