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TEMPORAL ARTERY BIOPSY A temporal artery biopsy is a medical procedure where a small section of the temporal artery, located just in front of the ear and continuing up into the scalp, is removed and examined under a microscope. This procedure is often used to diagnose temporal arteritis, also known as giant cell arteritis, an inflammation of the blood vessels that can cause headaches, jaw pain, and vision problems. ​ During the procedure, the patient is typically given a local anesthetic to numb the area. The surgeon then makes a small incision in the skin over the artery and removes a small section of the artery. The incision is then closed with stitches. The removed artery segment is sent to a laboratory for histological examination to look for signs of inflammation or other abnormalities. ​ Temporal artery biopsy is the primary modality to diagnose giant cell arteritis / temporal arteritis. ​ Giant cell arteritis (temporal arteritis) affects the vessels supplying the head, eyes, and optic nerves. Anesthetic Implications for Temporal Artery Biopsy ​ Anesthesia type: General, TIVA, MAC ​ Airway: LMA, ETT, spontaneous ventilation ​​ Preoperative: ​ ​ Shared workspace with the surgeon A doppler is used to find the temporal artery Disease occurs most frequently in people older than 70 Giant cell arteritis is frequently associated with polymyalgia rheumatica (inflammatory disorder that causes muscle pain and stiffness, mostly in the shoulders and hips) ​​ Intraoperative: ​ Duration: 15-45 minutes ​ Postoperative: ​ Procedural pain Pain management ​​ Complications: ​ Temporary or permanent damage to the temporal branch of the facial nerve Bleeding Infection Hematoma Wound dehiscence ​ Sources: ​ Chase E, Patel BC, Ramsey ML. Temporal Artery Biopsy. [Updated 2023 May 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470397/ Elisha, S. (2010). Case Studies in Nurse Anesthesia. ​ Elisha, S. (2010). Case Studies in Nurse Anesthesia. ​ Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. ​ Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). ​ Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult. ​ ​ ​ ​ ​​ ​​ Back to Surgical Tips Moran CORE Temporal Artery Biopsy Methodist DeBakey CV Education Temporal Artery Biopsy Live Life M.D. Temporal Arteritis

CYSTOSCOPY ​ A cystoscopy is a diagnostic procedure that allows a doctor to view the inside of the bladder and urethra in detail. It is performed using a thin, lighted instrument called a cystoscope. The cystoscope is inserted into your urethra and slowly advanced into your bladder. ​ A flexible cystoscope, rigid cystoscope, or resectoscope may be used. ​ ​ Reasons for performing a cystoscopy include: Investigating causes of symptoms like blood in urine (hematuria), painful urination, incontinence, frequent urinary tract infections, or unexplained pain in the lower back or pelvic area. Diagnosing conditions like bladder stones, bladder tumors, and interstitial cystitis. Treating conditions like bladder tumors, bladder stones, or blockages in the urethra. Monitoring treatment progress for conditions affecting the bladder and urethra. The bladder (cystoscopy) Urethra (urethroscopy) ​ Ureteral orifices (ureteroscopy) ​ Collecting system (transurethral ureteropyeloscopy) ​ Anesthetic Implications for Cystoscopy ​ Anesthesia type: General anesthesia, topical anesthesia, regional anesthesia ​ Airway: ETT or LMA ​​ Preoperative: ​ ​ X-rays and fluoroscopy are done during this procedure Paraplegics and quadriplegics present for multiple cystoscopies Assess for history and risk of autonomic hyperreflexia (patients with spinal cord injury above T10) Avoid succinylcholine in paraplegics and quadriplegics Muscle relaxation is not essential ​ Intraoperative: ​ ​ Suspect perforation if irrigation fluid fails to return Large perforations can lead to unexplained hemodynamic changes Lithotomy position Duration 15-45 minutes EBL minimal ​ Postoperative: ​ Post-op pain usually minimal Short-acting narcotics ​ Complications: ​ Bladder perforation Ureteral perforation Infection Bleeding Retained stones Autonomic hyperreflexia Peroneal nerve injury (foot drop) Fever Bacteremia ​ Sources: ​ Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. ​ Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). ​ Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult. ​ ​ ​ ​ ​ ​ ​​ ​​ Back to Surgical Tips Nucleus Medical Media Cystoscopy (Bladder Endoscopy) New Anatomy and Physiology Video Anatomy and Physiology of Urinary System Dr. Matt and Dr. Mike Autonomic Dysreflexia

CHOLECYSTECTOMY (LAPAROSCOPIC) ​ A laparoscopic cholecystectomy is a surgical procedure used to remove the gallbladder. The gallbladder is a small organ located under your liver that stores and concentrates bile, a digestive enzyme produced by the liver. ​ It is performed to treat gallstones and diseases of the gallbladder. ​ A laparoscopic cholecystectomy is performed under general anesthesia. The surgeon makes several small incisions in the abdomen. A port (trocar) is inserted into one of the incisions, and carbon dioxide gas inflates the abdomen. This helps to increase the visibility of the gallbladder and surrounding organs. ​ A laparoscope, a long, thin tube with a high-intensity light and a high-resolution camera at the front, is inserted through another port. The camera displays images on a video monitor, allowing the surgeon to see inside the abdomen and guide the surgical instruments. ​ The surgeon then uses specialized tools to separate the gallbladder from its attachments (the cystic duct and artery) and then removes it from the body through one of the ports. After the gallbladder has been removed, the surgeon will deflate the abdomen and remove the ports. The