Difference between revisions of "Ivor Lewis esophagectomy"
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=== 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. --> === | ||
* Arterial line +/- flowtrack | * Arterial line +/- flowtrack (ideally on left arm) | ||
* Fluid warmer | * Fluid warmer | ||
* Double-lumen tube | * Double-lumen tube (left) / bronchial blocker with SLT | ||
=== 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. --> === | ||
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=== 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. --> === | ||
* May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage | |||
* Left sided double lumen tube or single lumen ETT with bronchial blocker | |||
=== 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. --> === | ||
* Start in supine position if EGD is used | |||
* Patient will be later positioned to left lateral decubitus | |||
=== 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. --> === | ||
==== Abdominal Dissection ==== | |||
* Pt is placed supine and peritoneal cavity is examined for metastatic disease | |||
* Lower portion of the stomach is mobilized | |||
* Gastric conduit formed | |||
* A cervical anastamosis is performed and esophogus and stomach returned to mediastinum | |||
=== 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. --> === | ||
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=== 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. --> === | ||
* Post-op ICU | |||
=== 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. --> === | ||
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|Position | |Position | ||
| | | | ||
| | |Supine then left | ||
lateral decubitus | |||
| | | | ||
|- | |- | ||
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|- | |- | ||
|Postoperative disposition | |Postoperative disposition | ||
| | |ICU | ||
| | |ICU or ERAS | ||
| | |ICU or ERAS | ||
|- | |- | ||
|Pain management | |Pain management | ||
| | |Thoracic Epidural | ||
| | |Thoracic Epidural | ||
| | |Thoracic Epidural | ||
|- | |- | ||
|Potential complications | |Potential complications | ||
| | | | ||
| | |Anastamotic leak (4.3%) | ||
Vocal cord paresis (0.9%) | |||
Mortality (1.68%)<ref>{{Cite journal|last=Luketich|first=James D.|last2=Pennathur|first2=Arjun|last3=Awais|first3=Omar|last4=Levy|first4=Ryan M.|last5=Keeley|first5=Samuel|last6=Shende|first6=Manisha|last7=Christie|first7=Neil A.|last8=Weksler|first8=Benny|last9=Landreneau|first9=Rodney J.|last10=Abbas|first10=Ghulam|last11=Schuchert|first11=Matthew J.|date=2012-07|title=Outcomes after minimally invasive esophagectomy: review of over 1000 patients|url=https://pubmed.ncbi.nlm.nih.gov/22668811|journal=Annals of Surgery|volume=256|issue=1|pages=95–103|doi=10.1097/SLA.0b013e3182590603|issn=1528-1140|pmc=4103614|pmid=22668811}}</ref> | |||
| | | | ||
|} | |} | ||
Revision as of 21:21, 1 September 2021
Ivor Lewis esophagectomy
| Anesthesia type |
General |
|---|---|
| Airway |
DLT |
| Lines and access |
Large PIV, arterial line, NG tube |
| Monitors |
Standard, arterial line |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Provide a brief summary of this surgical procedure and its indications here.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Respiratory | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
- Arterial line +/- flowtrack (ideally on left arm)
- Fluid warmer
- Double-lumen tube (left) / bronchial blocker with SLT
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
- Invasive hemodynamic monitoring
- Large bore IV access
Induction and airway management
- May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage
- Left sided double lumen tube or single lumen ETT with bronchial blocker
Positioning
- Start in supine position if EGD is used
- Patient will be later positioned to left lateral decubitus
Maintenance and surgical considerations
Abdominal Dissection
- Pt is placed supine and peritoneal cavity is examined for metastatic disease
- Lower portion of the stomach is mobilized
- Gastric conduit formed
- A cervical anastamosis is performed and esophogus and stomach returned to mediastinum
Emergence
Postoperative management
Disposition
- Post-op ICU
Pain management
- Epidural
Potential complications
Procedure variants
| Open | Laparoscopic | Robotic | |
|---|---|---|---|
| Unique considerations | |||
| Position | Supine then left
lateral decubitus |
||
| Surgical time | |||
| EBL | |||
| Postoperative disposition | ICU | ICU or ERAS | ICU or ERAS |
| Pain management | Thoracic Epidural | Thoracic Epidural | Thoracic Epidural |
| Potential complications | Anastamotic leak (4.3%)
Vocal cord paresis (0.9%) Mortality (1.68%)[1] |
References
- ↑ Luketich, James D.; Pennathur, Arjun; Awais, Omar; Levy, Ryan M.; Keeley, Samuel; Shende, Manisha; Christie, Neil A.; Weksler, Benny; Landreneau, Rodney J.; Abbas, Ghulam; Schuchert, Matthew J. (2012-07). "Outcomes after minimally invasive esophagectomy: review of over 1000 patients". Annals of Surgery. 256 (1): 95–103. doi:10.1097/SLA.0b013e3182590603. ISSN 1528-1140. PMC 4103614. PMID 22668811. Check date values in:
|date=(help)
Top contributors: Nirav Kamdar and Olivia Sutton