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: TIVA
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”
Grommets
Short (15 min) ENT day case procedure with a distant airway Pre-op Paracetamol NSAID Peri-op 20G cannula Propofol TCI Alfentanil, 1.5mg bolus at induction, 0.5mg increments thereafter LMA, head ring Dexamethasone 6.6mg Post-op None- not painful Alternatives Propofol with 20mcg/ml Alfentanil Propofol + remifentanil 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 Paracetamol Peri-op Small cannula awake, largeContinue reading “Robotic cystectomy”
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”
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”
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
DIEP – reconstructive breast surgery
Quite long cases. The surgeons like good relaxation whilst taking the flap. Anticipate hypotension when they ask you to sit the patient up Pre-op Paracetamol Peri-op Keep warm 18G cannula on contralateral side Propofol/ remifentanil TIVA Muscle relaxant COETT and temperature probe Magnesium 3g TXA 1g Prophylactic antibiotics – may need repeat doses Paracetamol OxycodoneContinue reading “DIEP – reconstructive breast surgery”
