Difference between revisions of "Incision and drainage of perianal abscess"

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{{Infobox surgical procedure
{{Infobox surgical procedure
| anesthesia_type =  
| anesthesia_type = [[MAC]], General, spinal
| airway =  
| airway = Face Mask, [[LMA]], [[ETT]]
| lines_access =  
| lines_access = PIV
| monitors =  
| monitors = Standard
| considerations_preoperative =  
| considerations_preoperative = Airway and respiratory evaluation if considering prone position
| considerations_intraoperative =  
| considerations_intraoperative = Prone position
| considerations_postoperative =  
| considerations_postoperative =  
}}
}}'''Incision and drainage (I&D) of perianal abscess''' is a procedure for treatment of abscesses at and around the anal verge. Patients typically have co-morbidities such as inflammatory bowel disease, malignancy, or traumatic injury leading to perianal abscesses. Many patients often have repeated I&Ds before resolution of their abscesses. These patients tend to be males in their 40-50s but can across all patient populations.
 
Provide a brief summary of this surgical procedure and its indications here.


== Preoperative management ==
== Preoperative management ==
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|-
|-
|Airway
|Airway
|
|Standard evaluation
May be prone positioning so concern for airway difficulty may change anesthetic technique
|-
|-
|Neurologic
|Neurologic
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|-
|-
|Cardiovascular
|Cardiovascular
|
|Standard evaluation
|-
|-
|Pulmonary
|Pulmonary
|
|Evaluate for any signs/symptoms or co-morbidities that would signal decreased respiratory reserve, as patient positioning may be affected (lithotomy vs prone)
|-
|-
|Gastrointestinal
|Gastrointestinal
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|-
|-
|Hematologic
|Hematologic
|
|Blood loss from I&D of perianal abscesses is rare
|-
|-
|Renal
|Renal
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|-
|-
|Other
|Other
|
|Check with surgeon for ERAS protocol
|}
|}


=== 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. --> ===
=== kLabs 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
* BMP


=== 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. --> ===
=== 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. --> ===


=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
* Spinal can be used if MAC/general anesthesia is contraindicated


=== 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. --> ===
* Epidurals can often spare the anal region.


== 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
* PIV


=== 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. --> ===
* If MAC: standard induction, face mask
* If general: prone position requires ETT over LMA. Standard induction unless concerned about aspiration
* If spinal: aim for L1-L2 level of analgesia, face mask for airway


=== 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. --> ===
* Prone preferred
* If concerned about respiratory reserve, can consider lithotomy after discussion with surgeon


=== 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. --> ===
* Standard Maintenance
* Pain is usually greatest with initial incision, requiring up front analgesia


=== 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. --> ===
* Standard emergence
* Standard PONV prophylaxis


== Postoperative management ==
== Postoperative management ==


=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
Typically outpatient procedure


=== 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. --> ===
* Pain usually greatest intra-op, can be treated with rapid acting analgesics such as fentanyl, ketamine, or remifentanil given duration of procedure is short
* Post-op pain usually improved compared to pre-op, consider multi-modal adjuncts to long acting opioids if needed


=== 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. --> ===
* Sepsis
* Positioning can lead to axillary nerve damage or peroneal nerve damage (if lithotomy)
* Conversion from MAC to general


== 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). --> ==
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== References ==
== References ==
 
<ref>{{Cite book|last=Jaffe|first=Richard|title=Anesthesiologist's Manual of Surgical Procedures|publisher=Wolters Kluwer|year=2022|isbn=1496371259|pages=618-620}}</ref><ref>{{Citation|last=Sigmon|first=David F.|title=Perianal Abscess|date=2024|url=http://www.ncbi.nlm.nih.gov/books/NBK459167/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=29083652|access-date=2024-02-13|last2=Emmanuel|first2=Bishoy|last3=Tuma|first3=Faiz}}</ref>
[[Category:Surgical procedures]]
[[Category:Surgical procedures]]

Latest revision as of 23:13, 23 February 2024

Incision and drainage of perianal abscess
Anesthesia type

MAC, General, spinal

Airway

Face Mask, LMA, ETT

Lines and access

PIV

Monitors

Standard

Primary anesthetic considerations
Preoperative

Airway and respiratory evaluation if considering prone position

Intraoperative

Prone position

Postoperative
Article quality
Editor rating
In development
User likes
0

Incision and drainage (I&D) of perianal abscess is a procedure for treatment of abscesses at and around the anal verge. Patients typically have co-morbidities such as inflammatory bowel disease, malignancy, or traumatic injury leading to perianal abscesses. Many patients often have repeated I&Ds before resolution of their abscesses. These patients tend to be males in their 40-50s but can across all patient populations.

Preoperative management

Patient evaluation

System Considerations
Airway Standard evaluation

May be prone positioning so concern for airway difficulty may change anesthetic technique

Neurologic
Cardiovascular Standard evaluation
Pulmonary Evaluate for any signs/symptoms or co-morbidities that would signal decreased respiratory reserve, as patient positioning may be affected (lithotomy vs prone)
Gastrointestinal
Hematologic Blood loss from I&D of perianal abscesses is rare
Renal
Endocrine
Other Check with surgeon for ERAS protocol

kLabs and studies

  • CBC
  • BMP

Regional and neuraxial techniques

  • Spinal can be used if MAC/general anesthesia is contraindicated
  • Epidurals can often spare the anal region.

Intraoperative management

Monitoring and access

  • Standard monitors
  • PIV

Induction and airway management

  • If MAC: standard induction, face mask
  • If general: prone position requires ETT over LMA. Standard induction unless concerned about aspiration
  • If spinal: aim for L1-L2 level of analgesia, face mask for airway

Positioning

  • Prone preferred
  • If concerned about respiratory reserve, can consider lithotomy after discussion with surgeon

Maintenance and surgical considerations

  • Standard Maintenance
  • Pain is usually greatest with initial incision, requiring up front analgesia

Emergence

  • Standard emergence
  • Standard PONV prophylaxis

Postoperative management

Disposition

Typically outpatient procedure

Pain management

  • Pain usually greatest intra-op, can be treated with rapid acting analgesics such as fentanyl, ketamine, or remifentanil given duration of procedure is short
  • Post-op pain usually improved compared to pre-op, consider multi-modal adjuncts to long acting opioids if needed

Potential complications

  • Sepsis
  • Positioning can lead to axillary nerve damage or peroneal nerve damage (if lithotomy)
  • Conversion from MAC to general

Procedure variants

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

References

[1][2]

  1. ↑ Jaffe, Richard (2022). Anesthesiologist's Manual of Surgical Procedures. Wolters Kluwer. pp. 618–620. ISBN 1496371259.
  2. ↑ Sigmon, David F.; Emmanuel, Bishoy; Tuma, Faiz (2024), "Perianal Abscess", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 29083652, retrieved 2024-02-13

Top contributors: Mitchel DeVita, Sean Liu and Chris Rishel

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