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Appendicectomy

Appendicectomy
Procedure Resection of appendix
Time 20–40 min
Pain ++/+++
Position Supine
Blood loss Not significant
Practical technique Rapid sequence induction, ETT, IPPV, ilio-inguinal block
Preoperative
  • Patients are usually aged 5–20 years and are fit.
  • Can present in the elderly. May be the presenting condition of caecal adenocarcinoma requiring right hemicolectomy.
  • Consent required for suppositories.
  • Check fluid status.
  • If considering ilio-inguinal block, warn of possible associated femoral nerve blockade.
Perioperative
  • Rapid sequence induction.
  • Muscle relaxation required for surgery.
  • Replace fluid deficit.
  • Give PR diclofenac and PR paracetamol.
  • Right ilio-inguinal nerve block gives useful postoperative analgesia, or ask the surgeon to infiltrate locally.
  • Extubate awake and in left lateral.
Postoperative
  • Prescribe paracetamol, NSAIDs, morphine, and antiemetic until tolerating oral fluids.
  • Maintenance fluids.
Special consideration
  • Regional anaesthesia is an option in adults if GA contraindicated.
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