Breast WLE
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 as…
Robotic gynae surgery
E.g. hysterectomy, treatment of endometriosis. Can be part of a high turnover list, lasting 45-90 mins. Steep head down, need to be still whilst the robot is in use. Be familiar with emergency undocking procedures. Pre-op Paracetamol Peri-op 18G cannula Propofol/ remifentanil TIVA Muscle relaxant – rocuronium 1mg/kg ETT Dexamethasone 6.6mg / ondansetron 4mg Oxycodone…
Grommets
Short (15 min) ENT day case procedure with a distant airway Pre-op Paracetamol NSAID Peri-op 20G cannula Propofol TCI Alfentanil, 1.5mg bolus at induction, 0.5mg increments thereafter LMA, head ring Dexamethasone 6.6mg Post-op None- not painful Alternatives Propofol with 20mcg/ml Alfentanil Propofol + remifentanil TIVA
