Cholecystectomy

From WikiAnesthesia
Cholecystectomy
Anesthesia type General
Airway Endotracheal tube
Lines and access Peripheral IV
Monitors Standard ASA
5-lead EKG
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative

A cholecystectomy is generally performed to treat symptomatic cholelithiasis and other gallbladder conditions. This is one of the most common procedures performed in hospitals in the United States. Of the more than 20 million people in the US with gallstones, about 30% will eventually require cholecystectomy to relieve symptoms or treat complications. A cholecystectomy can be performed laparoscopically or as an open procedure. Surgical practice has largely transitioned to the laparoscopic approach. The rate of conversion to an open operation is 2-3% for elective gallbladder surgery and ~10% for acute cholecystitis[1].

Preoperative management

Patient evaluation

System Considerations
Respiratory
  • Acute abdominal pain can cause respiratory impairment (respiratory splinting) resulting in atelectasis
Cardiovascular
Renal
Gastrointestinal
Hematologic
  • Sepsis can result in tachycardia, tachypnea, hyperthermia, and leukocytosis/leucopenia
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

  • Consider epidural for open approach

Intraoperative management

Monitoring and access

Induction and airway management

Positioning

Maintenance and surgical considerations

  • Intraoperative insufflation may cause atelectasis, decrease FRC, increase PIPs, and increase CO2

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

Open Cholecystectomy Laparoscopic Cholecystectomy
Unique considerations
Position Supine Supine
Surgical time 2-4 hours 0.5-2 hours
EBL 250mL Minimal
Postoperative disposition PACU PACU
Mortality
Morbidity
Pain 5-7 3

References

  1. Jaffe, Richard A; Schmiesing, Clifford A; Golianu, Brenda (2014). Anesthesiologist's manual of surgical procedures. ISBN 978-1-4963-0594-7. OCLC 888551588.