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: Daycase
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”
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”
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
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
Insertion of peritoneal dialysis catheter
These are quick quick laparoscopic procedures in patients with renal failure. Usually day-case procedures Pre-op Aetiology of renal failure Check recent electrolytes Paracetamol Peri-op 18G cannula sited with 1% lidocaine Propofol/remifentanil TIVA Atracurium ETT Dexamethasone 6.6mg Fentanyl 100mcg Local anaesthetic to port sites Consider VBG at the end to check K+ Reversal if required Post-opContinue reading “Insertion of peritoneal dialysis catheter”
Arthroscopic knee repair – e.g. ACL repair
Often young, fit and well. Shorter repairs can be done with an LMA. Day case. Pre-op Often young, fit and well Consent for block Paracetamol and ibuprofen Peri-op 20G cannula Fentanyl ~200mcg Propofol Muscle relaxant ETT TIVA or volatile maintenance Adductor canal block- up to 20ml 0.25% L-bupivicaine Dilute anaesthetic infiltrated by surgeons at theContinue reading “Arthroscopic knee repair – e.g. ACL repair”
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
Day case TIVA
My default day case recipe Pre-op Paracetamol Ibuprofen Intra-op 20G cannula 1% propofol with 1mg alfentanil per 50ml (20mcg/ml) Marsh TCI Start at 6 Insert LMA Turn down to 4 Fentanyl 0-100mcg Dexamethasone 6.6mg Ondansetron 4mg Post-op Fentanyl 0-200 mcg in recovery Regular paracetamol and ibuprofen PRN anti-emetics Notes Propofol alfentanil admixture is fully inContinue reading “Day case TIVA”
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”
