Difference between revisions of "Hepatic resection"
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{{Infobox surgical procedure | |||
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Hepatic resection involves either an open or laparoscopic approach to removal of often metastatic disease from cancer, although other pathologies requiring resection exist. In the past, hepatectomy was associated with up to 20% mortality rate. However significant improvements in surgical technique and management have resulted in large reductions in mortality and morbidity. | |||
The surgical course includes four main phases: assessment, mobilization, parenchymal transection, and closure. Keeping central venous pressure (CVP) low through the first 3 phases is crucial in preventing excessive hemorrhage. A low CVP makes the dissection phase easier (less distended hepatic outflow), and it minimizes venous back bleeding). Following parenchymal transection, patients can be appropriately resuscitated. | |||
== Preoperative management == | |||
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> === | |||
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|Gastrointestinal | |||
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|Hematologic | |||
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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. --> === | |||
=== 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. --> === | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | |||
NPO past midnight on night prior. Some protocols include use of clear carbohydrate beverage up to 2 hours prior to surgery. | |||
Avoid preoperative acetaminophen or gabapentin | |||
Consider Celebrex for multimodal pain control | |||
Consider scopolamine patch for PONV (do not give in patients with glaucoma) | |||
=== 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. --> === | |||
== 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. --> === | |||
=== 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. --> === | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | |||
=== 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. --> === | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | |||
== Postoperative management == | |||
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | |||
== 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). --> == | |||
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!Variant 2 | |||
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|Unique considerations | |||
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|Position | |||
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|Surgical time | |||
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|EBL | |||
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|Postoperative disposition | |||
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|Pain management | |||
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== References == | |||
[[Category:Surgical procedures]] | |||
Revision as of 06:19, 24 February 2022
Hepatic resection
| Anesthesia type | |
|---|---|
| Airway | |
| Lines and access | |
| Monitors | |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Hepatic resection involves either an open or laparoscopic approach to removal of often metastatic disease from cancer, although other pathologies requiring resection exist. In the past, hepatectomy was associated with up to 20% mortality rate. However significant improvements in surgical technique and management have resulted in large reductions in mortality and morbidity.
The surgical course includes four main phases: assessment, mobilization, parenchymal transection, and closure. Keeping central venous pressure (CVP) low through the first 3 phases is crucial in preventing excessive hemorrhage. A low CVP makes the dissection phase easier (less distended hepatic outflow), and it minimizes venous back bleeding). Following parenchymal transection, patients can be appropriately resuscitated.
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
NPO past midnight on night prior. Some protocols include use of clear carbohydrate beverage up to 2 hours prior to surgery.
Avoid preoperative acetaminophen or gabapentin
Consider Celebrex for multimodal pain control
Consider scopolamine patch for PONV (do not give in patients with glaucoma)
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Mitchel DeVita, Tony Wang and Chris Rishel