incisions are then closed with sutures or staples and covered with dressings. ​ Anesthetic Implications for Laparoscopic Cholecystectomy ​ Anesthesia type: General with ETT ​ Airway: Endotracheal tube ​​ Preoperative: ​ Patients with acute cholecystitis may present with severe abdominal pain causing diaphragmatic splinting and basal lung atelectasis Assess for the possibility of a "full stomach" An orogastric tube should be inserted to decompress the stomach Make sure the patient is securely strapped Opioids may cause Sphincter of Oddi spasms ​ Intraoperative: ​ Carbon dioxide is used to insufflate the abdomen to help visualization Intraadbominal CO2 insufflation causes atelectasis, decreased pulmonary compliance and decreased functional residual capacity (FRC) CO2 insufflation is associated with increased PIP, increased PaCo2 and decreased PaO2 Intraabdominal pressure greater than 15 mmHg may be associated with decreased venous return, increased systemic vascular resistance, and decreased cardiac output Risk of bradycardia with pneumoperitoneum An intraoperative cholangiogram may be performed (requires fluoroscopy) Position: reversed T-burg with left-sided tilt (decreases venous return, increases lung volumes) EBL minimal Duration 0.5-2 hours. Intraoperative cholangiogram may add 10-20 minutes ​ Postoperative: ​ Pain management PONV prophylaxis ​ Complications: ​ Bleeding Injury to bowel Infection Major vascular injury Pneumoperitoneum Pneumothorax Pneumomediastinum Hypercarbia/hypoxemia Endobronchial intubation Subcutaneous emphysema PONV Shoulder pain from insufflation Pancreatitis Atelectasis Venous embolism ​ Sources: ​ Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice . ​ Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). ​ Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult. ​ ​ ​ ​ ​​ ​​ Back to Surgical Tips CHI Health What is Laparoscopic Cholecystectomy? School of Surgery Laparoscopic Cholecystectomy Explained Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Physiologic Effects Of Pneumoperitoneum

SURGICAL CASES Surgical cases involve invasive procedures to treat medical conditions, while anesthesia ensures patient comfort and immobility through pain relief and sedation Abdominal Aortic Aneurysm (open) Abdominal aortic aneurysm surgery: repairing or replacing weakened aorta section to prevent rupture, using and open technique Learn About AAA Repair Abdominal Endovascular Aneurysm (EVAR) EVAR repair: minimally invasive procedure using a stent-graft to reinforce and support the weakened aortic wall, preventing rupture Learn About EVAR Ablation for SVT or VT Ablation for SVT/VT: minimally invasive procedure using catheters to selectively destroy problematic heart tissue, restoring normal electrical conduction Learn About Ablation Amputation - Below the knee (BKA) Surgical removal of a leg at the knee joint due to trauma, infection, or disease Learn About Amputation Anterior Cruciate Ligament (ACL) repair ACL repair: surgical reconstruction of torn knee ligament, restoring stability, function, and preventing further injury Learn About ACL repair Arthroscopy - Knee Knee arthroscopy: minimally invasive procedure using a camera and instruments through small incisions to diagnose and treat knee issues Learn About Knee Arthroscopy Anal Rectal Procedures Anal and rectal procedures are medical interventions that address issues related to the anus and rectum. These can include diagnostic, therapeutic, and surgical procedures Learn About Procedures Appendectomy Surgical removal of the appendix, usually due to inflammation or infection Learn About Appendectomy Arthroscopy - Shoulder Shoulder arthroscopy is a minimally invasive surgical procedure using a small camera to diagnose and treat shoulder joint conditions Learn About Shoulder Arthroscopy Anterior Cervical Discectomy and Fusion (ACDF) ACDF is a surgical procedure removing damaged intervertebral disc, relieving spinal cord/nerve root compression, and fusing adjacent vertebrae for stability Learn About ACDF Arteriovenous access for hemodialysis Arteriovenous access connects an artery and vein, creating a high-flow site for efficient hemodialysis Learn About Arteriovenous Axillary lymph node dissection (ALND) Axillary node dissection is a surgical procedure performed to remove lymph nodes from the axillary (armpit) region of the body Learn About ALDN Bilateral Salpingo Oopherectomy (BSO) BSO is a surgical procedure removing both fallopian tubes and ovaries, typically for cancer prevention, treatment, or other conditions Learn About BSO Bronchoscopy Bronchoscopy is a diagnostic procedure using a flexible tube with a camera to examine airways and lungs for abnormalities Learn About Bronch Carotid Endarterectomy Carotid endarterectomy is a surgery to remove plaque buildup in the carotid artery, preventing stroke and improving blood flow Learn About CEA Cesarean Section Cesarean section is a surgical procedure to deliver a baby through an incision in the mother's abdomen and uterus Learn About C-section Colonoscopy Colonoscopy is a diagnostic procedure using a flexible tube with a camera to examine the colon for abnormalities Learn About Colonoscopy Endoscopic Retrograde Cholangiopancreatography (ERCP) ERCP is a procedure using an endoscope and X-rays to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas Learn About ERCP Breast Lumpectomy Breast lumpectomy is a surgery that removes a breast tumor and surrounding tissue, conserving most of the breast Learn About Lumpectomy Bunionectomy Bunionectomy is a surgical procedure to remove a bunion, a bony bump at the base of the big toe, relieving pain Learn About Bunion Carpal Tunnel Release Carpal tunnel release is a surgery to alleviate pressure on the median nerve by cutting the transverse carpal