Difference between revisions of "Ivor Lewis esophagectomy"
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* May consider RSI if high-aspiration risk due to esophageal tumor obstructing food passage | * 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 | * Left sided double lumen tube or single lumen ETT with bronchial blocker for one lung ventilation | ||
=== 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 | * Start in supine position if EGD is used at the beginning of the case | ||
* Patient will be later positioned to left lateral decubitus | * Patient will be later positioned to left lateral decubitus for the thoracic portion of the resection | ||
=== 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. --> === | ||
Revision as of 09:24, 2 September 2021
Ivor Lewis esophagectomy
| Anesthesia type |
General |
|---|---|
| Airway |
DLT / bronchial blocker |
| 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
- Thoracic epidural
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 for one lung ventilation
Positioning
- Start in supine position if EGD is used at the beginning of the case
- Patient will be later positioned to left lateral decubitus for the thoracic portion of the resection
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 anastomosis is performed and esophagus and stomach returned to mediastinum
Emergence
Postoperative management
Disposition
- Post-op ICU
Pain management
- Epidural
Potential complications
- Anastomotic leak
- Vocal cord paresis
- Recurrent laryngeal nerve injury
- Morbidity requiring re-operation
- Mortality
Procedure variants
| Open | Laparoscopic | Robotic | |
|---|---|---|---|
| Unique considerations | |||
| Position | Supine followed by 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