Staple fare of the CEPOD list, and usually a good starter for the day whilst more complex cases are worked up. Often the first case a junior anaesthetist will do solo.
These short procedures can be extremely stimulating, favouring rapid onset/offset drugs. Communication with the surgeon is key to ensure adequate analgesia at the point of knife to skin, to ensure you aren’t caught out.
Pre-op
- Paracetamol PO
- NSAID unless contraindicated
Intra-op
- 20G cannula
- Alfentanil 250-500 mcg
- Propofol TCI, initially set to 8 mcg/ml, reduced to ~5 mcg/ml once LMA in
- Bolus of Alfentanil 500mcg 30 seconds before knife to skin
- Load with fentanyl or morphine
- Paracetamol or NSAID if missed pre-op
Post-op
- Regular paracetamol
- Regular NSAID
- Dihydrocodeine
- Oral morphine
Alternatives
- Nitrous oxide has many appealing characteristics here including rapid onset/ offset, and analgesic properties. However, its environmental impact makes it hard to recommend
Anaesthetic Recipes 