Difference between revisions of "Appendectomy"

Appendectomy
Anesthesia type	General
Airway	Endotracheal tube
Lines and access	Peripheral IV
Monitors	Standard ASA / 5-Lead EKG
	Primary anesthetic considerations
Preoperative	Full Stomach Precautions
Intraoperative	Rapid Sequence Induction
Postoperative	PONV
	Article information
Editor rating	Certified
Likes	2
	Top authors
	Barrett Larson, Chris Rishel and Test User 8

VisualWikitext

Revision as of 21:23, 3 February 2021

An appendectomy is generally performed as an urgent or emergent procedure to treat appendicitis. Appendicitis can occur at any age, but is more common in patients 19-25 years old. Appendicitis is common, occurring in about 7% of the population. An appendectomy can be performed laparoscopically or as an open procedure. Surgical practice has largely transitioned to the laparoscopic approach.

Preoperative management

Preoperative evaluation


Respiratory	Acute abdominal pain can use respiratory impairment (respiratory splinting) resulting in atelectasis
Cardiovascular	May be dehydrated due to fever, emesis, and reduced oral intake Assess volume status by checking vital signs, mucus membranes, skin turgor. IV hydration before anesthetic induction
Gastrointestinal	Patients typically present with nausea and vomiting. Patients with acute abdomen should be treated as if they have full stomachs. Muscular resistance to palpation (muscle guarding) can correlate with severity of the inflammatory process.
Hematologic	Patients typically have moderate leukocytosis with left shift Expect hemoconcentration if patient dehydrated
Labs	CBC Chemistry Panel Pregnancy test (for women of child bearing age)

Operating room preparation

NG Tube

Intraoperative management

Monitoring and access

Standard ASA monitors
5-lead EKG
Urinary catheter
1 peripheral IV (typically 16-18 gauge)

Induction and airway management

Pre-oxygenate with 100% FiO2
Rapid Sequence Induction (RSI)
Intubation

Positioning

Supine

Maintenance and surgical considerations

Standard maintenance
- Consider avoiding nitrous oxide given potential for bowel dissension and increased risk of PONV
Place OG/NG before surgical incision to decompress the stomach

Emergence

Extubate when patient awake and able to protect airway
PONV prophylaxis

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants


	Open Appendectomy	Laparoscopic Appendectomy
Unique considerations
Position	Supine	Supine
Surgical time	1 hour	30-90 mins
EBL	<75 mL	<75 mL
Postoperative disposition	PACU	PACU
Mortality	Perforated: 2% Non-perforated: <0.1%	Perforated: 2% Non-perforated: <0.1%
Complications	Perforation Abscess Fistula Hematoma Illeus	Perforation Abscess Fistula Hematoma Illeus Conversion to Open
Pain	5-7	4

References

@@ Line 7: / Line 7: @@
 | considerations_intraoperative = Rapid Sequence Induction
 | considerations_postoperative = PONV
-}}An appendectomy is generally performed as an urgent or emergent procedure to treat acute appendicitis.  Appendicitis can occur at any age, but is more common in pages 19-25 years old.  Appendicitis is common, occurring in about 7% of people.  An appendectomy can be performed laparoscopically or as an open procedure.  Surgical practice has largely transitioned to the laparoscopic approach.
+}}An appendectomy is generally performed as an urgent or emergent procedure to treat appendicitis.  Appendicitis can occur at any age, but is more common in patients 19-25 years old.  Appendicitis is common, occurring in about 7% of the population.  An appendectomy can be performed laparoscopically or as an open procedure.  Surgical practice has largely transitioned to the laparoscopic approach.
 ==Preoperative management==
 ===Preoperative evaluation<!-- Provide a brief overview of the preoperative evaluation and optimization of patients for this case. Also list relevant labs, studies, or physical exam findings. If none, this section may be removed. -->===
@@ Line 50: / Line 50: @@
 * NG Tube
 *
-===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===
 ==Intraoperative management==
 ===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->===
+* Standard ASA monitors
+* 5-lead EKG
+* Urinary catheter
+* 1 peripheral IV (typically 16-18 gauge)
 ===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===
+* Pre-oxygenate with 100% FiO2
+* Rapid Sequence Induction (RSI)
+* Intubation
 ===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===
+* Supine
 ===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===
+* Standard maintenance
+** Consider avoiding nitrous oxide given potential for bowel dissension and increased risk of PONV
+* Place OG/NG before surgical incision to decompress the stomach
 ===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===
+* Extubate when patient awake and able to protect airway
+* PONV prophylaxis
 ==Postoperative management==