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”
Tag Archives: Anaesthetic recipe
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 OxycodoneContinue reading “Robotic gynae surgery”
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
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”
Microlaryngoscopy
20 minute day case ENT surgery. These patients often smoke. Shared airway. Discuss choice of airway device at the brief- options include: a subglottic jet ventilation catheter, microlaryngeal tube, injector needle on operator laryngoscope, or rarely a cricothyroidotomy needle. Pre-op Medications: paracetamol, NSAID Careful airway assessment- beware stridor Peri-op 20G cannula Processed EEG Muscle relaxantContinue reading “Microlaryngoscopy”
Lumbar spine decompression
These might be performed by neurosurgeons, or by orthopaedics. The patient will be lying prone, with their arms out in front. Pre-op Often have chronic pain, note current analgesic regime Note any neurology Explain post-op PCA Peri-op Propofol/ remifentanil TCI Rocuronium Flexible ETT Prophylactic antibiotics Prone, arms out front Magnesium Morphine up to 20mg Consider:Continue reading “Lumbar spine decompression”
Brain biopsy
Distant airway with the head in pins. There can be a lull whilst waiting for intra-op confirmation of abnormal brain tissue, and there will be some time spent hair washing at the end. Pre-op Paracetamol Any symptoms the patient has been experiencing Peri-op 20G cannula Consider ergonomics – (e.g. induce on trolley and rotate afterContinue reading “Brain biopsy”
Knee arthroscopy
Pre-op Often young, fit and well Day case Paracetamol and ibuprofen Peri-op 20G cannula LMA Fentanyl – 150mcg, then 100mcg just before knife to skin Propofol TCI Dexamethasone 6.6mg Ondansetron 4mg Consider adductor canal block if doing more than just arthroscopy, e.g ACL reconstruction Post-op Fentanyl in recovery Oramorph TTO paracetamol, NSAID, codeine
Hip fracture surgery- for neck of femur fracture/ NOF – GA
These can be done with either a GA or a spinal- there appears to be no mortality benefit of one over the other. The key is to deliver one excellent anaesthetic and not do a combination of the two. Pre-op Check they have been reviewed by ortho geris team There are very few reasons toContinue reading “Hip fracture surgery- for neck of femur fracture/ NOF – GA”
Endovascular Aneurysm repair – EVAR
Often performed on patients who are not fit enough for an open repair. This is for elective cases Pre-op Assessment of co-morbidities – often many Location of aneurysm relative to renal arteries Peri-op Small and large cannula awake Arterial line awake Processed EEG for anaesthetic sparing Metaraminol infusion Propofol TCI or volatile anaesthesia Remifentanil TCIContinue reading “Endovascular Aneurysm repair – EVAR”
