Tag Archives: lidocaine

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

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

 

Paediatric airway surgery recipe

e.g. laryngo-tracheo-bronchoscopy

Standard induction (IV or gas)

Maintenance using TIVA:

  • propofol 400 -> 300 -> 100 mcg/kg/min
  • remi 0.2 – 0.1 mcg/kg/min

Laryngoscopy:

  • 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

Ventilation:

  • 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