Difference between revisions of "Mastectomy"
From WikiAnesthesia
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|Respiratory | |Respiratory | ||
| | |Patients receiving radiation therapy to the chest/thorax can have respiratory compromise | ||
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|Gastrointestinal | |Gastrointestinal | ||
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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. --> === | === 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. --> === | ||
* CBC with diff and platelet count | * CBC with diff and platelet count | ||
** May have anemia or thrombocytopenia due to chemo | |||
* EKG | |||
* Consider echo | |||
** May have cardiomyopathy due to chemotherapy | |||
=== 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. --> === | ||
=== 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. --> === | ||
* Consider acetaminophen, gabapentin and/or celecoxib | |||
* Anxiolysis, as needed | |||
* ERA protocol | |||
=== 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, transversus abdomens plane (TAP) block, or thoracic epidural | ||
* 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>. | * 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>. | ||
Revision as of 19:43, 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 | |
| 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 | Patients receiving radiation therapy to the chest/thorax can have respiratory compromise |
| Gastrointestinal | |
| Hematologic | Chemotherapy can cause anemia and thrombocytopenia. |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
- CBC with diff and platelet count
- May have anemia or thrombocytopenia due to chemo
- EKG
- Consider echo
- May have cardiomyopathy due to chemotherapy
Operating room setup
Patient preparation and premedication
- Consider acetaminophen, gabapentin and/or celecoxib
- Anxiolysis, as needed
- ERA protocol
Regional and neuraxial techniques
- Consider paravertebral blocks, transversus abdomens plane (TAP) block, or thoracic epidural
- 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
- ↑ 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.