Testicular Torsion

Anesthesia Implications

Position: Supine
Time: 30-60 min (short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Ask surgeon

Approach – General/ETT with RSI – surgical management of testicular torsion is always an emergency, so all patients should be assumed to have a full stomach.

Paralytics – If the surgery is taking the scrotal approach, paralysis is typically not required, unless requested by the surgeon. If the surgery is taking the inguinal approach, paralysis may be required to reduce intra-abdominal pressure.

Blocks – Caudal block can be performed on young children.

PONV – Attempt to empty the stomach with an OGT and give antiemetics.

Emergence – Awake extubation due to the potential of a full stomach.

Testicular torsion occurs when the testicle and spermatic cord become twisted, resulting in the obstruction of arterial and venous blood supply. If blood supply is not restored within six hours the testicle will infarct and atrophy. Removal of the testicle (orchiectomy) is necessary in about 40-50% of these patients. Typical Patient population for testicular torsion are young boys aged 5-15, with peak incidence around 13-14 years of age.

If caught early manual de-torsion is usually attempted by a surgeon to restore blood flow. However, Surgical exploration is typically required even if blood flow is restored. Surgery is often performed on the scrotum but an inguinal approach may be required.