These are long (~6 hour) operations with the patient in a fairly steep head down position. The robot is completely unyielding, so the patient needs to be kept still throughout, with either regular muscle relaxant or a remifentanil infusion. Usually go to HDU afterwards as a level 2.
Pre-op
- Paracetamol
Peri-op
- Small cannula awake, large cannula asleep
- Propofol/ remifentanil TIVA
- Metaraminol infusion
- Muscle relaxant
- ETT – taped, or tied loosely in anticipation of swelling
- Temperature probe and forced air warmer
- Arterial line asleep
- Prophylactic antibiotics
- VTE prohylaxis- TEDs and IPCs
- Anti-emetics- dexamethasone 6.6mg and ondansetron 4mg
- IV fluids- tend to be run “dry”, 2 litres given over a case
- Analgesia- 0.1mg/kg morphine, magnesium, paracetamol
Post-op
- HDU
- Early resumption of oral intake
- PCA
- Laxatives
Alternatives
- Spinal with diamorphine (e.g. 2ml 0.5% heavy bupivacaine with 500mcg diamorphine)- this might wear off shortly after emergence, and mostly contribute to intra-operative hypotension
- Modified release oral opiate, with PRN immediate release opiate, instead of PCA
- Throat pack- head down position can lead to gastric contents pooling
Anaesthetic Recipes 