Circumcision

Circumcision
Anesthesia type	General, Caudal Epidural
Airway	ETT vs LMA
Lines and access	PIV x 1
Monitors	Standard, Temperature
	Primary anesthetic considerations
Preoperative	OR and table pre-warmed
Intraoperative	Temperature
Postoperative	Emergence delirium
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Editor rating	In development
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Circumcision is a procedure involving the foreskin removal of the penis exposing the glans penis. Indication includes family reasons, phimosis or recurrent balanitis ^[1]^[2]. Most circumcisions occur in the newborn nursery performed by pediatrician or obstetrician with different clamps when patients are neonates^[1]^[3]. However, if circumcision is performed in the operating room, the procedure begins with two incisions to remove the penile skin surrounding and covering the glans penis which is the most common method in the operating room^[3].

Preoperative management

Operating room setup

Set OR temperature to 70^o to 75^o
Underbody bair hugger preheated

Patient preparation and premedication

PO midazolam for anxiety in children experiencing separation anxiety
PO acetaminophen for pain

Regional and neuraxial techniques

Caudal epidural, penile block, or dorsal ring block for analgesia supplemented with general ^[1]^[2]'
Caudal: 0.25% Bupivacaine 1cc/kg

Intraoperative management

Monitoring and access

Standard ASA monitors
Temperature
PIV x 1

Induction and airway management

Mask induction with sevoflurane +/- N₂O
- ETT vs LMA
IV induction for patients > 10 years old

Positioning

Supine

Maintenance and surgical considerations

Maintenance with volatile anesthetics, IV anesthetic or a combination
Monitor temperature and ensure large surface areas are covered with warm blankets

Emergence

Emergence delirium

Postoperative management

Disposition

PACU
Usually discharged home

Pain management

Pain is mild
- Multimodal
  - PO/PR/IV acetaminophen
  - IV/PO NSAIDs
  - IV/PO opioids
  - Topical local anesthetic
  - Regional block
  - Caudal epidural

Potential complications

Infection
Hematoma

Procedure variants


	Circumcision
Position	Supine
Surgical time	30 minutes
EBL	Minimal
Postoperative disposition	Home
Pain management	Mild , multimodal
Potential complications	Infection, hematoma

References

↑ ^1.0 ^1.1 ^1.2 Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Sixth edition ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404. |edition= has extra text (help)CS1 maint: others (link)
↑ ^2.0 ^2.1 A guide to pediatric anesthesia. Craig Sims, Dana Weber, Chris Johnson (2nd ed ed.). Cham. 2020. ISBN 978-3-030-19246-4. OCLC 1117280100. |edition= has extra text (help)CS1 maint: others (link)
↑ ^3.0 ^3.1 Gregory's pediatric anesthesia. Dean B. Andropoulos, George A. Gregory (Sixth edition ed.). Hoboken, NJ. 2020. ISBN 978-1-119-37151-9. OCLC 1137179895. |edition= has extra text (help)CS1 maint: others (link)

Top contributors: Cornel Chiu, Gang Chen, Jashvin Patel and Chris Rishel

[:0-1] 1.0 ^1.1 ^1.2 Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Sixth edition ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404. |edition= has extra text (help)CS1 maint: others (link)

[:1-2] 2.0 ^2.1 A guide to pediatric anesthesia. Craig Sims, Dana Weber, Chris Johnson (2nd ed ed.). Cham. 2020. ISBN 978-3-030-19246-4. OCLC 1117280100. |edition= has extra text (help)CS1 maint: others (link)

[:2-3] 3.0 ^3.1 Gregory's pediatric anesthesia. Dean B. Andropoulos, George A. Gregory (Sixth edition ed.). Hoboken, NJ. 2020. ISBN 978-1-119-37151-9. OCLC 1137179895. |edition= has extra text (help)CS1 maint: others (link)

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