Abdominoplasty

Anesthesia Implications

Position: Supine, Prone, Semi-Fowler’s, arms extended
Time: 2-4 hours (long)
Blood Loss: Moderate (50 – 200 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Yes
Blocks: Quadratus Lumborum, Rectus Sheath, TAP

Isoflurane – The surgeon will typically use epinephrine infiltration to prevent blood loss, so if available, use isoflurane, as it is the least dysrhythmogenic of the inhaled anesthetics in the presence of epinephrine.

Antibiotic – Typically cefazolin

Extubation – Recommended deep extubation to prevent bucking.

Postop Positioning – Maintenance of the flexed position (semi-fowlers) post-op will minimize tension on the suture line.

Prone Position (general considerations): Maintain cervical neutrality. Keep IV’s out of the antecubital space. The patients arms are typically flexed, which will kink the IV. Eye protection should be used as the prone position heightens the risk of corneal abrasion and/or traction on the globe (which can result in blindness). Check the patients eyes/ears/nose regularly throughout the case to ensure they are free of pressure. Positioning of the leads is typically high on the posterior and posterolateral back (somewhere free of pressure and out of surgical borders). Keep your connections and tubing where you’ll have fast access.

Long procedure (general considerations): Procedures anticipated to last longer than 2 hours generally require a urinary catheter. Also consider checking lines and positioning regularly as the risks of infiltration and nerve damage are increased with procedure time. Consider an IV fluid warmer and a forced air warmer to keep the patient euthermic.

Indications for this procedure include abdominal wall laxity, diastasis of rectus muscles, excess skin, or a loose and sagging abdomen.

The surgeon will mark the patient in the upright position preoperatively. An incision is made above the pubic hair line and extended out to the  anterior-superior iliac spine. The surgeon will then raise a flap of skin, subcutaneous tissue, and fat at the abdominal wall fascia. This dissection will extend up to the costal margin. The OR table will then be positioned so the patient is in the semi-fowler position and the flap of skin will be pulled down to overlap the incision. The redundant soft tissue will be excised. The wound will then be closed with drains and the belly button will be brought out through a new incision. An abdominal binder may be applied. The patient will remain in the semi-Fowler position during transfer from the OR table back to the stretcher.