Laparoscopic Appendectomy
Patient phenotype
Most often young adult (15-40), acute appendicitis. May be febrile, dehydrated, leukocytosis. Pediatric appendicitis is the most common surgical emergency in kids 6-15.
Procedure
3-port laparoscopic, supine. Identify + mobilize appendix, divide mesoappendix, ligate base, retrieve via port. ~30-60 min. Conversion to open if perforation/abscess.
Anesthetic plan
GETA RSI (full stomach by definition), pneumoperitoneum, multimodal pain. Antibiotics dosed for surgical infection prophylaxis + treatment.
Setup
- ·Standard ASA monitors + Foley
- ·Two PIVs (one IV antibiotic running)
- ·OG tube (decompress for trocar safety)
- ·Type & screen if perforated
- ·RSI drugs
Biggest concerns by phase
Volume status — likely depleted
Pre-op vomiting + fever + reduced PO. 1-2 L IV crystalloid before induction (NS or balanced). Treats hypotension on induction + improves UOP.
RSI for full stomach
All appendicitis patients are full stomach. Cricoid + sux 1.5 mg/kg or roc 1.2 mg/kg + propofol 2 mg/kg. Pre-O₂ to ETO₂ > 90%. Intubate with cuffed ETT.
Antibiotic timing + bowel manipulation
Cefoxitin 2g IV + metronidazole 500mg pre-incision OR pip-tazo 3.375g. If perforated, expect prolonged antibiotics. Bowel manipulation can release bacteremia → transient sepsis physiology (HR↑, BP↓).
Pneumoperitoneum + young healthy patient
Most appy patients tolerate insufflation well. Standard concerns. Trendelenburg slight (10-15°) for visualization.
Pain + PONV control
Multimodal: APAP 1g IV, ketorolac 30 mg if no contraindication, local infiltration to ports, opioid PRN. PONV: dex 4 mg + ondansetron. Many discharge same day.
Watch for missed pathology + abscess
Postop fever or pain disproportionate = think abscess, perforation missed, postop ileus. Most discharge in 24h for non-perforated; perforated need 3-7 days IV antibiotics.
Mock-defense scenarios
Practice answering these out loud. The probes show what an examiner is listening for.
8-year-old boy with perforated appendicitis. Hr 130, BP 90/55, T 39.2, WBC 22, AGA. Walk me through your induction.
What an examiner probes for
- ▹Pediatric volume resus 20 mL/kg before induction
- ▹RSI: propofol + sux (2 mg/kg) + atropine pretreatment
- ▹Antibiotics broader (pip-tazo or cefoxitin + metronidazole)
- ▹Anticipates: post-op fluid resuscitation, possible drain, prolonged stay
Sources
- AAGBI emergency surgery
- SAGES guidelines
Anatomy reference
Sourced reference images. 4 matches for "abdomen bowel digestive".
Browse the full image library →
