These cases have a distant airway (feet closest to machine), and are generally sat up in a “beach chair” position. As a result, the main concerns surround loss of airway and cerebral hypoperfusion. They are often intubated.
Pre-op
- Counsel about nerve block, emphasising the need to take analgesia before the block wears off
Peri-op
- 20G cannula on contralateral side
- Propofol TCI set to 1mcg/ml
- Interscalene block
- 1% lidocaine to skin
- 50mm block needle
- 10ml 0.5% L-bupivicaine
- Increase propofol TCI for GA
- Short acting opiate
- Insert flexible LMA or intubate with an armored ETT (will need muscle relaxant for this)
- Tranexamic acid
- Prophylactic antibiotics
Post-op
- Paracetamol QDS
- Ibuprofen QDS
- Dihydrocodeine 30mg QDS
Anaesthetic Recipes 