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| {{Infobox surgical procedure
| | #REDIRECT [[Colectomy]] |
| | anesthesia_type = General
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| | airway = ETT
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| | lines_access = PIV
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| | monitors = Standard, usually no A line needed
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| | considerations_preoperative = NPO status, volume status
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| | considerations_intraoperative = hypercapnia, decreased preload
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| | considerations_postoperative = PONV
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| }}
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| Laparoscopy approach to surgery requires insufflation of gas, most commonly carbon dioxide (CO2), to allow for visualization through laparoscopic instruments. A [[colectomy]] is a surgical procedure to remove all or part of the colon. A partial colectomy (also known a segmental or hemi-colectomy) involves removing a portion of the colon, followed by the creation of an anastomosis or stoma.
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| Compared to open surgery, laparoscopic approaches generate multiple different physiologic effects. Most concerning are increased intra-abdominal pressure and its hemodynamic effects as well as hypercapnia from CO2 absorption. Laparoscopic procedures also tend to require increased time vs an open procedure.
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| == Preoperative management ==
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| === 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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| {| class="wikitable"
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| |+
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| !System
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| !Considerations
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| |-
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| |Airway
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| |-
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| |Neurologic
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| |-
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| |Cardiovascular
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| |-
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| |Pulmonary
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| |-
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| |Gastrointestinal
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| |-
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| |Hematologic
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| |-
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| |Renal
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| |-
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| |Endocrine
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| |-
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| |Other
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| |}
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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. --> ===
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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. --> ===
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| === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
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| === 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. --> ===
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| While laparoscopic procedures have been successfully preformed under neuraxial, this is less commonly done. Abdominal insufflation is generally less well tolerated in an awake patient and positioning (trendelenburg vs reverse trendelenburg) can also limit this technique. If done, usually a T4-T6 level is required.
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| Post induction or pre emergence truncal blocks, such as a transversus abdominis plane (TAP) block or quadratus lumborum (QL) block can help reduce post operative pain.
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| == Intraoperative management ==
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| === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
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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. --> ===
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| Generally an endotracheal tube is required as it allows for the optimal control of ventilation as well as aspiration protection.
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| Natural airway should be avoided given the increased intra abdominal pressure and concern for aspiration.
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| Supraglottic airway devices such as the laryngeal mask airway (LMA) are also typically avoided. Increased airway pressures are required to overcome the increased intra abdominal pressures generated by insufflation. Second generation LMA devices theoretically can hols a seal at these elevated pressures, however they do not protect against aspiration.
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| === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
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| === 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. --> ===
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| === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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| == Postoperative management ==
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| === Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
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| === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
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| === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
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| == 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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| {| class="wikitable wikitable-horizontal-scroll"
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| |+
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| !
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| !Variant 1
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| !Variant 2
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| |-
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| |Unique considerations
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| |-
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| |Position
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| |-
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| |Surgical time
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| |-
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| |EBL
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| |-
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| |Postoperative disposition
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| |-
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| |Pain management
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| |-
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| |Potential complications
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| |}
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| == References ==
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| [[Category:Surgical procedures]]
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