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Total Proctocolectomy with Ileal Pouch-Anal Anastomosis

Anesthesia Implications

Clinically reviewed by anesthesia providers · Updated

Position : Lithotomy, arms tucked
Time : 4+ hours (very long)
Blood Loss : Very High (500+ ml)
Post-op Pain : High (7-10)
Maintenance Paralytic : Yes
Blocks : TAP, Rectus Sheath
Considerations : Arterial line, Central line, High Blood Loss, PONV, Prolonged Lithotomy / Well-Leg Compartment

Anesthetic Approaches

1GETT, Epidural
2GETT, TIVA, Propofol Drip
3GETT, Nerve Block
The Surgery

Positioning and setup - modified lithotomy in padded Allen stirrups so the surgeon has simultaneous abdominal and perineal access. Foley placed. Two-table instrument setup (separate abdominal and...

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