Perioperative Considerations for Person-Centered Gender-Affirming Surgery

Tollinche, Luis; Rosa, William E.; Rooyen, Christian D van

doi:10.1016/j.aan.2021.07.005

Cited by 21 publications

(11 citation statements)

References 80 publications

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“…When caring for patients with prior lower facial masculinization procedures, a judicious approach should be taken to airway management since decreased mandibular height, width, and mobility from scar tissue may create difficulty with mask ventilation and endotracheal intubation [14,37].…”

Section: Facial Masculinizationmentioning

confidence: 99%

“…]. Patients with prior FFS may be at risk of difficult mask ventilation and endotracheal intubation during future surgeries [14,37]. Given the potential for future difficult airway scenarios, facial and vocal feminization surgeries are reserved as final procedures in the GAS sequence [15 & ].…”

Section: Andandmentioning

confidence: 99%

“…Anesthesiology professionals may be tasked with caring for TGD patients despite unfamiliarity with these procedures or the nuanced needs of these patients. Literature on anesthetic considerations for TGD patients has expanded over the last few years [14,15 ▪ ,16 ▪ ,17].…”

Section: Introductionmentioning

confidence: 99%

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Anesthesia for gender-affirming surgery: a practical review

Sanchez,

Tollinche,

Reece-Nguyen

2024

Current Opinion in Anaesthesiology

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Purpose of review Gender-affirming surgery (GAS) is an effective, well studied, and often necessary component of gender-affirming care and mitigation of gender dysphoria for transgender and gender-diverse (TGD) individuals. GAS is categorized as chest surgeries, genitourinary surgeries, facial feminization/masculinization, and vocal phonosurgery. Despite increased incidence of GAS during recent years, there is a gap in knowledge and training on perioperative care for TGD patients. Recent findings Our review discusses the relevant anesthetic considerations for the most common GAS, which often involve highly specialized surgical techniques that have unique implications for the anesthesia professional. Summary Anesthesiology professionals must attend to the surgical and anesthetic nuances of various GAS procedures. However, as many considerations are based on common practice, research is warranted on anesthetic implications and outcomes of GAS.

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Section: Facial Masculinizationmentioning

confidence: 99%

Section: Andandmentioning

confidence: 99%

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Anesthesia for gender-affirming surgery: a practical review

Sanchez,

Tollinche,

Reece-Nguyen

2024

Current Opinion in Anaesthesiology

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“…14 Perioperative considerations for TGD patients are often described in relation to the clinical and biomedical needs of the patient during the preoperative, intraoperative, and postoperative periods. [15][16][17][18] The biopsychosocial approach sees patients as part of their medical care and aims to treat them holistically in the perioperative space.…”

Section: Biopsychosocial Approachmentioning

confidence: 99%

Perioperative Care of Transgender and Gender-Diverse Patients: A Biopsychosocial Approach

Sanchez

Khallouq

et al. 2023

Anesthesia &Amp; Analgesia

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Transgender and gender-diverse (TGD) people endure numerous physical and mental health disparities secondary to lifelong stigma and marginalization, which are often perpetuated in medical spaces. Despite such barriers, TGD people are seeking gender-affirming care (GAC) with increased frequency. GAC facilitates the transition from the sex assigned at birth to the affirmed gender identity and is comprised of hormone therapy (HT) and gender-affirming surgery (GAS). The anesthesia professional is uniquely poised to serve as an integral support for TGD patients within the perioperative space. To provide affirmative perioperative care to TGD patients, anesthesia professionals should understand and attend to the biological, psychological, and social dimensions of health that are relevant to this population. This review outlines the biological factors that impact the perioperative care of TGD patients, such as the management of estrogen and testosterone HT, safe use of sugammadex, interpretation of laboratory values in the context of HT, pregnancy testing, drug dosing, breast binding, altered airway and urethral anatomy after prior GAS, pain management, and other GAS considerations. Psychosocial factors are reviewed, including mental health disparities, health care provider mistrust, effective patient communication, and the interplay of these factors in the postanesthesia care unit. Finally, recommendations to improve TGD perioperative care are reviewed through an organizational approach with an emphasis on TGD-focused medical education. These factors are discussed through the lens of patient affirmation and advocacy with the intent to educate the anesthesia professional on the perioperative management of TGD patients.

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“…With this increase in gender-affirming pelvic surgery, anesthesiologists are also challenged with managing these patients with unique biological, hormonal, and psychosocial needs [ 4 , 5 ]. Anesthesiologists must be aware of factors including the effects of hormone therapy on the perioperative period and potential airway complications due to masculinization or feminization procedures [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Intrathecal Morphine Injection for Postoperative Analgesia Following Gender-Affirming Pelvic Surgery: A Retrospective Case-Control Study

Swisher¹,

Dolendo²,

Sztain³

et al. 2023

Cureus

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BackgroundGender-affirming pelvic surgery (GAPS) can be associated with significant postoperative pelvic pain. Given the lack of available peripheral nerve blocks to the perineum, intrathecal morphine (ITM) injection could offer a potent analgesic modality for this patient population. No prior studies to date have been performed examining the analgesic effects of intrathecal morphine for these patients. MethodsThis retrospective case-control study aims to understand the postoperative analgesic effects of intrathecal morphine for these patients with a historical comparison group of patients who did not receive intrathecal morphine. ResultsFourteen patients presented for gender-affirming pelvic surgery over an eight-month period at a single institution and were offered intrathecal morphine for postoperative analgesia. Their analgesic results were compared to a similar historical group of 13 patients who were not offered or declined intrathecal morphine. ConclusionsIntrathecal morphine injection is a potent analgesic modality for patients presenting for gender-affirming pelvic surgery.

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Perioperative Considerations for Person-Centered Gender-Affirming Surgery

Cited by 21 publications

References 80 publications

Anesthesia for gender-affirming surgery: a practical review

Anesthesia for gender-affirming surgery: a practical review

Perioperative Care of Transgender and Gender-Diverse Patients: A Biopsychosocial Approach

Intrathecal Morphine Injection for Postoperative Analgesia Following Gender-Affirming Pelvic Surgery: A Retrospective Case-Control Study

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