Used for opioid sparing analgesia and enhanced recovery in colorectal , cystectomy…
Recipe for intra-op +/- post-op lidocaine infusion (aka lignocaine for us Brits!)
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
Add 50mg ketamine to 50ml syringe. Run at 10mg per hour.
Pre-op paracetamol, gabapentin.
Single shot spinal. 1-1.5ml 0.5% heavy bupivicaine (consider plain) + diamorphine (500mcg-1000mcg) or morphine (100-300mcg).
(TAP blocks at end. If [high risk] laparotomy + based on risk v benefit: wound infusion catheter vs epidural (pre-KTS vs post-op))
A-line + main warmed fluids in left arm (big drip)
Pressor (metaraminol) infusion + remi infusion + fluids for line patencey in right arm (bid drip)
IV Lignocaine (+/- ketamine) infusion. Can be continued post-op.
Post-op: PO analagesia + s/c morphine rescue. Avoids epidural & PCA to allow Enhanced Recovery
Standard induction (IV or gas)
Maintenance using TIVA:
- propofol 400 -> 300 -> 100 mcg/kg/min
- remi 0.2 – 0.1 mcg/kg/min
- Use to judge adequate depth of anaesthesia
- insert nasal uncuffed (standard) ETT to level just proximal to cords
- Spray larynx/cords/distally – take max allowed dose of lignocaine 10%, dilute to make up to desired volume, spray using MAD/atomiser
- Aim for spontaneous ventilation of oxygen enriched air while applying PEEP with bag
- Can hand ventilate if mouth is closed (but risks insufflation of stomach)
Emergence of spontaneously breathing patient with NPA
– KP @ LRI
Lignocaine 1-1.5mg/kg IV or topical
Pre-med with benzo/midaz (for LMA)
Anticholinergics (reduce secretions)