Category Archives: recipes

Anaesthetic considerations for robotic surgery

Key points:

Maintain muscle paralysis while robot is docked – consider infusion of relaxant

Meticulous positioning with pressure point protection

Difficult to access patient intra-op

Have enough slack on lines

If steep trendelunburg e.g. prostatectomy caution with fluids, raised ICP and IOP, airway oedema.

Recipe for radical prostatectomy:

GA, ETT, 2x IVI, a-line

O2/air/desflurane. MAC 0.8-1.0

Remifentanil (0.1-0.2mcg/kg/min) and atracurium infusion

<500ml prior to anastomosis, max 2000ml in total (if no significant blood loss).

Peri-op lidocaine infusion

Used for opioid sparing analgesia and enhanced recovery in colorectal , cystectomy…

Recipe for intra-op +/- post-op lidocaine infusion (aka lignocaine for us Brits!)

Lidocaine 1%

Loading dose: 1.5mg/kg over 10min

Maintenance intra-op and post-op: 1% in 50ml syringe at 1.5mg/kg/hr

Post-op use 0.4% lidocaine (in 250ml bag)

Dose range 0.5-2mg/kg/hr

MONITOR FOR LOCAL ANAESTHETIC TOXICITY SIDE EFFECTS!

Use IBW if BMI>30

Optional extra:

Add 50mg ketamine to 50ml syringe. Run at 10mg per hour.

Ref: http://prc.coh.org/FF%20LidoIVPer12-10.pdf

 

RDH

Radical Cystectomy Recipe

Issues:

Long/major-op
Laparotomy – usually umbilicus to pubis, may be longer
Potential major blood loss
Anastomoses
Prolonged ileus

Recipe:
Xmatch 4 units/fluid warmer/cell salvage
Large bore IV
Awake epidural @ T10. Test does 3ml of mix (of 20ml 0.25% levobupivicaine + 100mcg/2ml fentanyl)
GA/ETT ( – 2mcg/ml fentanyl, less propofol)
Asleep art line/CVC +/- CO monitor

Dex/paracetamol
Des
Just before KTS: Top-up epidural with 5ml mix/5ml H20/5ml mixRun epidural infusion 0.125% l-bupivicaine + 2mcg/ml fentanyl 4-8ml/hr.

At end bolus 5 ml of epidural infusion.
Ondansetron
Alternative:
Run remi intra-op then epidural at end/extubation
Adv: can switch off if major haemorrhage to avoid hypotension
Dis: May be difficult to wean remi->epidural and establish post-op analgesia reliably