Author Archives: Anaesthetic Recipes

Stroke Thrombectomy

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 Paracetamol NSAID Peri-op Any cannula for induction, upgraded to 16G asleep Modified RSI if indicated Fentanyl ~200mcg at induction, total ~300mcg by end Propofol ~150mg Rocuronium 1mg/kg ETT Sevoflurane maintenance 2-3g Magnesium into the IV fluids Dexamethasone 6.6mg Ondansetron 4mg towards endContinue reading “Lap appendix”

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 All of these patients have cardiovascular disease Note BP Note pre-existing neurological deficits Anti-platelets always continue Peri-op 18G cannula Arterial line – awake Metaraminol infusion titrated to maintain MAP within 20% of normal Short acting opiateContinue reading “Carotid endarterectomy (CEA) under GA”

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 AMPLE history Antacids as per local protocol Peri-op Left tilt on table Ensure 16G cannula in situ,Continue reading “Category 1 Section Under GA”

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 Counsel about nerve block, emphasising the need to take analgesia before the block wears off Peri-op 20GContinue reading “Shoulder surgery”

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”