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


* Consider Paravertebral Blocks
* Consider paravertebral blocks
* Studies have shown a trend towards increasing utilization of peripheral nerve blocks (PNB) for mastectomy.  As of 2018, ~13% of cases involved a PNB according to the National Anesthesia Clinical Outcomes Registry<ref>{{Cite journal|last=Lam|first=Stephanie|last2=Qu|first2=Helena|last3=Hannum|first3=Margaret|last4=Tan|first4=Kay See|last5=Afonso|first5=Anoushka|last6=Tokita|first6=Hanae K.|last7=McCormick|first7=Patrick J.|date=2021-05-24|title=Trends in Peripheral Nerve Block Usage in Mastectomy and Lumpectomy: Analysis of a National Database From 2010 to 2018|url=https://journals.lww.com/anesthesia-analgesia/Abstract/9900/Trends_in_Peripheral_Nerve_Block_Usage_in.56.aspx|journal=Anesthesia & Analgesia|language=en-US|pages=10.1213/ANE.0000000000005368|doi=10.1213/ANE.0000000000005368|issn=0003-2999}}</ref>. 


== Intraoperative management ==
== Intraoperative management ==

Revision as of 19:37, 25 May 2021

Mastectomy
Anesthesia type

General

Airway

ETT vs. LMA

Lines and access

PIV

Monitors

Standard monitors

Primary anesthetic considerations
Preoperative

Place IV in non-operative extremity

Intraoperative
Postoperative
Article quality
Editor rating
In development
User likes
0

A total mastectomy (simple mastectomy) refers to the complete removal of breast tissue. A modified radical mastectomy refers to the removal of the breast and the corresponding axillary lymph nodes.

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular Chemotherapy (ex. anthracyclines) can cause cardiomyopathy that is often irreversible. Use of trastuzamab can cause reversible decrease in LV function.
Respiratory
Gastrointestinal
Hematologic Chemotherapy can cause anemia and thrombocytopenia.
Renal
Endocrine
Other

Labs and studies

  • CBC with diff and platelet count

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

  • Consider paravertebral blocks
  • Studies have shown a trend towards increasing utilization of peripheral nerve blocks (PNB) for mastectomy. As of 2018, ~13% of cases involved a PNB according to the National Anesthesia Clinical Outcomes Registry[1].

Intraoperative management

Monitoring and access

  • 20g PIV (non-operative extremity)
  • Place BP cuff on non-operative extremity

Induction and airway management

Positioning

  • Supine
  • Ipsilateral arm may be prepped into field
  • Repositioning may be required
  • Avoid brachial plexus stretch

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

  • PACU

Pain management

Potential complications

  • PONV
  • Lymphedema
  • Seroma
  • Pneumothorax

Procedure variants

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

References

  1. Lam, Stephanie; Qu, Helena; Hannum, Margaret; Tan, Kay See; Afonso, Anoushka; Tokita, Hanae K.; McCormick, Patrick J. (2021-05-24). "Trends in Peripheral Nerve Block Usage in Mastectomy and Lumpectomy: Analysis of a National Database From 2010 to 2018". Anesthesia & Analgesia: 10.1213/ANE.0000000000005368. doi:10.1213/ANE.0000000000005368. ISSN 0003-2999.