Difference between revisions of "Appendectomy"
From WikiAnesthesia
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==Postoperative management== | ==Postoperative management== | ||
===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->=== | ===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->=== | ||
* PACU | |||
** Patients undergoing laparoscopic appendectomy can often be discharged home from PACU | |||
===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ||
* Oral analgesics | |||
* Non-opioid analgesics | |||
** Ketoralac (Toradol) | |||
** Acetaminophen (Tylenol) | |||
* IV narcotics for breakthrough pain | |||
===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->=== | ===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->=== | ||
* PONV | |||
* Urinary retention (consider straight catheterization of bladder prior to emergence) | |||
==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->== | ==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->== | ||
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!Open Appendectomy | !Open Appendectomy | ||
!Laparoscopic Appendectomy | !Laparoscopic Appendectomy | ||
|- | |- | ||
|Position | |Position | ||
Revision as of 21:28, 3 February 2021
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 | |
| Likes | 2 |
| Top authors | |
| Barrett Larson, Chris Rishel and Test User 8 | |
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 |
|
| Cardiovascular |
|
| Gastrointestinal |
|
| Hematologic |
|
| Labs |
|
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
- PACU
- Patients undergoing laparoscopic appendectomy can often be discharged home from PACU
Pain management
- Oral analgesics
- Non-opioid analgesics
- Ketoralac (Toradol)
- Acetaminophen (Tylenol)
- IV narcotics for breakthrough pain
Potential complications
- PONV
- Urinary retention (consider straight catheterization of bladder prior to emergence)
Procedure variants
| Open Appendectomy | Laparoscopic Appendectomy | |
|---|---|---|
| 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 |