Tag Archives: Remifentanil

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 Peri-op Post-op Alternatives Out of fashion

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 Peri-op Post-op Alternatives

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”

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”

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”