Varicose vein stripping and ablation
Anesthesia type

General vs regional vs local + MAC

Airway

LMA

Lines and access

PIV

Monitors

Standard, 5 Lead EKG

Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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Varicose vein stripping is a procedure involving removing the portion of the incompetent vein. It is the gold standard. Endovenous thermal ablation (laser and light) have mostly replaced the surgical treatment of varicose veins[1]

Usual indications include failure of medical management with vein hemorrhage, superficial thrombophlebitis, or symptomatic veinous reflux [1][2]

Contraindication to surgery include pregnancy, superficial or deep vein thrombosis, and arterial insufficiency of the lower extremities[1][2]

Preoperative management

Patient preparation and premedication

  • IV midazolam
  • PO acetaminophen

Regional and neuraxial techniques

  • Lower extremity regional techniques
  • Spinal and or epidural

Intraoperative management

Monitoring and access

  • Standard ASA monitors
  • 5-lead EKG
  • PIV x 1

Induction and airway management

  • If general is chosen, standard induction
    • LMA or Mask vs ETT
    • Neuromuscular blockade may not be needed
  • If regional/neuraxial is chosen, minimal to deep sedation is reasonable
  • If local + MAC, deep sedation to general may be required [3]
    • May require airway manipulation including oral airway or chin lift

Positioning

  • Supine

Maintenance and surgical considerations

  • Maintenance with volatile anesthetics or TIVA
  • If regional/neuraxial is chosen, minimal to deep sedation is reasonable

Emergence

  • PONV prophylaxis

Postoperative management

Disposition

  • PACU
  • Usually discharged home

Pain management

  • Pain is minimal to mild
    • Multimodal
      • PO/IV acetaminophen
      • PO/IV NSAIDS
      • PO/IV short acting opioid
      • Regional technique

Potential complications

  • Bleeding
  • Ulcers
  • Nerve injury

Procedure variants

Variant 1
Position Supine
Surgical time 2-3 hours
EBL 50-250 mL
Postoperative disposition PACU, and usually discharged home
Pain management Minimal, multimodal
Potential complications Bleeding and ulcers

References

  1. ↑ 1.0 1.1 1.2 Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Sixth edition ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404. |edition= has extra text (help)CS1 maint: others (link)
  2. ↑ 2.0 2.1 Stoelting's anesthesia and co-existing disease. Roberta L. Hines, Stephanie B. Jones, Robert K. Stoelting (Eighth edition ed.). Philadelphia, PA. 2022. ISBN 978-0-323-71861-5. OCLC 1280374077. |edition= has extra text (help)CS1 maint: others (link)
  3. ↑ Cho, Sooyoung; Han, Jong In; Baik, Hee Jung; Kim, Dong Yeon; Chun, Eun Hee (2016-04). "Monitored anesthesia care for great saphenous vein stripping surgery with target controlled infusion of propofol and remifentanil: a prospective study". Korean Journal of Anesthesiology. 69 (2): 155–160. doi:10.4097/kjae.2016.69.2.155. ISSN 2005-6419. PMC 4823411. PMID 27066207. Check date values in: |date= (help)

Top contributors: Cornel Chiu and Chris Rishel

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