ANAL RECTAL PROCEDURES
Anal and rectal procedures are medical or surgical interventions performed to diagnose or treat various conditions affecting the anus or rectum. Some common anal and rectal procedures include:
1) Hemorrhoidectomy: A surgical procedure to remove hemorrhoids, which are swollen and inflamed veins in the anus and lower rectum. This procedure can be done using various techniques, such as conventional surgery, stapled hemorrhoidectomy, or laser surgery.
2) Fissurectomy: A surgical procedure to treat anal fissures, which are tears in the lining of the anus. The surgeon removes the fissure and any surrounding tissue, promoting healing and preventing recurrence.
3) Fistulotomy: A surgical procedure to treat anal fistulas, which are abnormal connections between the anal canal and the skin around the anus. The surgeon opens the fistula, cleans the area, and allows it to heal from the inside out.
4) Pilonidal cyst excision: A surgical procedure to remove a pilonidal cyst, which is an abnormal pocket of skin and hair near the tailbone that can become infected and form an abscess. The surgeon removes the cyst and any surrounding tissue, and the wound is either closed with stitches or left open to heal.
5) Rectopexy: A surgical procedure to correct rectal prolapse, a condition in which the rectum protrudes through the anus. The surgeon repositions the rectum and secures it to the surrounding tissue to prevent it from prolapsing again.
These are just a few examples of anal and rectal procedures.
Anesthetic Implications for Anal Rectal Procedures
Anesthesia type: General anesthesia, local MAC, TIVA, neuraxial (spinal or epidural), or combination anesthesia
may be employed
Airway: Endotracheal tube or LMA
Preoperative:
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Check with the team regarding patient position such as lithotomy or prone jack-knife
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if prone, need prone view device and protection of face and eyes
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if prone without an advanced airway, have oral and nasal airways readily available
Intraoperative:
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May have to limit IV fluids to 500 ml. Check with surgeon
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Nerve supply to anorectal area
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Sympathetic supply: sympathetic chain to hypogastric plexus(L1 –L5 ) and celiac plexus (T11–L2)
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Parasympathetic supply comes from ventral rami of S2 –S4
Postoperative:
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Local anesthesia is usually injected for postoperative pain relief
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It is not uncommon to have difficulty completely emptying your bladder after surgery
Complications:
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Urinary retention
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Bleeding
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Infection
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Pain
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Fecal impaction
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.