Usually day case skin surface surgery. LA provides much of the analgesia. 1-2hrs Pre-op Paracetamol Peri-op 20G cannula Propofol TCI started at 1mcg/ml once cannula in Fentanyl 150-200mcg at induction Anti-emetics- dexamethasone 6.6mg, ondansetron 4mg LA infiltrated by surgeons Further fentanyl titrated to respiratory rate Post-op Regular paracetamol Regular ibuprofen Alternatives Regional techniques such asContinue reading “Breast WLE”
Category Archives: General
Robotic cystectomy
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, largeContinue reading “Robotic cystectomy”
Diagnostic Laparoscopy
Usually daycases on a gynae list Pre-op Paracetamol Ibuprofen Peri-op 20G cannula Propofol/ remifentanil TIVA Atracurium 10-20mg ETT Dexamethasone 6.6mg Oxycodone 10mg ~40 mins before the end Check TOF and reverse if necessary Post-op Paracetamol Ibuprofen PRN dihydrocodeine
DIEP – reconstructive breast surgery
Quite long cases. The surgeons like good relaxation whilst taking the flap. Anticipate hypotension when they ask you to sit the patient up Pre-op Paracetamol Peri-op Keep warm 18G cannula on contralateral side Propofol/ remifentanil TIVA Muscle relaxant COETT and temperature probe Magnesium 3g TXA 1g Prophylactic antibiotics – may need repeat doses Paracetamol OxycodoneContinue reading “DIEP – reconstructive breast surgery”
Robotic Nephrectomy
These cases are well worth discussing with the surgeon beforehand- anticipated potential for blood loss varies greatly
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”
Incision and drainage of abscess – I&D
Staple fare of the CEPOD list, and usually a good starter for the day whilst more complex cases are worked up.
Day case “hot” lap chole
For the fit and well patient Pre-op Paracetamol Intra-op Propofol – Marsh TCI Remifentanil – Minto TCI Remi on first building up to 6ng/ml, wait two minutes, then propofol 6mcg/ml Atracurium 16G cannula COETT Depth of anaesthesia monitoring 350mcg fentanyl throughout case Post-op Fentanyl 0-200mcg in recovery Regular paracetamol Regular ibuprofen Tramadol or codeine AlternativesContinue reading “Day case “hot” lap chole”
