Difference between revisions of "Endoscopic retrograde cholangiopancreatography"
From WikiAnesthesia
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| airway = ETT | | airway = ETT | ||
| lines_access = 1 PIV | | lines_access = 1 PIV | ||
| monitors = | | monitors = Standard ASA monitors | ||
| considerations_preoperative = | | considerations_preoperative = Aspiration Precautions | ||
| considerations_intraoperative = | | considerations_intraoperative = Most patients should be considered for RSI | ||
| considerations_postoperative = | | considerations_postoperative = | ||
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | === Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | ||
* CBC | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
Make sure you have a lead apron available | |||
* Make sure you have a lead apron available | |||
* Have a prone pillow available and staff to help turn | |||
* Have bite block to facilitate scope passage available. | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
* N/A | |||
== Intraoperative management == | == Intraoperative management == | ||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
* Standard ASA monitors | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
* RSI | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
* Most patients will be prone for this procedure to aid in manipulation of scope into proper placement. If patient cannot tolerate position, lateral or supine positioning can be done (increases difficulty for proceduralist). | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
| Line 76: | Line 88: | ||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
* If obstruction in bile duct is removed, there is a high risk of bile aspiration. Have suction readily available. | |||
== Postoperative management == | == Postoperative management == | ||
Revision as of 13:13, 19 August 2022
Endoscopic retrograde cholangiopancreatography
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
1 PIV |
| Monitors |
Standard ASA monitors |
| Primary anesthetic considerations | |
| Preoperative |
Aspiration Precautions |
| Intraoperative |
Most patients should be considered for RSI |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Endoscopic approach to access the bile duct utilized to diagnose and treat liver, gallbladder, biliary, and pancreatic problems. Endoscope is inserted from the mouth to duodenum. Then the papilla of vater (Common bile duct outlet) is identified, catheterized, and injected with contrast to identify obstructions.
Overview
Indications
liver, gallbladder, biliary, and pancreatic pathology
Surgical procedure
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | ETT required, bite block |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other | Check cervical ROM |
Labs and studies
- CBC
Operating room setup
- Make sure you have a lead apron available
- Have a prone pillow available and staff to help turn
- Have bite block to facilitate scope passage available.
Patient preparation and premedication
Regional and neuraxial techniques
- N/A
Intraoperative management
Monitoring and access
- Standard ASA monitors
Induction and airway management
- RSI
Positioning
- Most patients will be prone for this procedure to aid in manipulation of scope into proper placement. If patient cannot tolerate position, lateral or supine positioning can be done (increases difficulty for proceduralist).
Maintenance and surgical considerations
General anesthesia with ETT. TIVA or volatile
Emergence
- If obstruction in bile duct is removed, there is a high risk of bile aspiration. Have suction readily available.
Postoperative management
Disposition
Pain management
Potential complications
Pancreatitis
Cholangitis
Perforation
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |