Nuss Bar Insertion

Nuss Bar Insertion

Anesthesia type	General
Airway	ETT
Lines and access	2 PIVs, atleast one should be a Large bore IV (16G or lower).
Monitors	Standard
Primary anesthetic considerations
Preoperative	Administer Valium for muscle spasm
Intraoperative	Erector spinae block for analgesia. Potential for massive hemorrhage due to injury to heart or major vessels. Consider neuromoscular blockade as movement during important surgical events can lead to inadvertent damage to great vessels.
Postoperative	Significant post-op pain, consider valium administration for spasms.
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Overview

Indications

Pectus Excavatum

Surgical procedure

Nuss Bar insertion

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular	Potential for injury to heart and great vessels during placement of Bar. Patient will have a pre-op echo to look at effect on cardiac function.
Pulmonary	Patients usually have a Pulmpnary function test or "CPET". Results often provide useful information on amount of restrictive disease
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Check CBC and order Type and Screen

Patient preparation and premedication

Diazepam is often administered as it helps with muscle spasm after surgery

Regional and neuraxial techniques

Erector Spinae Block

Intraoperative management

Monitoring and access

Two large bore IVs preferred.

Positioning

Supine

Postoperative management

Disposition

Patient will be admitted inpatient post surgery

Pain management

Valium for post-op muscle spasm. Consider Ketorolac

Potential complications

Need for mass transfusion due to injury to great vessels

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications