Thoracic outlet syndrome surgery

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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
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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