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
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Barrett Larson, Chris Rishel and Test User 8

An appendectomy is generally performed as an urgent or emergent procedure to treat acute appendicitis. 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)

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