Monopolar & Bipolar Electrocautery

Updated: 
February 26, 2024
Source Link

Electrocautery is a surgical technique used for tissue cutting, coagulation (sealing blood vessels), and tissue destruction through the application of high-frequency electrical current. There are two primary types of electrocautery: monopolar and bipolar.

Monopolar Electrocautery:

Principle: Monopolar electrocautery consists of a handheld device that delivers electrical current to the target tissue via an active electrode. The current flows from the active electrode, through the tissue, and returns to the generator via a grounding pad attached to the patient's skin at a distant site.

Settings and Indications:

  • Cutting (Pure Cut): High-frequency current (typically 300–500 kHz) is applied continuously to generate heat, resulting in tissue vaporization and cutting. This setting is suitable for precise incisions in tissues with minimal blood supply, such as skin or subcutaneous tissue.
  • Example Setting: Power level of 40–60 watts for skin incisions.
  • Coagulation (Blend): Combines cutting and coagulation functions by alternating between high-frequency current bursts and low-frequency current. This produces both cutting and hemostatic effects, making it suitable for procedures requiring simultaneous incision and hemostasis.
  • Example Setting: Power level of 40–60 watts for incisions with controlled bleeding.
  • Desiccation: Continuous application of high-frequency current for tissue drying and superficial tissue destruction. Used for removing small lesions or tumors without significant bleeding.
  • Example Setting: Power level of 20–40 watts for desiccation of skin lesions.
  • Fulguration: Pulsed application of high-frequency current for tissue destruction and hemostasis. Suitable for coagulating small blood vessels and treating superficial lesions.
  • Example Setting: Power level of 20–40 watts for coagulation of superficial bleeding.
Bipolar Electrocautery:

Principle: Bipolar electrocautery utilizes two closely spaced electrodes within the handheld device. The electrical current flows directly between these electrodes, effectively confining the energy to the target tissue without requiring a distant grounding pad.

Settings and Indications:

  • Tissue Sealing: Delivers controlled thermal energy to tissue, causing collagen denaturation and vessel sealing without significant charring or tissue damage. Ideal for sealing small to medium-sized blood vessels and tissues with minimal collateral damage.
  • Example Setting: Power level of 20–40 watts for sealing blood vessels up to 5 mm in diameter.
  • Hemostasis: Provides rapid coagulation and sealing of blood vessels while minimizing thermal spread and tissue damage. Suitable for procedures requiring precise vessel sealing in delicate tissues.
  • Example Setting: Power level of 20–40 watts for coagulation of bleeding in neurosurgical procedures.
  • Tissue Cutting with Sealing (Ultrasonic): Combines cutting and sealing functions using ultrasonic vibration and thermal energy. Enables precise tissue dissection with simultaneous vessel sealing, reducing blood loss and operative time.
  • Example Setting: Power level of 20–40 watts for ultrasonic dissection and vessel sealing in laparoscopic surgery.

These settings and indications are general guidelines, and actual parameters may vary based on factors such as tissue type, thickness, and surgical technique. Surgeons should adjust settings based on individual patient characteristics and procedural requirements to achieve optimal outcomes while minimizing tissue damage and complications.

Anesthesia

  • ​Cumulative Anesthetic (Off Service Anesthesia+ OMFS) Experience:
  • general anesthesia/deep sedation for a minimum of 300 cases.
  • Must involve care for 50 patients younger than 13.
  • A minimum of 150 of the 300 cases must be ambulatory anesthetics for oral and maxillofacial surgery outside of the operating room.

Major Surgery

  • Final Year Requirement:
  • 175 major oral and maxillofacial surgery procedures on adults and children, documented by at least a formal operative note.
  • For the above 175 procedures there must be at least 20 procedures in each category of surgery. Sufficient variety in each category, as specified below, must be provided.
  • The categories of major surgery are defined as: Trauma, Pathology, Orthognathic Surgery, Reconstructive and Cosmetic Surgery
  • Surgery performed by oral and maxillofacial surgery residents while rotating on or assisting with other services must not be counted toward this requirement
  • ​​Surgical procedures performed during foreign rotations must not count toward fulfillment of the 175 major surgical procedures.

Research

  • Oral or poster presentations at scientific meetings aside from program curriculum
  • Submission for publication of abstracts, journal articles (particularly peer reviewed) or book chapters
  • Active participation in or completion of a research project (basic science or clinical) with mentoring

Certifications

  • ACLS maintained throughout residency
  • PALS- certified during residency
  • ATLS- certified during residency

Accepted Codes by Category:

Select Surgical Category

Cleft

Alveolar

  • 42205, 42210

Lip

  • 40700, 40701, 40702, 40720, 40761, 42260

Palate

  • ​42200, 42215, 42220, 42225, 42226, 42227, 42235, 42950

Craniofacial

Osteotomies

  • 21137, 21138, 21139, 21150, 21151, 21154, 21155, 21159, 21160, 21172, 21175, 21179, 21180, 21181, 21182, 21183, 21184, 21260, 21261, 21263, 21267, 21268, 21275, 61557, 61559

