Category Archives: recipe

Enhanced Recovery Cystectomy / Colorectal recipe

 

Recipe:

Pre-op paracetamol, gabapentin.

Single shot spinal. 1-1.5ml 0.5% heavy bupivicaine + diamorphine or morphine.

GA

A-line, big drips. May need pressor infusion.

TAP blocks.  (Could consider regional or wound infusion catheter)

IV Lignocaine (+/- ketamine) infusion. Can be continued post-op.

Post-op: PO analagesia + s/c morphine rescue. Avoids epidural & PCA to allow Enhanced Recovery

 

 

RDH

 

Cardiac recipe

For a ‘well patient’ of 70kg

Pre-med temazepam 10mg notce and mane

Standby:
Phenylepherine 100mcg/ml 20ml
Atropine 600mcg/ml
Phenylepherine 1mg/ml 10ml for perfusionist
CaCl 10% 10ml
MgSO4 50% 10ml

16G IVI
Awake arterial line

Antibiotics

Pre-O2
+/-Diazepam 10mg
Fentanyl 1mg (20ml of 50mcg/ml)
Etomidate 10-20mg (5-10ml of 2mg/ml) or propofol 50-100mg
Rocuronium 100mg (10ml of 5mg/ml)

ISO 0.5%
Tranexamic acid 1g
Propofol 1% at 10ml/hr

KTS:
MgSO4 5-10ml of 50% (500mg/ml or 2mmol/ml)
+/- Increase ISO up to 1%

Baseline ACT, ABG
Baseline ACT is 120-140sec

Have heparin ready. 400units/kg
OR, if using 1000units/ml then 0.4ml/kg or 2.5kg per ml or 50kg man = 20ml

ACT must be > 480 sec prior to bypass

Protamine for off-bypass
1mg per 100 units of heparin
4mg/kg
1ml heparin (1000iu/ml) = 1ml protamine (10mg/ml)

10mg morphine

On rewarming:
Noradrenaline 80mcg/ml @ 2ml/hr

Also need 50mg protamine per 500ml ‘pump blood’ transfused back.

CABG
+/- dobutamine

AVR
+/- GTN 1mg/ml

AA

Remifentanil recipe II – mcg/kg/min

PHASE CONTINUOUS IV
INFUSION OF ULTIVA (REMIFENTANIL)
(MCG/KG/MIN)
INFUSION DOSE
RANGE OF ULTIVA (REMIFENTANIL)
(MCG/KG/MIN)
SUPPLEMENTAL IV
BOLUS DOSE OF
ULTIVA (REMIFENTANIL) (MCG/KG)
Induction of Anesthesia (through intubation) 0.5 – 1*
Maintenance of anesthesia with:
  Nitrous oxide (66%) 0.4 0.1 – 2 1
  Isoflurane (0.4 to 1.5 MAC) 0.25 0.05 – 2 1
  Propofol (100 to 200 mcg/kg/min) 0.25 0.05 – 2 1
Continuation as an analgesic into the immediate postoperativeperiod 0.1 0.025 – 0.2 not recommended
*An initial dose of 1 mcg/kg may be administered over 30 to 60 seconds.

Anesthesia, Maintenance

0.25-0.5 mcg/kg/min IV; may bolus with 0.5-1 mcg/kg q2-5min in response to light anesthesia or transient episodes of intense surgical stress

Conscious Analgesia

1 mcg/kg IV bolus, followed by 0.05-0.2 mcg/kg/min IV

Analgesia, Immediate Post-Op Period

0.025-0.2 mcg/kg/min IV