Laparotomy
Updated On: December 2, 2024
Anesthetic Approaches
Get clarity - speak to the surgeon and ask what the surgery is being performed for. This will help gauge the length of the procedure, need for a gastic tube, need for an epidural, etc. Time - the length of these procedures varies widely (avg 1-4 hours). This is another good question for the surgeon. Pain - there's quite a bit of pain after these procedures. Some surgeons will request an epidural. Make sure you're prepared. Blood loss - These cases vary quite a lot between minimal to high blood loss. This will be highly dependent on the patients condition and reason for the laparotomy. Hemodynamics - Many of these patients will be very sick (eg ischemic bowel, sepsis). Anticipate difficulty maintaining a healthy hemodynamic status. Hydration - Open abdominal cases have the greatest third space losses. Recommendations are 10-15 ml/kg for the first hour and 5-10 ml/kg thereafter.
High Blood Loss (general considerations): Type and cross, CBC, and CMP should be done prior to the procedure. Consider having an A-line, blood tubing, and extra push-lines. Depending on the fragility of the patient, you may want to have blood in the room and available.
Long procedure (general considerations): Procedures anticipated to last longer than 2 hours generally require a urinary catheter. Also, consider checking lines and positioning regularly as the risks of infiltration and nerve damage are increased with procedure time. Consider an IV fluid warmer and a forced air warmer to keep the patient euthermic.
Arterial line (general considerations): Preoperatively check pulses to gauge the best side to attempt the A-line. Perform an Allen test to ensure adequate blood flow. Have the A-line equipment set up and ready in the room.