212 REVISION PALATOPLASTY with possible PHARYNGEAL FLAP

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

     Usual age range 4-12 years old updated July 17, 2016 - 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

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

■ Coblator II Surgery System Machine - available [hold]

Available [hold] - do not open

■ Tisseel 5cc - available [hold]

■ 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]

PREP

Chlorxylenol with minimal water, cotton tip applicators to clean nose, wipe inside mouth, lightly over eyes

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!

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

MEDICATIONS

• Kefzol

• Bacitracin ointment

Tranexamic acid for irrigation (500mg)

 

Tranexamic Acid (TXA) for bleeding IV & topical

Tranexamic Acid , 10mg/kg up to 1 gram

Give beginning of case and at repeated at 2 hours

(note: TXA also used as topical irrigation)

212 REVISION PALATOPLASTY with possible PHARYNGEAL FLAP PAGE 2

 

 

SETS TO OPEN

Cleft palate set

INSTRUMENTS USED (ON MAYO STAND)

     FORCEPS

Packing forceps, [3] Cushings, Debakey

     SCISSORS

Reynolds,

     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, 2mm osteotome, mallet

    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 pharyngeal 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

bacitracin to lips, remember to remove pharyngeal pack and cut ETT suture

 

POSTOPERATIVE

■ call for pediatric bed

■ IV pump

■ 2 warm blankets in corral shape

■ 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