ligament Learn About CTR Breast Reconstruction Breast reconstruction is a surgical procedure to rebuild the breast's shape and appearance after mastectomy or lumpectomy Learn About Breast Cardioversion Cardioversion is a medical procedure using electrical shocks to restore normal heart rhythm in arrhythmia patients Learn About Cardioversion Cervical Cerclage Cervical cerclage is a surgical procedure placing stitches in the cervix to prevent premature opening during pregnancy Learn About Cerclage Cholecystectomy (Laparoscopic) Laparoscopic cholecystectomy is a minimally invasive surgery to remove the gallbladder using small incisions and a laparoscope Learn About Cholecystectomy Colectomy Colectomy is a surgical procedure to remove all or part of the colon, treating various diseases, including colon cancer Learn About Colectomy Cystoscopy Cystoscopy is a diagnostic procedure using a thin tube with a camera to examine the bladder and urinary tract Learn About Cystoscopy Dilation And Curettage (D&C) Dilation and Curettage (D&C) is a procedure where the cervix is dilated and a special instrument is used to scrape the uterine lining for medical or surgical reasons. Learn About D&C Esophagogastroduodenoscopy (EGD) EGD is a diagnostic procedure using an endoscope to examine the esophagus, stomach, and upper part of the small intestine Learn About EGD Exploratory Laparotomy Exploratory laparotomy is a surgical procedure allowing doctors to inspect the abdomen to diagnose and treat potential health issues Learn About Exp Lap Extracorporeal Shockwave Lithotripsy Extracorporeal Shockwave Lithotripsy is a non-invasive treatment that uses sound waves to break down kidney stones Learn About ESWL Femoral Artery Endarterectomy Femoral artery endarterectomy is a surgical procedure removing plaque from the femoral artery to improve blood flow to the legs Learn About Femoral Endarterectomy Femorofemoral Bypass, Fempop Bypass & Femtib Bypass Surgery rerouting blood flow around blocked femoral artery, connecting one femoral artery to another artery Gastric Bypass (Roux en Y) Gastric bypass (Roux-en-Y) is a weight-loss surgery, reducing stomach size and rerouting food past a portion of the small intestine Learn About Roux En Y Gastric Sleeve Gastric Sleeve involves removing approximately 85% of the stomach, leaving a narrow, tube-like portion, or "sleeve" Learn About Gastric Sleeve Gastrostomy Tube Insertion Gastrostomy tube insertion is a procedure to place a feeding tube directly into the stomach through the abdominal wall Learn About Gastrostomy Hemorrhoidectomy Hemorrhoidectomy is a surgical procedure for removing hemorrhoids, swollen blood vessels located in or around the anus and rectum Learn About Hemorrhoidectomy Hydrocelectomy Hydrocelectomy is a surgical procedure to remove a hydrocele, a fluid-filled sac causing swelling in the scrotum Learn About Hydrocelectomy Hysteroscopy Hysteroscopy is a minimally invasive procedure using a hysteroscope to examine the uterus's interior for diagnosis or treatment Learn About Hysteroscopy Hysterectomy Hysterectomy is a surgical procedure for removing the uterus, often including the cervix, and occasionally the ovaries and fallopian tubes Learn About Hysterectomy Inferior Vena Cava (IVC) Filter Placement Inferior Vena Cava (IVC) filter placement is a procedure to implant a device in the IVC vein, preventing pulmonary embolism Learn About IVC Filter Inguinal Hernia Repair Kyphoplasty & Vertebroplasty Inguinal hernia repair is a surgery to fix a hernia in the lower abdomen or groin, reinforcing the weakened area Learn About Inguinal Hernia Liposuction Liposuction is a cosmetic surgery removing excess body fat from specific areas to reshape and contour the body. Kyphoplasty: Minimally invasive surgery inflating a balloon in a compressed vertebra, then injecting bone cement. Vertebroplasty: Procedure injecting bone cement into fractured vertebra to relieve pain and restore function Learn About Vertebral Augmentation Lobectomy Lung lobectomy is a surgery that removes a lobe of the lung, often performed to treat conditions like lung cancer. Learn About Liposuction Mastectomy Mastectomy is a surgical procedure to remove one or both breasts, often performed to treat or prevent breast cancer Learn About Mastectomy Mediastinoscopy Mediastinoscopy is a procedure using a scope to examine the mediastinum, the area between the lungs, often to biopsy lymph nodes Learn About Mediastinoscopy Inferior Vena Cava (IVC) Filter Removal Inferior Vena Cava (IVC) Filter Removal is a procedure to extract an IVC filter, previously implanted to prevent pulmonary embolism Learn About IVC Filter Removal Leep Procedure LEEP procedure (Loop Electrosurgical Excision Procedure) is a treatment removing abnormal cervical tissue to prevent cervical cancer Learn About LEEP Lumbar Laminectomy Lumbar laminectomy is a surgical procedure to remove part of the vertebral bone (lamina) in the lower back, relieving nerve pressure Learn About Lumbar Laminetomy Myringotomy Myringotomy is a procedure where a small incision is made in the eardrum to relieve pressure or drain ear fluid Learn About Myringotomy Nephrectomy Nephrectomy is a surgical procedure to remove part or all of a kidney, often due to disease or kidney donation Learn About Nephrectomy Parathyroidectomy Parathyroidectomy is a surgical procedure to remove one or more of the parathyroid glands, typically to treat hyperparathyroidism Learn About Parathyroidectomy Posterior Cervical Fusion Posterior cervical fusion is a surgery to join select bones in the neck, providing stability and relieving spinal cord pressure Learn About PCF Nissen Fundoplication Nissen Fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) by wrapping the stomach around the esophagus Learn About