Esthetic

Augmentation/Reduction Surgery

  • 21120, 21125, 21127, 21208, 21209, 21270

Chemodenervation

  • 64612

Fillers

  • 11950, 11951, 11952, 11954

Soft Tissue Facial Non-Surgical

  • 15780, 15781, 15782, 15783, 15786, 15787, 15788, 15789, 15792, 15793, 17004, 17106, 17107, 17108

Soft Tissue Facial Surgical

  • 15819, 15820, 15821, 15822, 15823, 15824, 15825, 15826, 15828, 15829, 15876, 67900, 67901, 69300

Rhinoplasty

  • ​15760, 21235, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30520

Infection

Major

  • 10061, 10121, 10140, 10180, 40801, 41005, 41006, 41007, 41008, 41009, 41015, 41016, 41017, 41018, 42300, 42305, 42310, 42320, 42700, 42720, 42725

Minor

  • 10060, 10120, 10160, 21501, 40800, 41000, 41800, 41805, 41806

Orthognathic

Genioplasty Osteotomies

  • 21121, 21122, 21123

Mandibular Osteotomies

  • 21193, 21194, 21195, 21196, 21198, 21199

Maxillary Osteotomies

  • ​21141, 21142, 21143, 21145, 21146, 21147, 21188, 21206

Pathology

Biopsies

  • 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 20240, 20245, 21550, 40490, 40808, 41100, 41105, 41108, 42100,42400, 42405

Lesion Excision/Resection Bone Benign

  • 20615, 21025, 21026, 21029, 21030, 21040, 21046, 21047, 21048, 21049, 21295, 21296, 41825, 41826, 41827, 41850

Lesion Excision/ Resection Malignant

  • 11620, 11621, 11622, 11623, 11624, 11626, 11640, 11641, 11642, 11643, 11644, 11646, 17270, 17272, 17273, 17274, 17276, 17280, 17281, 17282, 17283, 17284, 17286, 21015, 21034, 21044, 21045, 21557, 40500, 40510, 40520, 40530, 41120, 41130, 41135, 41140, 41145, 41150, 41153, 41155

Lesion Excision/Resection Soft Tissue Extraoral/Benign

  • 11420, 11421, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 17000, 17110, 21555, 42810, 42815

Lesion Excision/Resection Soft Tissue Intraoral/Benign

  • 40810, 40812, 40814, 40816, 40820, 41110, 41112, 41113, 41114, 41116, 42104, 42106, 42107, 42120

Salivary Gland

  • 42330, 42335, 42408, 42409, 42410, 42415, 42420, 42425, 42426, 42440, 42450

Sinus

  • 30580, 31030, 31032

Preprosthetic

Implants

  • 21244, 21245, 21246, 21248, 21249, D6010

Preprosthetic Surgery

  • 40840, 40842, 40843, 40844, 40845, 41822, 41823, D4263

Preprosthetic Surgery Soft Tissue

  • 40818, D4273, D4275, D4276, D4277, D4278

Reconstruction

Cartilage Grafting

  • 20912, 21230

Major Bone Grafting Free Bone Grafting

  • 20969, 20970, 20972, 21210, 21215

Microvascular

  • 15757, 20955, 20956, 20957, 20962

Nerve Surgery

  • 64716, 64732, 64734, 64736, 64738, 64742, 64885, 64886

Salivary Duct

  • 42500, 42505, 42507, 42509, 42510, 42665

Soft Tissue Flap Local/Adjacent

  • 14020, 14021, 14040, 14041, 14060, 14061

Soft Tissue Flap Regional/Nearby

  • 15572, 15574, 15576, 15610, 15620, 15630, 15732, 40525, 40527

Soft Tissue Graft Free Skin Grafting

  • 15120, 15121, 15220, 15221, 15240, 15241, 15260, 15261, 15770

Temporomandibular Joint

Arthroscopy

  • 29800, 29804

Minimally Invasive

  • 20605, 21480, 21485

Open Joint

  • 21010, 21050, 21060, 21070, 21240, 21242, 21490

Reconstructive Autogenous

  • 20910

Reconstructive Prothetic

  • 21243

Tracheostomy

Tracheostomy

  • 31600, 31601, 31603, 31605, 31610

Trauma

Dentoalveolar Trauma

  • 21440, 21445, D7270

Mandible Fractures

  • 21450, 21451, 21452, 21453, 21454, 21461, 21462, 21465, 21470

Midface/Upper Face Fractures, Frontal Sinus Fractures

  • 21343, 21344

Midface/Upper Face Fractures, LeFort Fractures

  • 21345, 21346, 21347, 21348, 21421, 21422, 21423, 21431, 21432, 21433, 21435, 21436

Midface/Upper Face Fractures, Malar Fractures

  • 21356, 21360, 21365, 21366

Midface/Upper Face Fractures, Nasal Fractures

  • 21310, 21315, 21320, 21325, 21330, 21335, 21336, 21337, 30020

Midface/Upper Face Fractures, NOE Fractures

  • 21338, 21339, 21340

Midface/Upper Face Fractures, Orbital Fractures

  • 21280, 21282, 21385, 21386, 21387, 21390, 21395, 21400, 21401, 21406, 21407, 21408

