Pancreaticoduodenectomy
Anesthesia type

General

Airway

ETT

Lines and access

PIV x 2
ART

Monitors

Standard
5-lead EKG
ABP
+/- CVP

Primary anesthetic considerations
Preoperative

Mechanical bowel prep
ERAS

Intraoperative

Combined general + epidural
Goal-directed fluid therapy
Glucose control
Blood transfusion management
Lung protective ventilation
Avoid hypothermia

Postoperative

PONV
ERAS
Goal-directed fluid therapy
Early NG, foley, and drain removal
Early PO nutrition
Glycemic control
Non-opioid analgesia
DVT PPx
Pulmonary rehab
Early ambulation

Article quality
Editor rating
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The Pancreaticoduodenectomy is also known as the Whipple Procedure, after Dr. Allen Whipple. This is the most commonly performed surgery to remove pancreatic tumors, and is typically done for patients who have tumors located in the head of the pancreas or adjacent regions. The procedure is anatomically complicated, and there may be anatomical variations among the various involved blood vessels and ducts in the area. Even after pancreatic resection, the 5-year survival rate is only 15-20% (compared with 5% without surgery).

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

  • CBC, BMP, LFTs, coags
  • EKG in any patient with risk factors for CAD

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

Induction and airway management

Positioning

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

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

References