The procedure itself is very short, but intensely stimulating. Perfect for short acting drugs. Awareness and recall are common, reflecting deep sedation more than true general anaesthesia.
Pre-op
- Usually a day case
- Check they have been correctly anticoagulated- minimum of preceding 3 weeks
- May have significant cardiovascular, respiratory disease. Also obesity, diabetes, OSA
- Check pre-op FBC, U&Es, TFTs, INR, ECG and ECHO
- ACE inhibitors and ARBs usually held for 2 days before
Intra-op
- 20G cannula
- Pads applied, defib switched on, energy chosen and “sync” enabled before any drugs given (to minimise wasted time after induction)
- Pre-oxygenate
- Alfentanil ~500mcg
- Propofol 0.5-1 mg/kg (TCI if expected to be longer than a single shock)
- Remove oxygen
- Delivery of shock
- Gentle ventilation until spontaneously ventilating again
Post-op
- Usually wake quickly and don’t need anything in recovery
- ECG in recovery
Anaesthetic Recipes 