Repair of Lacerations Extraoral

  • ​12001, 12002, 12004, 12005, 12006, 12007, 12011, 12013, 12014, 12015, 12016, 12017, 12018, 12031, 12032, 12034,12035, 12036, 12037, 12041, 12042, 12044, 12045, 12046, 12047, 12051, 12052, 12053, 12054, 12055, 12056, 12057, 13120, 13121, 13122, 13131, 13132, 13133, 13151, 13152, 13153, 40650, 40652, 40654, 40830, 40831

Repair of Lacerations Intraoral

  • 41250, 41251, 41252, 42180
Select Drug Category

Lidocaine (Xylocaine):   - Maximum Dose without Epinephrine: 4.5 mg/kg (without epinephrine)   - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine)   - Toxicity: Symptoms of lidocaine toxicity may include dizziness, confusion, seizures, cardiovascular collapse, and cardiac arrest.

Bupivacaine (Marcaine):   - Maximum Dose without Epinephrine: 2 mg/kg (without epinephrine)   - Maximum Dose with Epinephrine: 3 mg/kg (with epinephrine)   - Toxicity: Bupivacaine toxicity can cause significant cardiotoxicity, leading to cardiac arrhythmias, cardiac arrest, and central nervous system (CNS) effects such as seizures and dizziness.

Mepivacaine (Carbocaine):   - Maximum Dose without Epinephrine: 4.5 mg/kg (without epinephrine)   - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine)   - Toxicity: Symptoms of mepivacaine toxicity are similar to other local anesthetics and may involve CNS and cardiovascular effects.

Procaine (Novocaine):   - Maximum Dose without Epinephrine: 7 mg/kg (without epinephrine)   - Maximum Dose with Epinephrine: Not typically used with epinephrine   - Toxicity: Procaine toxicity may present with symptoms similar to other local anesthetics but is less frequently used today due to its shorter duration and higher allergenic potential.

Articaine (Septocaine):   - Maximum Dose without Epinephrine: 7 mg/kg (without epinephrine)   - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine)   - Toxicity: Articaine has a longer duration of action but can cause similar toxicity symptoms as other local anesthetics if administered excessively or if there's accidental intravascular injection.

Select an Electrolyte

Hypokalemia (Low Potassium Levels):  

- Mild to Moderate Hypokalemia (3.0-3.5 mEq/L):    

- Oral potassium supplementation: Potassium chloride tablets or liquid, 20-40 mEq orally per day in divided doses.  

- Severe Hypokalemia (<3.0 mEq/L):    

- IV potassium chloride: Start with 10-20 mEq/hour, under continuous cardiac monitoring.

Hyperkalemia (High Potassium Levels):  

- Mild Hyperkalemia (5.1-6.0 mEq/L):    

- Dietary potassium restriction and discontinuation of potassium supplements.  

- Severe Hyperkalemia (>6.0 mEq/L or with ECG changes):    

- Calcium gluconate or calcium chloride IV to stabilize cardiac membranes.    

- Insulin with glucose IV, beta-agonists (e.g., albuterol), or sodium bicarbonate to shift potassium into cells.     - Loop diuretics or exchange resins (e.g., sodium polystyrene sulfonate) to enhance potassium removal.

Hypocalcemia (Low Calcium Levels):  

- Mild Hypocalcemia (8.0-8.5 mg/dL):    

- Oral calcium supplements: Calcium carbonate or calcium citrate, doses vary based on elemental calcium content.  

- Severe Hypocalcemia (<8.0 mg/dL or symptomatic):    

- IV calcium gluconate or calcium chloride, dosages depend on severity and symptoms.

Hypercalcemia (High Calcium Levels):  

- Mild Hypercalcemia (10.5-11.9 mg/dL):    

- Hydration with IV saline and loop diuretics.  

- Severe Hypercalcemia (>12 mg/dL or symptomatic):    

- Bisphosphonates, calcitonin, or corticosteroids may be used for severe cases.

Hypomagnesemia (Low Magnesium Levels):  

- Mild to Moderate Hypomagnesemia (1.2-1.8 mg/dL):    

- Oral magnesium supplements: Magnesium oxide, magnesium citrate, or magnesium glycinate, dosages vary.  

- Severe Hypomagnesemia (<1.2 mg/dL or symptomatic):    

- IV magnesium sulfate, doses vary based on severity and response.

Hypermagnesemia (High Magnesium Levels):  

- Mild to Moderate Hypermagnesemia (2.5-3.0 mg/dL):    

- Discontinuation of magnesium-containing medications.  

- Severe Hypermagnesemia (>3.0 mg/dL or with symptoms):    

- IV calcium gluconate for severe symptoms.    

- Dialysis may be necessary in extreme cases.

Select Surgical Category
(Click or Pinch to Zoom)