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Category: Oxford Handbook Of Anaesthesia

Haemorrhoidectomy Procedure Excision of haemorrhoids Time 20 min Pain ++/+++ Position Supine, lithotomy, head down Blood loss Not significant Practical technique GA, SV LMA and/or caudal Spinal (“saddle block”) Preoperative Assess suitability for LMA + lithotomy + head down position. Consider ETT if the patient is obese. Perioperative Opioid analgesia—short but intensely painful stimulus. Fentanyl […]

Inguinal hernia repair Procedure Repair of inguinal muscular canal defect through which bowel protrudes Time 30–60 min Pain ++/+++ Position Supine Blood loss Not significant Practical techniques GA, SV LMA, inguinal field block Spinal Local infiltration and/or sedation Preoperative Patients are usually adult males or young children. Perioperative Will need opioid if not using a […]

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. […]

Laparoscopic cholecystectomy Procedure Laparoscopic removal of gall bladder Time 1–2 h Pain ++/++++ Position Supine, 15–20 degree head up, table tilted towards surgeon Blood loss Not significant Practical technique GA, ETT, IPPV Preoperative Patients typically ‘fair, fat, female, forty’. The procedure is potentially painful. Perioperative The stomach may need deflating, hence insert a larger bore […]

General principles for laparoscopic surgery Laparoscopic techniques have been developed for many operations including cholecystectomy, fundoplication, vagotomy, hemicolectomy, hernia repair, appendicectomy, and oesophagectomy. Compared with laparotomy the major advantages are: Reduced tissue trauma required for surgical exposure. Reduced wound size and postoperative pain. Improved postoperative respiratory function: Following open cholecystectomy FVC is reduced by approximately […]

The sick laparotomy (See also ‘Anaesthesia for the Septic Patient’ p. 682.) Patients for emergency intra-abdominal surgery are at a much greater risk of perioperative complications than those presenting electively. The time available for preparation varies from only a few minutes to 12 h or more. The key is to strike the correct balance between […]

General principles of anaesthesia for laparotomy Laparotomy is a major physiological insult. Perioperative complications are common and often unpredictable. Even after ensuring that the patient’s physiological status is optimized, fluid replacement and analgesia are adequate, and appropriate monitoring is carried over into the postoperative period, complications may still occur. High dependency or intensive care is […]

Conduct of anaesthesia Use local anaesthetic, or short-acting general anaesthetic drugs which have few residual psychomotor effects and a low incidence of postoperative nausea or vomiting (PONV). Preoperative Nurses, surgeon, and anaesthetist will need to undertake an adequate history and examination as a full medical clerking is not usually performed by junior medical staff. This […]

General principles A surgical day case is a patient who is admitted for investigation or operation on a planned non-resident basis and who nonetheless requires facilities for recovery. –Royal College of Surgeons Guidelines 1992 Organization Organization is the key to efficient good-quality day surgery and requires close cooperation between all agencies involved, including surgeons, anaesthetists, […]

Rare syndromes Aaskog-Scott syndrome Characteristics: Cervical spine hypermobility/odontoid anomaly, mild/ moderate short stature, cleft lip/palate, skin and skeletal anomalies/laxity, interstitial pulmonary disease. Key points: Intubation may be difficult. Reference: Teebi AS et al. (1993). Aarskog syndrome: report of a family with review and discussion of nosology. American Joournal of Medical Genetics, 46, 501–9. Achalasia of […]

Anaesthesia and chronic alcohol abuse Colin Berry Anaesthetists may assist in the management of patients who have ingested alcohol acutely or chronically: trauma (vehicle related, violence, domestic accidents, child abuse) complications of drinking (coma, GI bleeding, portal hypertension, pancreatitis) unrelated surgical procedures in alcoholics. Physical complications of alcohol abuse Acute intoxication and coma. Blood alcohol […]

Anaesthesia for drug misusing patients Colin Berry General points In the United Kingdom around 1 in 4 of the population aged over 16 has taken an illegal drug at some stage (10 million people). Misuse of street drugs is not isolated to inner cities and areas of social deprivation. Consider drug misuse in all patients […]

Latex allergy Michael Richards Background Latex is the sap of Hevea brasiliensis (the rubber tree). It is a complex mixture of polyisoprene particles in a phospholipoprotein envelope and a serum containing sugars, lipids, nucleic acids, minerals, and proteins. Latex is made heat stable and elastic by vulcanization (heating in the presence of sulphur). Chemicals such […]

Anaesthesia for the elderly Fiona Kelly Anaesthesia and surgery in the elderly population are associated with increased morbidity and mortality. Specific factors to consider include: Degenerative disease of all types is commoner in geriatric patients. History may be unreliable and hospital notes occasionally formidable. Cardiovascular: ischaemic heart disease is common, with reduced ventricular compliance, contractility, […]

Down’s syndrome Brendan Carvalho Down’s syndrome (trisomy 21) is the commonest congenital abnormality, with an incidence of 1.6 per 1000 births. Anaesthesia and surgery carry a higher morbidity and mortality than in the general population. General considerations In addition to the characteristic dysmorphic features and impaired global development, Down’s syndrome is associated with disorders of […]

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