Fentanyl – Anaesthetic Recipes

Breast WLE

Usually day case skin surface surgery. LA provides much of the analgesia. 1-2hrs Pre-op Peri-op Post-op Alternatives

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

Diagnostic Laparoscopy

Usually daycases on a gynae list Pre-op Peri-op Post-op

Ankle fusion / arthrodesis

Pre-op Paracetamol Peri-op 20G cannula Prophylactic antibiotics Popliteal block – up to 20ml 0.5% L-bupivicaine fentanyl 100-200mcg Propofol TCI LMA Anti-emetics- dexamethasone 6.6mg + ondansetron 4mg Post-op Paracetamol Codeine Aspirin 150mg OD

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”

VP shunt

There will be a distant airway, head in pins, and the abdomen will be exposed. Use a forced air warming blanket as for abdominal surgery. Tunneling the line can be quite stimulating – increase the remifentanil or give a bolus of fentanyl before the surgeons do this. Pre-op Paracetamol Aetiology of hydrocephalus Intra-op Small cannulaContinue reading “VP shunt”

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”

Microvascular decompression

Distant airway with the head in pins. Lasts 2-3 hours. Park bench positioning means some consideration needs to be given to lines and monitoring Pre-op Paracetamol Peri-op 18G cannula on same side as surgery (so it is facing up once patient is positioned) Propofol/ remifentanil TIVA Rocuronium 0.5mg/kg Armored ETT, taped Depth of anaesthesia monitoring,Continue reading “Microvascular decompression”

Vagal Nerve Stimulator (VNS) Battery Change

Short cases that can usually be done on the trolley. These patients usually have epilepsy, so it is worth exploring in the pre-op visit. The battery tends to be located in the same place you would find an ICD. Pre-op Ensure usual anti-epileptics have been taken Epilepsy history – e.g. types of seizure, frequency, self-terminatingContinue reading “Vagal Nerve Stimulator (VNS) Battery Change”