Anaesthetic Recipes

Robotic Nephrectomy

These cases are well worth discussing with the surgeon beforehand- anticipated potential for blood loss varies greatly

Cervical suture

A short procedure where a short acting spinal is ideal Pre-op Paracetamol Intra-op 20G cannula Spinal with 2% hyperbaric prilocaine, up to 2.5ml Post-op Regular paracetamol No NSAIDS

This is the Cat 1 section of neuroradiology: every minute hundreds of thousands of neurons die. There needs to be meticulous maintenance of blood pressure. You will be in an unfamiliar environment- one of the IR theatres. GA is favoured here as there is a higher chance of clot retrieval and therefore better functional outcome.Continue reading “Stroke Thrombectomy”

Lap appendix

Staple fodder of CEPOD. This recipe is for a straightforward lap appendix. Pre-op Peri-op Post-op Alternatives/ advanced techniques

Carotid endarterectomy (CEA) under GA

Below is an anaesthetic recipe for carotid endarterectomy under general anaesthetic. They can also be performed under regional. Pre-op Peri-op Post-op

Category 1 Section Under GA

These can be stressful situations. Ideally intubation is immediately followed by knife to skin, with the abdomen prepped before induction. There is a very high incidence of difficult intubation, and of awareness under anaesthesia in these situations. Pre-op Peri-op Post-op Alternatives

Shoulder surgery

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 Peri-op Post-op

Gynae day case hysteroscopy

A short procedure, often part of a high turnover day case list Pre-op Paracetamol Ibuprofen Intra-op 20G cannula Propofol TCI Marsh model 1mg Alfentanil in each 50ml of propofol (20mcg/ml) 6.6mg dexamethasone LMA Post-op PRN paracetamol PRN ibuprofen

Category 1 section under spinal

This can be a highly stressful situation. There may be little time to prepare. Communication here is absolutely vital. Is there time for a single attempt at a spinal? Many different things will need to occur in parallel here. In the operating theatre Patient will likely be in a left lateral position for intra-uterine resuscitationContinue reading “Category 1 section under spinal”

Safe spinal documentation

Documentation of risks Risks discussed: Hypotension Urinary retention Pain on injection Headache Nerve damage Bleeding/ haematoma Failure Documentation of procedure Operator and supervisor Position Antiseptic solution used Asepsis – gloves, gown, mask, hat, drape Level/ space Local anaesthetic used Spinal needle used- gauge and tip design How many attempts Visualisation of CSF What was injectedContinue reading “Safe spinal documentation”