00864 Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; total cystectomy

Name of the Procedure:

Anesthesia for Extraperitoneal Procedures in Lower Abdomen, Including Urinary Tract; Total Cystectomy Common name: Total Cystectomy Anesthesia

Summary

A total cystectomy is a surgical procedure to remove the urinary bladder. This type of surgery is often performed to treat bladder cancer. Anesthesia is required to ensure the patient is pain-free during the surgery.

Purpose

The primary purpose of a total cystectomy is to treat bladder cancer or other serious conditions affecting the bladder that cannot be managed with less invasive treatments. The goals are to remove the diseased bladder, prevent the spread of cancer, and alleviate symptoms such as severe pain or bleeding.

Indications

• Bladder cancer (muscle-invasive or high-grade non-muscle invasive)
• Severe, uncontrollable bleeding from the bladder
• Chronic, severe infections (interstitial cystitis) not responsive to other treatments
• Birth defects like exstrophy of the bladder
• Dysfunctional bladder causing severe symptoms or high risk of kidney damage

Preparation

• Patients are usually required to fast for at least 8 hours before the procedure.
• Preoperative tests may include blood work, ECG, imaging studies, and a comprehensive physical examination.
• Patients might need to adjust their medications, especially blood thinners, as advised by their doctor.
• A pre-anesthetic consultation to assess the patient's health status and any potential anesthesia-related risks.

Procedure Description

1. Preparation and Monitoring: The patient is brought to the operating room, and monitoring devices are applied (e.g., ECG, blood pressure cuff, oxygen saturation probe).
2. Induction of Anesthesia: Intravenous medications are administered to induce general anesthesia, rendering the patient unconscious and pain-free.
3. Airway Management: An endotracheal tube is inserted to secure the airway and ensure adequate ventilation during surgery.
4. Maintenance of Anesthesia: Anesthesia is maintained throughout the surgery using inhaled anesthetics or intravenous medications.
5. Surgical Procedure: The surgeon performs the cystectomy, which involves removing the bladder and possibly creating a urinary diversion (e.g., ileal conduit or continent urinary reservoir).
6. Monitoring and Support: Throughout the procedure, the anesthesiologist continuously monitors vital signs and adjusts anesthetic depth as required.
7. Emergence from Anesthesia: At the end of the surgery, the patient is gradually brought out of anesthesia, and the endotracheal tube is removed once they can breathe adequately on their own.

Duration

The total cystectomy procedure typically takes between 4 to 6 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon
• Anesthesiologist
• Scrub Nurse
• Circulating Nurse
• Surgical Technologist

Risks and Complications

• Anesthesia-related risks: Allergic reactions, respiratory complications, cardiovascular issues.
• Surgical risks: Infection, bleeding, blood clots, injury to surrounding organs, leakage or obstruction of the urinary diversion.
• Postoperative risks: Delayed wound healing, hernia formation, intestinal blockage, electrolyte imbalances.

Benefits

• Removal of the diseased bladder can alleviate symptoms and potentially cure or control bladder cancer.
• Improves quality of life for patients with chronic, severe bladder conditions.
• Benefits are often realized almost immediately, although full recovery may take several weeks to months.

Recovery

• Patients typically stay in the hospital for 5 to 10 days post-surgery.
• Initial recovery includes managing pain with medications, monitoring for complications, and gradual reintroduction of oral intake.
• Instructions may include wound care, dietary modifications, and physical activity limitations.
• Follow-up appointments will be necessary to monitor recovery and adjust treatments as needed.

Alternatives

• Radiation Therapy: Less invasive but may not be as effective for advanced cancer.
• Chemotherapy: Often used in conjunction but not as a standalone treatment.
• Partial Cystectomy: An option if the cancer is localized and not as extensive.
• Immunotherapy: Emerging treatments that may be suitable for some patients.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel any pain.
• Post-surgery, patients may experience discomfort and will be provided pain management.
• Patients will have a catheter and potential urinary diversion to manage urine output initially.
• Emotional support may be necessary due to the significant lifestyle changes following a total cystectomy.