Sentinel lymph node biopsy

Sentinel lymph node biopsy

Anesthesia type	GA, local with sedation
Airway	LMA
Lines and access	PIV sufficient
Monitors	standard
Primary anesthetic considerations
Preoperative	Cancer considerations. Radioisotope tagging beforehand means that cancelling "elective" cases is discouraged once they have been tagged.
Intraoperative	avoid BP cuff on ipsilateral arm.
Postoperative	PONV (breast surgery). With local infilitration, pain is usually minimal.
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Overview

Indications

• The sentinel lymph node is the first node or group of lymph nodes that drains from the primary cancer. Thus, it is used to check for metastastic breast cancer.

Surgical procedure

• Carried out in conjunction with radioisotope tagging beforehand. The nodes with the highest degree of activity are removed.
• Involves incision in axilla to excise corresponding nodes.

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Intraoperative management

Monitoring and access

• Standard monitors
• PIV sufficient

Induction and airway management

• If GA - standard induction. Usually a fairly healthy population.
• If MAC - propofol infusion +/- narcotic prn

Positioning

• Supine. Arms out

Postoperative management

Disposition

• Day procedure

Pain management

• Usually small incision. Local infilitration +/- prn narcotic, multimodals sufficient.

Procedure variants

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