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Anaesthesia for THR

 

 

 

  1.  Following preop assessment, IV insertion, attachment of monitoring
  2.  Lateral position , always L side down (for a R handed anaesthetist)
  3.  Spinal inserted, 2.6 – 2.8 mls heavy bupivacaine 0.5% with fentanyl 10 mcg
  4.  For R THR move patient to R side down. For L leave in L lateral position for 5 minutes
  5.  Cephalothin 2 gm IV unless allergic
  6.  Position on operating table
  7.  Give midazolam 2 mg depending on age etc
  8.  Propofol 20 – 30mg  boluses intermittently keeping patient able to still communicate but sedated (or infusion 10 – 20 mls per hour)
  9.  Headphones on patient with music
  10.   Hartmanns solution 1 – 1.5 L intraoperatively, more  if significant bleeding
  11.   Metaraminol 0.5 mg IV boluses to maintain systolic BP > 90, higher if elderly or history of  hypertension
  12.   Parecoxib 40 mg IV if no contraindications, paracetamol 1 gm
  13.   Dexamethazone 4 mg IV for PONV prophylaxis
  14.   Postop analgesia PCA morphine ) 0.5 – 1 mg bolus, 5 minute lockout 10 – 20 mg 4 hr dose limit.
  15.   Also paracetamol 1 gm 6/24 for 24/24, oxycodone 5 – 20 mg O 4/24 PRN only when PCA ceased, tramadol 50 – 100 mg O / IM PRN 8/24
  16.  Clexane 20 – 40 mg S/C 6/hours postop then daily thereafter until discharge.
Comment 1
"for THR or TKR, does anyone also give a gentle SVGA with LMA. If you speak to a lot of patients about being awake and hearing loud noises, most of them will say put me to sleep as well. Sometime it is easier to control their airway with LMA then hudson mask and holding their jaw up"
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