206 MAJOR REVISION of CLEFT LIP,

        UNILATERAL or BILATERAL, CHILD or ADULT

updated June 14, 2013

 

OPERATIVE TIME: 3 hours

LOCATION: Pres Main only

ICD9 CODE: 749.21 CLEFT LIP & PALATE, UNILATERAL, COMPLETE

                     749.23 LIP & PALATE, BILATERAL, COMPLETE

CPT CODE: 40720 REVISION CLEFT LIP RECREATION DEFECT

 

ANESTHESIA NOTES

▪ regular ET tube (no RAE)

▪ straight anesthesia connector

▪ Dr. C to start IV and sew in tube with 2-0 silk

▪ IV pump in room and charging

▪ temp probe

▪ Kefzol IV 25mg/kg

ADULT: may use RAE tube, no suture of tube

PATIENT POSITION | SETUP

▪ Will turn bed counter clockwise after PE tubes

▪ Dr. C to suture tube with 2-0 silk SH, scissors, needle

▪ Rolled terrycloth towel

▪ Large round gel doughnut under head

▪ Pedi-wrap elbow restraints with D-ring - not necessary in

    older child ASK

▪ Pedi Baer hugger or lower body Baer hugger for larger child,

▪ Blanket, green towels, 1" tape to secure tube

TABLE POSITION

Lower foot, close head gap, Do Not Remove Head Piece

Large round gel donut head rest. Place Baer after turning.

ROOM SETUP

Warm bed and head rest w/ Baer

Separate mayo stand for video equip

 

EQUIPMENT and SPECIALS

▪ Light source w/ headlight

▪ Baer hugger

▪ IV pump plugged in

▪ Video tower

▪ Omni “Lapotrac” scope holder and clamp

▪ Endoscope, camera, light cord.

PREP

PCMX with minimal water, cotton tip applicators to clean nose, wipe gently inside mouth, lightly over face

DRAPING and PACKS

Cleft Palate Custom Pack, Towel Pack

White towels for Mayo stand

Head sheet (two green towels and a ¾ sheet), ¾ sheet, magnetic pad, rigid box for bovie, towel clips, ½” steri-strip for eyes, 1000 drape, 2" Kling for pharyngeal pack,

Split sheet for adult

CAUTERY

Bovie 8/8 pure, [1]Colorado tip, [1] 0118A Megadyne needle point tips, holster

SUCTION

single with 7fr Frazier tip, 10fr NG suction catheter at end

 

SOLUTIONS | IRRIGATION

Kefzol irrigation 500mg/500cc NS, saline, water

NEEDLES | SYRINGES

[2] 3cc syringe, [1] 30cc syringe,

[4] 30g needle 5/8", [1]12g angiocath

LOCAL ANESTHETIC

peds mixture: 50/50 - In 3cc syringe with 30g needle x 2

• 1% lidocaine w/ epi 1:100,000 +

• 0.5% Ropivicaine plain

MEDICATIONS

■ methylene blue for tattooing lip

■ Kefzol for irrigation

■ Bacitracin ointment

206 MAJOR REVISION of CLEFT LIP,

        UNILATERAL or BILATERAL, CHILD or ADULT

page 2

 

SETS TO OPEN

Cleft palate, Fine instrument set

INSTRUMENTS USED (ON MAYO STAND) - 2 mayo stands

     FORCEPS

Packing forceps, 05 Adson, .3 & .5 CV fine, 0.5 titanium

     SCISSORS

Gradle, fine, straight tenotomy, curved tenotomy, Iris, Stevens

     NEEDLE HOLDERS

[3] Castroviejos, Webster

     RETRACTORS

Dingman mouth gag, 2mm, 5mm, 10mm skin hooks

     KNIFE | BLADES

[4] 30° super sharp blades #7531, [2] 15 BP scalpel blades

     ELEVATORS

Hockey stick, Tebbetts, McCollough

     OTHER

calipers, measuring cup, med glasses

 

STERILE SUPPLIES

▪ [2] marking pens with ruler

▪ Gelfoam (surgifoam #1972)

▪ Surgicel 2"x14" #1951

▪ bacitracin ointment

▪ non-disposable light handles

▪ methylene blue

▪ med glasses

▪ 7½ Protegrity latex gloves

▪ defogger

▪ scope lens cleaning pad

▪ ½" steri-strips for eyes

▪ instrument wipe

▪ 10fr suction catheter

▪ Basin set

▪ [3] 3" cotton tip applic

SPONGES

Raytec, 2" Kling for pharyngeal pack, [3] 3" cotton tip applicators, towel pack

NON-STERILE SUPPLIES

Pedi Baer hugger #555, Pedi-Wrap arm restraints [hold]

 

 

No

Type

SN

status

SUTURES 

[ 1 ]

2-0 Silk SH

K 833

 

hold

[ 4 ]

4-0 Chromic P3

1654

 

hold

[ 2 ]

5-0 Chromic P-3

687

open

 

[ 2 ]

6-0 Chromic G-1single

796

open

 

[ 1 ]

4-0 Monocryl RB1

Y214

 

hold

[ 1 ]

5-0 Monocryl TF

Y433

open

 

[ 1 ]

6-0 Monocryl P-1

Y489

open

 

[ 1 ]

7-0 PDS BV-1

Z 135

 

hold

[ 2 ]

6-0 Prolene P-1

8697

 

hold

[ 2 ]

7-0 Prolene P-6

8648

 

hold

 

DRAINS

none

DRESSINGS

none - bacitracin to wound, remember to remove pharyngeal pack and cut suture, 10fr suction catheter to suction stomach.

 

POSTOPERATIVE

call for pediatric crib (6th floor), 2 warm blankets in corral shape, connect IV infuser before moving baby, oxygen for transport

NOTES

does not usually include anterior hard palate, may or may not have PE tubes, all cases will have video monitoring.

 

DATES MODIFIED

March 2008, May 2009, Aug 2012, Jun 2013