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

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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
Renal
Endocrine
Other

Labs and studies

Generally not necessary as most patients are young and healthy

Operating room setup

  • Standard GETA w/ paralysis setup

Patient preparation and premedication

  • Anxiolysis as needed

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

Induction and airway management

Standard induction for GETA, paralysis okay as 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

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