Difference between revisions of "Thoracic outlet syndrome surgery"
From WikiAnesthesia
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m (Added info about set up and anesthetic considerations) |
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|Hematologic | |Hematologic | ||
| | |May have DVT in the upper extremity affected and may be on anticoagulation | ||
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|Renal | |Renal | ||
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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. --> === | === 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. --> === | ||
* | * If the surgeon wants to have neuro-monitoring to avoid injury to the brachaial plexus, you will need to avoid paralysis | ||
**TIVA with succinylcholine for induction would be ideal | |||
*Can set up for GA with paralysis if no need for neuro-monitoring | |||
=== 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. --> === | ||
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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. --> === | ||
* Paravertebral Block may help with post-op pain control | |||
== Intraoperative management == | == Intraoperative management == | ||
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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. --> === | === 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. --> === | ||
Standard induction for GETA, paralysis okay | Standard induction for GETA, paralysis okay if no nerve monitoring needed | ||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === 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. --> === | === 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. --> === | ||
Avoid any IVs or BP cuff on the surgical side as that arm will be prepped and in the surgical field. | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
Latest revision as of 07:30, 10 September 2022
Thoracic outlet syndrome surgery
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative |
Generally young healthy females |
| Intraoperative | |
| Postoperative |
PONV |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Thoracic outlet syndrome surgery includes procedures such as first rib resection and scalenectomy. Symptoms include pain, tingling, or weakness in the upper extremity, with vascular involvement including venous swelling, arterial flow disruption, and deep vein thrombosis.
Overview
Indications
Surgical procedure
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | May have numbness/tingling in affected upper extremity |
| Cardiovascular | May have vascular involvement (venous swelling, DVT, arterial compression) |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | May have DVT in the upper extremity affected and may be on anticoagulation |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Generally not necessary as most patients are young and healthy
Operating room setup
- If the surgeon wants to have neuro-monitoring to avoid injury to the brachaial plexus, you will need to avoid paralysis
- TIVA with succinylcholine for induction would be ideal
- Can set up for GA with paralysis if no need for neuro-monitoring
Patient preparation and premedication
- Anxiolysis as needed
Regional and neuraxial techniques
- Paravertebral Block may help with post-op pain control
Intraoperative management
Monitoring and access
Induction and airway management
Standard induction for GETA, paralysis okay if no nerve monitoring needed
Positioning
Left or right lateral decubitus, with affected upper extremity in operative field facing up. Generally with shoulder roll.
Maintenance and surgical considerations
Avoid any IVs or BP cuff on the surgical side as that arm will be prepped and in the surgical field.
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
Top contributors: Tony Wang, J T and Chris Rishel