Nissen Fundoplication Pacemaker Pacemaker insertion is a procedure where a small device is implanted under the skin to regulate the heart's electrical activity Learn About Pacemaker Percutaneous nephrolithotomy (PCNL) Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure to remove large kidney stones through a small back incision Learn About Percutaneous Nephrolithotomy Portacath/Mediport Insertion Portacath insertion is a procedure to implant a venous access device under the skin, facilitating long-term intravenous medication delivery Learn About Portacath/Mediport Sentinel Lymph Node Biopsy Sentinel lymph node biopsy is a procedure to identify and remove the first lymph node(s) cancer may spread from the primary site Learn About SLNB Septoplasty & Rhinoplasty Septoplasty is a surgical procedure to correct a deviated septum, improving nasal breathing by straightening the partition in the nose Learn About Septoplasty & Rhinoplasty Spinal Cord Stimulator Temporal Artery Biopsy Spinal Cord Stimulator is an implantable device delivering electrical pulses to the spinal cord, managing chronic pain conditions. Temporal artery biopsy is a procedure where a small section of the temporal artery is removed and examined for vasculitis. Learn About Spinal Cord Stimulator Learn About Temporal Artery Biopsy Tonsillectomy and Adenoidectomy (T&A) Total Hip Arthroplasty (THA) Tonsillectomy and Adenoidectomy (T&A) is a surgery to remove the tonsils and adenoids, often to treat recurrent infections or breathing issues. Learn About T&A Total Hip Arthroplasty (THA) is a surgical procedure to replace a worn or damaged hip joint with an artificial one Learn About THA Thyroidectomy Thyroidectomy is a surgical procedure to partially or entirely remove the thyroid gland, often due to cancer, goiter, or hyperthyroidism Learn About Thyroidectomy Total Knee Arthroplasty (TKA) Total Knee Arthroplasty (TKA) is a surgery replacing a damaged knee joint with an artificial one to restore function and relieve pain Learn About TKA Tracheostomy Tracheostomy is a surgical procedure creating a hole in the neck into the trachea, providing an alternative airway for breathing Learn About Tracheostomy Transcatheter Aortic Valve Replacement (TAVR) Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive procedure replacing a diseased aortic valve without open-heart surgery Learn About TAVR Transesophageal Echocardiography (TEE) Transesophageal Echocardiography (TEE) is a diagnostic procedure using an ultrasound probe in the esophagus to visualize heart structures Learn About TEE Transurethral Resection of Bladder Tumor (TURBT) TURBT is a surgical procedure to diagnose and treat bladder cancers by removing tumors via the urethra, often using electrocautery Learn About TURBT Transurethral Resection of the Prostate (TURP) TURP is a surgical procedure to alleviate urinary symptoms by removing part of the enlarged prostate gland through the urethra Learn About TURP Umbilical Hernia Repair Ureteroscopy Umbilical hernia repair is surgery to fix an umbilical hernia, a protrusion of the abdomen through the belly button area Ureteroscopy is a minimally invasive procedure using a thin scope to examine or treat problems in the ureters and kidneys Learn About Umbilical Hernia Learn About Ureteroscopy Ventral Hernia Repair Vitrectomy Ventral hernia repair is a surgical procedure to correct a bulge or tear in the abdominal wall (ventral hernia) Learn About Ventral Hernia Vitrectomy is a surgical procedure to remove the vitreous humor gel from the eye to treat various retinal conditions Learn About Vitrectomy Tympanoplasty Tympanoplasty is a surgical procedure to repair a damaged eardrum or middle ear bones to improve hearing and prevent infections Learn About Tympanoplasty Vasectomy A vasectomy is a surgical procedure for male sterilization or permanent contraception, by cutting or sealing the vas deferens. Learn About Vasectomy Watchman Procedure The Watchman procedure is a minimally invasive surgery that implants a device in the left atrial appendage to prevent stroke in patients with atrial fibrillation Learn About Watchman Whipple Procedure (Pancreaticoduodenectomy) Whipple Procedure, or Pancreaticoduodenectomy, is a major surgery removing parts of the pancreas, duodenum, and gallbladder to treat pancreatic diseases Learn About Whipple

HYSTEROSCOPY ​ ​ Hysteroscopy is a procedure that allows a doctor to look inside the uterus in order to diagnose and treat causes of abnormal bleeding. The hysteroscope is a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. The procedure can be either diagnostic or operative. ​ Diagnostic hysteroscopy is used to diagnose problems of the uterus. It is also used to confirm results of other tests, such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and fallopian tubes. Diagnostic hysteroscopy can often be done in an office setting. ​ Additionally, hysteroscopy can often be used to identify the cause of unexplained bleeding or spotting in postmenopausal women. ​ Operative hysteroscopy i s used to correct an abnormal condition that has been detected during a diagnostic hysteroscopy. If an abnormal condition was detected during the diagnostic hysteroscopy, an operative hysteroscopy can often be performed at the same time, avoiding the need for a second surgery. During operative hysteroscopy, small instruments are used to correct the condition. These instruments are inserted through the hysteroscope. ​ Procedures that may be performed during a hysteroscopy include: Polyp removal: Polyps are small benign growths in the uterus. They can cause heavy or irregular periods and sometimes interfere with pregnancy. Fibroid removal: Fibroids are noncancerous tumors in the uterus that can cause pain, heavy bleeding, and complications during pregnancy. Adhesion removal: Adhesions or scar tissue in the uterus can lead to changes in menstrual flow as well as infertility. Endometrial ablation: This procedure can help control heavy, prolonged menstrual bleeding. It works by permanently removing or destroying the lining of the uterus (the endometrium). Endometrial biopsy: During this procedure, a small sample of the lining of the uterus is taken to be examined under a microscope. ​ Anesthetic Implications for Hysteroscopy ​ Anesthesia type: General, neuraxial, or local ​ Airway: ETT or LMA ​​ Preoperative: ​ ​ Patients may be hypovolemic and anemic if done for uterine bleeding Neuraxial anesthesia (spinal to the T10 level) Lithotomy position can impair respiratory mechanics Common peroneal nerve injury can occur from pressure on the nerve over the fibula Hyperflexion of the hip joint can cause femoral nerve injury Avoid finger injuries from positioning (place arms on arm boards) The sensory nerve supply of the vagina arises from the pudendal nerve (S2, S3, S4) The sympathetic and parasympathetic nerve supply arise from the hypogastric plexus (L1-L3) and sacral nerves Intraoperative: ​ Vagal nerve stimulation can occur from traction on the uterus and cervical dilation Monitor the patient for signs of fluid overload (hyponatremia, hypervolemia, and decreased osmolarity) Dilute solutions of vasopressin and epinephrine may be injected locally in the cervix and cause hypertension Position: Lithotomy, Trendelenburg with arms out Duration: 30-60 minutes ​ Postoperative: ​ PONV prophylaxis Pain management ​ Complications: ​ Infection Bleeding Fluid overload Air embolism Uterine perforation Bowel perforation Cerebral edema Pulmonary edema Electrolyte imbalances Nerve injuries ​ ​ . ​ ​ Sources: ​ Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed. Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. ​ Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). ​ Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult. ​ ​ ​ ​ ​​ ​​ Back to Surgical Tips Nucleus Medical Media Hysteroscopy CCMIG London Diagnostic Hysteroscopy Step by Step Dr. R. K. Mishra How to do Diagnostic Hysteroscopy?

INFERIOR VENA CAVA (IVC) FILTER REMOVAL ​ ​ Inferior Vena Cava (IVC) filters are small, cage-like devices that are implanted in the IVC, the main vessel returning blood from the lower half of the body to the heart. These filters are designed to catch blood clots and prevent them from reaching the lungs, where they can cause a potentially fatal pulmonary embolism. ​ IVC filters are typically used in patients who have a high risk of developing blood clots but cannot take anticoagulant medication, or in whom anticoagulants have failed. While some IVC filters are intended to be permanent, others are designed to be retrievable and can be removed once the risk of clotting has decreased. ​ IVC filter removal is a minimally invasive procedure. Here's a basic rundown of what it might look like: Preparation: The patient is prepared for the procedure, usually with a mild sedative to help them relax. They will be positioned on an X-ray table. Access: The doctor will numb a small area of skin, usually in the neck or groin, where a thin tube called a catheter can be inserted into a vein. Procedure: Using fluoroscopy (real-time X-ray imaging), the doctor guides the catheter to the location of the IVC filter. A small snare or other device is passed through the catheter to the IVC filter. The filter is then carefully grasped and pulled into the catheter. Removal: Once the filter is inside the catheter, both are removed together. Post-procedure: After the filter is removed, pressure will be applied to the catheter insertion site to prevent bleeding. The patient will be observed for a certain period of time before being discharged. ​ Anesthetic Implications for IVC Filter Removal ​ Anesthesia type: General, local anesthesia, and sedation (MAC) ​ Airway: LMA or ETT ​​ Preoperative: ​ ​ Fluoroscopy/Xray is used for this procedure Lead aprons and thyroid shields should be available Assess the patient's coagulation status ​ Intraoperative: ​ ​ Position: Supine, arms tucked Duration: 30-60 minutes ​ Postoperative: ​ Pain management PONV prophylaxis ​ Complications: ​ Bleeding Infection Damage to the vena cava Failure to retrieve the filter Clot formation ​ S ources: ​ Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed. Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. ​ Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). ​ Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult. ​ ​ ​ ​ ​​ ​​ Back to Surgical Tips Florida Interventional Specialists IVC Filter Retrieval Methodist Hospital Inferior Vena Cava Filter Retrieval Using Advanced Techniques Which Medical Device IVC Filter Retrieval

PARATHYROIDECTOMY ​ ​ A parathyroidectomy is a surgical procedure to remove one or more of the parathyroid glands. These glands are small endocrine glands located in the neck, behind the thyroid. The procedure is typically performed to treat conditions such as hyperparathyroidism, where the parathyroid glands produce too much parathyroid hormone, leading to elevated calcium levels in the blood. ​ ​ Anesthetic Implications for Parathyroidectomy ​ Anesthesia type: General ​ Airway: ETT ​​ Preoperative: ​ ​ Parathyroid glands control serum calcium and bone calcium levels Serum calcium levels are important in muscle and nerve function Low calcium levels can cause tetany Nerve integrity monitor (NIM) endotracheal tube may be used (detects recurrent laryngeal nerve injury) If NIM ETT is used, avoid neuromuscular blockers\ Patients may experience significant nausea secondary to hypercalcemia ​ Intraoperative: ​ ​ Adequacy of resection can be assessed using intraoperative PTH monitoring Parathyroid reimplantation may be done in the setting of total parathyroid removal Reimplantation: pieces of one parathyroid gland are placed in the muscle of the forearm (good blood supply) Reimplanted gland should be able to maintain adequate calcium levels Position: Supine with shoulder roll ​ Postoperative: ​ Assess for hypocalcemia in the postoperative period Symptoms of hypocalcemia include tetany, paresthesias, perioral numbness, laryngospasm, seizures, and prolonged QT interval Hypomagnesemia aggravates hypocalcemia Postoperative inspiratory stridor may occur ​ Complications: ​ Recurrent laryngeal nerve (RLN) injury Superior laryngeal nerve injury Phrenic nerve injury Hematoma Laryngeal edema Transient hypocalcemia Stridor Pneumothorax ​ ​ S ources: ​ Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed. Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. ​ Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). ​ Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult. ​ Vacanti, C., Segal, S., Sikka, P., & Urman, R. (Eds.). (2011). Essential Clinical Anesthesia (1st ed.) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​​ ​​ Back to Surgical Tips University of Kentucky Thyroid and Parathyroid Disorders and Anesthesia Ninja Nerd Hypoparathyroidism Ninja Nerd Hyperparathyroidism

APPENDECTOMY ​ An appendectomy i s a surgical procedure to remove the appendix, a small, tube-like structure attached to the large intestine (colon) in the lower right side of the abdomen. The appendix has no known essential function in the human body, but it can become inflamed or infected, leading to a condition called appendicitis. ​ Appendicitis is a medical emergency and requires prompt treatment, as a ruptured appendix can lead to serious complications, including peritonitis (infection of the lining of the abdominal cavity) and sepsis (a life-threatening infection that can spread throughout the body). ​ There are two primary methods for performing an appendectomy: ​ Open appendectomy: This method involves making a single, larger incision in the lower right side of the abdomen to access and remove the appendix. The surgeon then closes the incision with sutures or staples. Laparoscopic appendectomy: This is a minimally invasive procedure that utilizes a few small incisions in the abdomen. A laparoscope (a thin, flexible tube with a light and camera) is inserted through one of the incisions, allowing the surgeon to visualize the appendix and surrounding organs on a monitor. Specialized surgical instruments are then inserted through the other incisions to remove the appendix. This method typically results in less pain, faster recovery, and smaller scars compared to an open appendectomy. ​ The choice of surgical method depends on factors such as the patient's overall health, the severity of the appendi citis, and the surgeon's experience and preference. After surgery, most patients can return to normal activities within a few weeks, although full recovery may take longer in cases with complications. ​ Anesthetic Implications for A ppendectomy ​ Anesthesia type: General ​ Airway: Endotracheal tube ​​ Preoperative: ​ ​ Abdominal pain can result in atelectasis from respiratory splinting Patients may present nauseous, vomiting, and dehydrated Expect hemoconcentration if the patient is dehydrated (fever, emesis, decreased oral intake) Assess volume status and provide adequate hydration prior to induction If emergency case, full stomach precautions Rapid-sequence induction if abdominal distention or ileus is present 1 peripheral IV (normally 18-20 gauge) Peritonitis can cause volume shifts Electrolyte abnormalities are common secondary to N/V. Orogastric or nasogastric tube for stomach suctioning If the appendix is perforated, or peritonitis is present, a nasogastric tube is commonly placed for 24 hours Position: Supine with arms out or tucked Usually, just the left arm is tucked ​ Intraoperative: ​ Avoid using nitrous oxide to minimize gastric/bowel distention. If laparoscopic case, pneumoperitoneum is created to enhance visualization Pneumoperitoneum can impair ventilation by decreasing lung compliance and functional residual capacity Trendelenburg position may be implemented to displace bowel with gravity which can further impair ventilation Neuromuscular paralysis is indicated Approximate time 60 minutes EBL expected < 75 mL ​ Postoperative: ​ Extubation/emergence: Ideally, patient should be fully awake and fully reversed, capable of protecting airway Increased risk of PONV Mild to moderate pain expected Regional techniques may be used (TAP block) ​ Complications: ​ Perforation Wound abscess Fecal fistula Hematoma Illeus Appendiceal stump leak Injury to other structures Atelectasis Thromboembolism PONV ​ Sources: ​ Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. ​ Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). ​ Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult. ​ ​ ​ ​ ​​ ​​ Back to Surgical Tips The Surgery Squad Laparoscopic Appendectomy Osmosis Appendicitis Zero to Finals Appendicitis

VASECTOMY A vasectomy is a surgical procedure used as a form of male contraception. It involves cutting or blocking the vas deferens, the tubes that carry sperm from the testicles to the urethra. This procedure prevents sperm from mixing with the semen that is ejaculated from the penis. As a result, the semen no longer contains sperm, which means it can't cause pregnancy. ​ The procedure is typically done under local anesthesia and is known for being quick and having a low risk of complications. It's considered a permanent form of birth control, although in some cases, it can be reversed through a more complicated surgical procedure. In certain cases, or if there are specific medical considerations, a doctor might opt to use general anesthesia. ​ After a vasectomy, it's important to note that it takes some time before the semen is free of sperm. Men are usually advised to have follow-up semen tests to confirm the absence of sperm before relying on the vasectomy for contraception. ​ Anesthetic Implications for Vasectomy ​ Anesthesia type: General, local anesthesia, sedation, spinal ​ Airway: ETT or LMA ​​ Preoperative: ​ ​ Commonly young and healthy patients Commonly done under local anesthesia unless anxiety or health issues A sensory level of T10 is required to block pain from testicular manipulation ​​ Intraoperative: ​ Position: supine Duration: 30-60 minutes A small incision is made into the scrotum on both sides The vas deferens is isolated and ligated Manipulation of the genitals can cause profound vagal bradycardia ​ Postoperative: ​ After this surgery, the testicles will continue to produce sperm, but the sperm will be reabsorbed by the body PONV prophylaxis Pain management ​​ Complications: ​ Scrotal hematoma Wound infection Swelling Bruising ​ ​ Sources: ​ Elisha, S. (2010). Case Studies in Nurse Anesthesia. ​ Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. ​ Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). ​ Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult. ​ ​ ​ ​ ​​ ​​ Back to Surgical Tips CFPCMedia Vasectomy Nucleus Medical Media Vasectomy Dr Matt & Dr Mike Male Reproductive System

COLONOSCOPY ​ A colonoscopy is a medical procedure that allows a doctor, usually a gastroenterologist, to examine the inner lining of the large intestine (rectum and colon). They use a thin, flexible tube called a colonoscope to view the colon. This device has a small camera attached to its end, which transmits images to a monitor for the doctor to review. ​ It may be performed for either diagnostic or therapeutic purposes. ​ A grounding pad may need to be placed for cautery excision. ​ Here are the key steps in the procedure: Preparation: Before the procedure, patients need to clean out your colon (colon prep) to give the doctor a clear view. This usually involves a liquid diet for 1 to 3 days before the procedure and taking a strong laxative or over-the-counter enema kit. Sedation: Before the colonoscopy starts, patients receive a sedative to help them relax and reduce discomfort. Procedure: The doctor will slowly insert the colonoscope into the rectum and guide it into the colon. Air or carbon dioxide will be introduced to expand the colon for a better view. Polyp Removal & Biopsy: If the doctor finds polyps (abnormal growths), they can remove them during the procedure using tiny tools passed through the scope. Similarly, if other abnormal tissues are found, they can be sampled (biopsy) for further testing. ​ Colonoscopies are often used to diagnose gastrointestinal symptoms, screen for colon cancer, and follow up on a positive stool test. The American Cancer Society recommends that people at average risk of colon cancer begin regular screenings at age 45, ​ Anesthetic Implications for Colonoscopy ​ Anesthesia type: TIVA, sedation ​ Airway: Oral airway, nasal ariway ​​ Preoperative: ​ ​ Patients receive a bowel prep and present with dehydration and hypovolemia Oxygen is administered via nasal cannula or simple face mask CO2 monitoring is a helpful adjunct Airway equipment and emergency medications must be available Risk of aspiration for patients with obstruction Patients with colon cancer are likely to be anemic Metastatic colon cancer maybe associated with concomitant organ dysfunction (liver and lungs) ​ Intraoperative: ​ ​ Vagal effect and bradycardia may occur from colon insufflation Position: left lateral position, with knees pulled up and legs bent The doctor may ask to press on abdomen (stimulating) Insufflation of the colon can decrease functional residual capacity (FRC) Duration 15-60 minutes EBL none to minimal. Unless associated with underlying GI bleed or coagulopathy ​ Postoperative: ​ Recovery period ​ Complications: ​ Bleeding Colonic perforation Airway obstruction Desaturation ​ Sources: ​ Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. ​ Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). ​ Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult. ​ ​ ​ ​ ​ ​ ​​ ​​ Back to Surgical Tips You and Colonoscopy What happens during and after a colonoscopy? Olympus Medical Systems Europe Basics of Colonoscopy The Everett Clinic Intravenous Sedation for Endoscopy Colonoscopy

SENTINEL LYMPH NODE BIOPSY (SL NB) Sentinel lymph node biopsy (SLNB) is a surgical procedure used to determine if cancer, such as breast cancer or melanoma, has spread to the lymph nodes. It involves the identification and removal of the sentinel lymph node(s) — the first lymph node(s) to which cancer cells are likely to spread from a primary tumor. To identify the sentinel lymph node, a dye and/or a radioactive substance is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes, and the first node that receives the dye is identified as the sentinel node. ​ During the procedure, the surgeon makes a small incision in the area of the lymph node and removes it. The lymph node is then examined under a microscope to check for the presence of cancer cells. If cancer is found in the sentinel node, it may indicate that the cancer has spread, and additional lymph nodes may need to be removed for further examination. If the sentinel node is free of cancer, it's likely that the cancer hasn't spread to other lymph nodes, and no further lymph node surgery is needed. ​ The sentinel lymph node is commonly located in the axilla but may be situated in the internal mammary chain or other extraaxillary sites. ​ The sentinel lymph node is the first lymph node to drain lymphatics from breast cancer and is most likely to harbor metastatic tumor cells. ​ The radioactive tracer commonly used in this precedure has very low radioactivity, and no special protection is required around the patient. Anesthetic Implications for SLNB ​ Anesthesia type: General anesthesia or local anesthesia + IV sedation ​ Airway: Endotracheal tube or LMA ​​ Preoperative: ​ ​ Patients are frequently very anxious due to the possibility of breast malignancy Avoid BP cuff or IV in the ipsilateral arm Monitor and prevent brachial plexus injuries caused by overstretching the arm Breast cancer is the most common cancer among women In lymph node mapping, the lymphatic flow carries dye or a radioactive tracer creating a “map” of the nodes If the sentinel node is positive for cancer, an axillary node dissection is needed ​​ Intraoperative: ​ May need to avoid muscle relaxants (surgeon may want nerve function monitoring) Operative field (chest and lymph node-bearing areas) is surveyed with a gamma probe, identifying tracer in lymph nodes Duration for SLNB: 10-30 minutes ​Position: Supine, one arm extended, one arm tucked EBL: Minimal Isosulfan blue dye may cause an artifactual drop in O2 saturation Isosulfan dye reaction: Itching, localized swelling, blue hives, hypotension ​ Postoperative: ​ Smooth emergence is important Pain management Monitoring for complications Risk of PONV ​​ Complications: ​ ​Allergic dye or radioisotope reaction Discoloration of urine and stool Blue staining of the skin Anaphylaxis Nerve injury: Long thoracic nerve, thoracodorsal nerve, and intercostobrachial nerve Lymphedema ​ Sources: ​ Elisha, S. (2010). Case Studies in Nurse Anesthesia. ​ Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. ​ Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). ​ Sherwin, A., & Buggy, D. J. Anaesthesia for breast surgery. Mater Misericordiae University Hospital and University College Dublin. Retrieved from https://www.bjaed.org/article/S2058-5349(18)30101-X/pdf ​ Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult. ​ ​ ​ ​ ​​ ​​ Back to Surgical Tips Learn About ALDN Medicosis Perfectionalis Sentinel Lymph Node Biopsy (SLNB) NEJM Group Sentinel-Lymph-Node Biopsy Breast Cancer School for Patients Sentinel Node Biopsy

TRACHEOSTOMY A tracheostomy is a medical procedure that involves creating an opening in the neck in order to place a tube into a person's trachea (windpipe). This opening, or stoma, allows air to enter the lungs, bypassing any blockages or obstructions in the upper airways. The procedure can be performed for various reasons, including: ​ Airway Blockage: To bypass an obstructed airway, which could be due to tumors, swelling, or foreign objects. Breathing Problems: For people with chronic respiratory diseases, severe neck or mouth injuries, or other conditions that make normal breathing difficult. Long-term Ventilation: In cases where long-term use of a ventilator is needed, such as with severe neurological or muscular disorders, a tracheostomy may be more comfortable and safer than prolonged intubation through the mouth. Pulmonary Hygiene: To help with the removal of secretions in patients who are unable to cough effectively or have thick secretions. ​ The procedure is typically done under general anesthesia in a hospital setting. Post-procedure care includes regular cleaning of the tracheostomy tube and the stoma, monitoring for possible complications such as infection or blockage of the tube, and eventually, the process of weaning off the tracheostomy tube if the underlying condition improves. ​ A tracheostomy can be temporary or permanent, depending on the reason for its placement and the overall health and recovery potential of the patient. It significantly affects the patient's ability to speak and swallow, and thus rehabilitation and adaptation are crucial aspects of care for individuals with a tracheostomy. ​ Anesthetic Implications for Tracheostomy ​ Anesthesia type: General, local anesthesia ​ Airway: ETT, Tracheostomy tube (TT) ​​ Preoperative: ​ ​ Patients are normally intubated and on a ventilator Have equipment for a possible difficult airway Potentially critically ill patient with limited reserve or multi-organ failure ​​ Intraoperative: ​ "Shared airway" Maintain close communication with the surgeon Airway fire precautions (low FiO2 and limited cautery use) Duration: 30-60 minutes Position: Supine, head extended with shoulder roll Motionless surgical field with neuromuscular paralysis The tissues of the trachea and neck are quite vascular The recurrent laryngeal nerves may be damaged if dissection deviates from the midline The innominate artery crosses anteriorly The tube is withdrawn cephalad, the surgeon inserts the tracheostomy cannula, and the anesthesia circuit is connected Major resistance to ventilation shoulder alert practitioner of incorrect cannula placement Capnography is essential to confirm that the tube is in the trachea After ventilation is verified, the endotracheal tube is removed entirely ​ Postoperative: ​ PONV prophylaxis Smooth emergence The obturator for the tracheostomy tube must accompany the patient The obturator is needed if the tracheostomy becomes dislodged and needs to be replaced ​​ Complications: ​ Bleeding Loss of airway False lumen Airway fire Air embolism Airway stenosis Bronchospasm Pneumothorax Pneumomediastinum Subcutaneous emphysema Pulmonary edema Tracheoinnominate artery fistula Infection Aspiration Tracheal necrosis Tracheo-arterial fistula Nerve damage ​ ​ Sources: ​ Elisha, S. (2010). Case Studies in Nurse Anesthesia. ​ Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. ​ Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). ​ Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult. ​ ​ ​ ​ ​​ ​​ Back to Surgical Tips Fauquier ENT Tracheostomy Amerra Medical Tracheotomy - 3D animation University of Kentucky ENT Anesthesia