Pancreatectomy

Pancreatectomy

Anesthesia type	GA +/- epidural
Airway	ETT
Lines and access	2 PIV + A-line
Monitors	Standard
Primary anesthetic considerations
Preoperative	Electrolyte disturbances from pancreatitis common, diabetes management
Intraoperative	Hypovolemia common in pancreatitis, insulin/glucose management
Postoperative
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A pancreatectomy can be indicated for conditions such as pancreatic stones, cysts, benign or malignant tumors, ductal obstructions, or chronic pancreatitis. It can be classified as total, where the entire organ is removed, often along with the spleen, gallbladder, local lymph nodes, the common bile duct, and portions of the small intestine and stomach, or partial, where the pancreas is resected from the mesenteric vessels distally, leaving the head and uncinate process intact.

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

• CBC
• Electrolytes, especially K+, serum glucose, BUN, Cr
• Coags including PT, PTT, INR
• LFTs
• urinalysis
• EKG
• CXR
• Echo is commonly requested

Operating room setup

• Have insulin available for glucose management

Regional and neuraxial techniques

• Epidurals are common to manage postoperative pain
• If epidural is not performed, TAP blocks can be an alternative

Procedure variants

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