Sentinel Lymph Node Biopsy

A sentinel lymph node is the first lymph node a malignant cancer is likely to spread to. So, the anesthetic approach and position here really depends on the location of the cancer. Most often, the biopsy will be done by a general anesthetic approach. Below are the indications for breast cancer (one of the most common) Non-depolarizing muscle relaxants - Intentionally AVOID long-acting muscle relaxants/paralytics. Succinylcholine is fine to get the case started, but the surgeon will need the patient to be paralytic-free later in the case. This is because he/she will be working close to the thoracodorsal and/or long thoracic nerve. Use of cautery in the affected area will cause a twitch when getting close to these nerves. Surgeons like the twitch as an indicator that they are close to the nerve. Typical positioning - The surgeon typically likes the affected side rotated up towards him/her along with reverse trendelenburg. End of case - The patient may be hand-hoisted to the sitting position at the end of the case to allow application of a chest binder or wrap. Be cautious of having the patient too light as this will be especially stimulating.

The surgeon may use a combination of the gamma probe and a blue dye to find and surgically remove the lymph node.