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
Tag Archives: TIVA
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”
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”
Shoulder surgery
These cases have a distant airway (feet closest to machine), and are generally sat up in a “beach chair” position. As a result, the main concerns surround loss of airway and cerebral hypoperfusion. They are often intubated. Pre-op Counsel about nerve block, emphasising the need to take analgesia before the block wears off Peri-op 20GContinue reading “Shoulder surgery”
Gynae day case hysteroscopy
A short procedure, often part of a high turnover day case list Pre-op Paracetamol Ibuprofen Intra-op 20G cannula Propofol TCI Marsh model 1mg Alfentanil in each 50ml of propofol (20mcg/ml) 6.6mg dexamethasone LMA Post-op PRN paracetamol PRN ibuprofen
Incision and drainage of abscess – I&D
Staple fare of the CEPOD list, and usually a good starter for the day whilst more complex cases are worked up.
Cardioversion (DCCV)
The procedure itself is very short, but intensely stimulating. Perfect for short acting drugs. Awareness and recall are common, reflecting deep sedation more than true general anaesthesia. Pre-op Usually a day case Check they have been correctly anticoagulated- minimum of preceding 3 weeks May have significant cardiovascular, respiratory disease. Also obesity, diabetes, OSA Check pre-opContinue reading “Cardioversion (DCCV)”
Renal Transplant
There’s an apocryphal tale about an inadequately relaxed patient “coughing” out their perilously perched transplant kidney at a key moment. As a result, the surgeons ask every few minutes whether we are “happy with the relaxation”. Pre-op Label fistula arm Establish “dry weight” and current weight Date of last dialysis Native urine output Co-morbidities –Continue reading “Renal Transplant”
Pituitary surgery
Pre-op Paracetamol Intra-op Sat up shared airway Armored tube Wide bore IV access Steroids Post-op Rapid smooth emergence
Day case “hot” lap chole
For the fit and well patient Pre-op Paracetamol Intra-op Propofol – Marsh TCI Remifentanil – Minto TCI Remi on first building up to 6ng/ml, wait two minutes, then propofol 6mcg/ml Atracurium 16G cannula COETT Depth of anaesthesia monitoring 350mcg fentanyl throughout case Post-op Fentanyl 0-200mcg in recovery Regular paracetamol Regular ibuprofen Tramadol or codeine AlternativesContinue reading “Day case “hot” lap chole”
