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
Tag Archives: Spinal
Robotic Nephrectomy
These cases are well worth discussing with the surgeon beforehand- anticipated potential for blood loss varies greatly
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
Category 1 section under spinal
This can be a highly stressful situation. There may be little time to prepare. Communication here is absolutely vital. Is there time for a single attempt at a spinal? Many different things will need to occur in parallel here. In the operating theatre Patient will likely be in a left lateral position for intra-uterine resuscitationContinue reading “Category 1 section under spinal”
Safe spinal documentation
Documentation of risks Risks discussed: Hypotension Urinary retention Pain on injection Headache Nerve damage Bleeding/ haematoma Failure Documentation of procedure Operator and supervisor Position Antiseptic solution used Asepsis – gloves, gown, mask, hat, drape Level/ space Local anaesthetic used Spinal needle used- gauge and tip design How many attempts Visualisation of CSF What was injectedContinue reading “Safe spinal documentation”
TKR – Total Knee Replacement
The focus here is on early mobilisation and discharge, using enhanced recovery protocols. Patients tend to have been well briefed to expect a spinal +/- sedation
THR – Total Hip Replacement
The focus here is on early mobilisation and discharge, using enhanced recovery protocols. Patients tend to have been well briefed to expect a spinal +/- sedation
C-section under spinal
In obstetrics more than anywhere else, the anaesthetist is an entertainer. Aside from the clinical parts, consider other elements: do they have a playlist they would like to play? Pre-op Intra-op Documentation Always document (if true!): Post-op Variations
Anaesthetic Recipes 