Q Splenectomy
Patients presenting for splenectomy can be divided into two groups: trauma patients and patients with myeloproliferative disorders and other varieties of hypersplenism. Anesthetic management is individualized based on the individual patient’s medical condition. Patients who have received chemotherapy must be assessed for potential organ system complications. Laparoscopic-assisted splenectomy best suited for normal and slightly enlarged spleens. The laparoscopic approach is unusually contraindicated in patients with cancer, large hilar lymph nodes, and portal hypertension. The only absolute contraindication to laparoscopic splenectomy is massive splenomegaly (spleen >30 in longitudinal axis).
2. Preoperative assessment
a) History and physical examination
(1) Cardiovascular: Patients with systemic disease may be chronically ill and have decreased cardiovascular reserve. Patients who have received doxorubicin (Adriamycin) may have a dose-dependent cardiotoxicity that can be worsened by radiation therapy. Manifestations include decreased QRS amplitude, congestive heart failure, pleural effusions, and dysrhythmia.
(2) Respiratory: Patients may have a degree of left lower lobe atelectasis and altered ventilation. If they are treated with bleomycin, pulmonary fibrosis may occur. Methotrexate, busulfan, mitomycin, cytarabine, and other chemotherapeutic agents may cause pulmonary toxicity. A laparoscopic approach may be contraindicated in patients with severe cardiac or respiratory disease.
(3) Neurologic: Patients may have neurologic deficits after taking chemotherapeutic agents. Vinblastine and cisplatin can cause peripheral neuropathies. Any evidence of neurologic dysfunction should be documented.
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