Cystectomy
Anesthesia type General / Neuraxial
Airway ETT
Lines and access Partial: PIV x 1 (20)
Radical: PIV x 2 (18 or 16)
Monitors Partial: Standard
Radical: Std + art line
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative


A cystectomy is the removal of all or part of the urinary bladder. Most commonly, this procedure is performed to address cancer.

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Respiratory
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

  • If spinal used, ensure T4 sensory level
    • Consider using epi in spinal to prolong block
  • Can consider placing epidural if significant post-op pain anticipated

Intraoperative management

Monitoring and access

  • 2 PIVs for open, radical, or robotic cystectomy (18g+)

Induction and airway management

  • GETA

Positioning

  • Supine
  • Sometimes females placed in lithotomy

Maintenance and surgical considerations

  • If radical cystectomy, have T&S and consider T&C 2 units
  • Some centers use indocyanine 25mg to visualize blood flow to the ureters

Emergence

Postoperative management

Disposition

  • PACU

Pain management

Potential complications

  • Bleeding

Procedure variants

Radical cystectomy Partial Cystectomy Open cystectomy Minimally invasive cystectomy Robotic cystectomy
Unique considerations
Position Steep Trendelenburg
Surgical time 4-6 hours ~ 2 hours (urinary diversion not required) ~ 4-6 hrs
EBL 300-1500 Minimal 1000mL 100-200mL
Postoperative disposition PACU
Pain management 2
Potential complications

References