Difference between revisions of "Esophagastric fundoplication"
From WikiAnesthesia
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General | ||
| airway = | | airway = ETT (DLT if thoracic approach) | ||
| lines_access = | | lines_access = Large bore PIV | ||
| monitors = | | monitors = Standard | ||
| considerations_preoperative = | | considerations_preoperative = Patients often Obese | ||
| considerations_intraoperative = | | considerations_intraoperative = Severe GERD - consider RSI | ||
| considerations_postoperative = | | considerations_postoperative = | ||
}} | }} | ||
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=== Indications === | === Indications === | ||
* Usually for symptomatic reflux refractory to medical management | |||
=== Surgical procedure === | === Surgical procedure === | ||
* The fundus of stomach is wrapped around the lower oesophagus | |||
== Preoperative management == | == Preoperative management == | ||
| Line 58: | Line 62: | ||
=== 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. --> === | ||
* Aspiration precautions if severe GERD | |||
=== 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 if laparoscopic approach | |||
== 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 monitors unless indicated by patient comorbidities | |||
* Large bore PIV generally sufficient. | |||
=== 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. --> === | ||
* Consider RSI | |||
* If laparoscopic abdominal approach: ETT | |||
=== 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. --> === | ||
* Supine | |||
=== 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. --> === | ||
* Laproscopic approach: ~5 porst in upper abdomen. | |||
=== 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. --> === | ||
* Routine. Ensure well suctioned of any gastric contents. | |||
== Postoperative management == | == Postoperative management == | ||
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=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
* Prn multimodals | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
* Complications are rare | |||
* Atelectasis | |||
* Esophageal or gastric perforation | |||
* Hemorrhage | |||
* Pneumothorax | |||
* Capnomediastinum | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
Revision as of 06:44, 15 February 2024
Esophagastric fundoplication
| Anesthesia type |
General |
|---|---|
| Airway |
ETT (DLT if thoracic approach) |
| Lines and access |
Large bore PIV |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative |
Patients often Obese |
| Intraoperative |
Severe GERD - consider RSI |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Provide a brief summary of this surgical procedure and its indications here.
Overview
Indications
- Usually for symptomatic reflux refractory to medical management
Surgical procedure
- The fundus of stomach is wrapped around the lower oesophagus
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
- Aspiration precautions if severe GERD
Regional and neuraxial techniques
- N/A if laparoscopic approach
Intraoperative management
Monitoring and access
- Standard monitors unless indicated by patient comorbidities
- Large bore PIV generally sufficient.
Induction and airway management
- Consider RSI
- If laparoscopic abdominal approach: ETT
Positioning
- Supine
Maintenance and surgical considerations
- Laproscopic approach: ~5 porst in upper abdomen.
Emergence
- Routine. Ensure well suctioned of any gastric contents.
Postoperative management
Disposition
Pain management
- Prn multimodals
Potential complications
- Complications are rare
- Atelectasis
- Esophageal or gastric perforation
- Hemorrhage
- Pneumothorax
- Capnomediastinum
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |