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First Rib Resection for Thoracic Outlet Syndrome

Anesthesia Implications

Clinically reviewed by anesthesia providers · Updated

Position : Supine, Lateral, head turned away from field, one arm extended, Operative arm suspended from an overhead holder and pulled cephalad intermittently to open the outlet.
Time : 1-2 hours (average)
Blood Loss : Moderate (50 - 200 ml)
Post-op Pain : High (7-10)
Maintenance Paralytic : Ask Surgeon
Considerations : Arterial line, MEP monitoring, SSEP monitoring, Fluoroscopy / Xray, PONV, Anticoagulation / Antiplatelet Therapy, One-Lung Ventilation / Lung Isolation

Anesthetic Approaches

1GETT, TIVA, Propofol Drip, Remifentanil Drip
2GETT, 1/2 MAC Gas, Remifentanil Drip
The Surgery

Approach - transaxillary through the axilla with the arm suspended, or supraclavicular through the lower neck; infraclavicular and thoracoscopic-assisted routes are used in selected cases. Scalene...

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