Tag Archives: 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 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

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

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”