212 MAJOR REVISION CLEFT PALATE with possible PHARYNGEAL FLAP

     May include: closure fistula, minor lip revision, coblation of turbinates --> ask

     Usual age range 4-12 years old updated October 18, 2018- page 1

 

ANESTHESIA NOTES

regular ET tube (no RAE), long circuit, straight anesthesia connector

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

IV pump in room and charging

Kefzol IV 25mg/kg;

Tranexamic Acid , 10mg/kg up to 1 gram

   Give at beginning of case and repeat dose at 2 hours

PATIENT POSITION | SETUP

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

■ IV kit for Dr C to start

■ Rolled terrycloth towel under shoulder

■ Large round gel doughnut under head

■ Pedi Baer hugger, blanket, green towels, 1" tape

■ Chux “diaper” for older kids

TABLE POSITION

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

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

rotate 180° counter clockwise after intubation

ROOM SETUP

Pre-warm room 72O, Baer to bed, Separate mayo for video

 

EQUIPMENT and SPECIALS

■ Dr. C light source w/headlight

■ Baer hugger, IV pump plugged in

■ Omni “Lapotrac” scope holder and clamp

■ Video tower, endoscope, camera, light cord

Available [hold] - do not open

■ Lorenz maxillofacial screws and set - available [hold]

■ Ostene bone wax EIC4835-01 -[hold]

■ ReFlex Ultra 45 Plasma Coblator ref#EIC4845 - available [hold]

■ [2] 3.0 mm OD endotracheal tubes - available [hold]

■ Coblator II Surgery System Machine - available [hold]

■ Ligaclips blue LT1000 with small ligaclip appliers - available [hold]

Bipolar bayonet cautery (blue insulated) - available [hold]

PREP

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

DRAPING and PACKS

Cleft Palate Custom Pack, Towel Pack

Head sheet (two towels and a ¾ sheet), ¾ sheet, magnetic pad,

[2[ holsters for Bovie, towel clips, ½” steri-strip for eyes, 1000 drape,

2" Kling for pharyngeal pack

CAUTERY

Bovie 8/8 pure, [2] 0118A Megadyne needle tip, [1] Valleylab long fine needle tip, extra holster, SAVE PLASTIC!

Bipolar bayonet cautery (blue insulated) - available [hold]

SUCTION

[2] suctions: with 7fr Frazier tip, baby Yankauer,

10fr suction NG catheter at end

 

SOLUTIONS | IRRIGATION

Saline irrigation. Water irrigation.

Kefzol/TXA irrigation: MIX

           500mg Kefzol in 500cc NS + 500mg tranexamic acid

LOCAL ANESTHETIC

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

mix 1% lidocaine w/ epi 1:100,000 + 0.5% Ropivicaine

NOTE Add for pharyngeal flap: 10cc syringe w/ 27g needle - ask

NEEDLES | SYRINGES

[2] 3cc syringe, [1] 10cc syringe, [1] 30cc syringe, [2] 1cc TB syringes

[2] 30g needle 5/8", [1] 1" 27g needle, [1] 14g angiocath

MEDICATIONS

Tranexamic Acid IV, 10mg/kg up to 1 gram, repeat at 2 hours

TXA/Kefzol irrigation: 200cc NS / 4gm TXA / 200 mg cefazolin

2-5 ml phenylephrine from anesthesia in medicine cup

Aquaphor ointment for lips at end

 

212 MAJOR REVISION CLEFT PALATE with possible PHARYNGEAL FLAP

page 2


 

SETS TO OPEN

Cleft palate set

INSTRUMENTS USED (ON MAYO STAND)

     FORCEPS

Packing forceps, [3] Cushings, Debakey

Bipolar bayonet cautery (blue insulated) - available [hold]

     SCISSORS

Reynolds, Joseph, Mayo

     NEEDLE HOLDERS

[4] Sontec angled - smooth and serrated, Crile Wood, Mayo Hagar, Debakey - medium and long

     RETRACTORS

Dingman mouth gag retractor [NOT MILLARD]

     KNIFE | BLADES

No. 15 BP, No. 12 BP

     ELEVATORS

McCullough, hockey stick, McIndoe, Tebbets

OTHER

1.1mm drill bit, 3mm osteotome, mallet, small Ligaclip appliers

    VIDEO and SCOPES on MAYO

Camera, light cord, 4mm ENT scopes str, Omni LapoTract

 

STERILE SUPPLIES

■ [3] marking pens

■ Gelfoam surgifoam #1972

■ Surgicel 2"x14" #1951

■ Plastic light handles

■ Basin set

■ suction tubing

■ defogger FRED

■ 10fr suction catheter

■ ½" steri-strips for eyes

■ ground pad

■ [3] 3" cotton tip applic

■ [2] 3.0mm ET tubes - hold

SPONGES

■ Raytec

■ 2" Kling for throat pack

■ [3] 3" cotton tip applicators

NON-STERILE SUPPLIES

Pedi Baer hugger, Pedi-Wrap arm restraints with D ring

 

 

 

No

Type

SN

status

SUTURES

[ 4 ]

3-0 Chromic RB-1

U 204

 

hold

[ 6 ]

4-0 Chromic P-3

1654

 

hold

[ 6 ]

4-0 Chromic RB-1

U203

 

hold

[ 4 ]

5-0 Chromic P-3

687

 

hold

[ 4 ]

3-0 Vicryl RB-1

J 416

 

hold

[ 2 ]

4-0 Vicryl RB-1 undyed

J 214

 

hold

[ 1 ]

2-0 Silk SH

K 833

 

hold

 

DRAINS

None

DRESSINGS

Aquaphor to lips, remember to remove throat pack and cut ETT suture

 

POSTOPERATIVE

■ call for pediatric bed

■ IV pump

■ 2 warm blankets in shape of corral

■ charge and connect IV pump before moving patient

■ oxygen for transport

NOTES

may or may not have PE tubes, all cases will have video monitoring. Separate Mayo stand for video equip

 

DATES MODIFIED

2006, 2007, 2008, Jul 2009, Nov 2009,Oct 2010, Jul 2011, Jan 2012,

Jan 2013, Jul 2016, Nov 2017, Aug 2018, Oct 2018