213 REPAIR ANTERIOR HARD PALATE w/ vomer flaps

This is the first of two-stage repair of a wide cleft palate performed at age 6 months of age.

Set up is identical to 207 Repair Cleft Palate.

It is a simpler procedure than full cleft palate repair - note differences.

Usually done with 220 PE tubes by Dr. Horn - (pull his card)

page 1 updated January 12, 2013

 

OPERATIVE TIME: 1 ½ hours

LOCATION: Pres Main only

FREQUENCY:20-30/year

ASSISTANT: No, but Horn usually puts in PE tubes at start of case

ICD9 CODE: 749.01 CLEFT PALATE

CPT CODE(S): 42235 REPAIR AHP W/ VOMER FLAPS

 

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

PATIENT POSITION | SETUP

Will turn bed counter-clockwise after PE tubes

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

Pedi-wrap elbow restraints with D-ring (neonate size)

Large round gel doughnut under head

Rectal temperature probe per anesthesia

Pedi Baer hugger, blanket, green towels, 1" tape for 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 room 72o, 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 and 2nd monitor

Omni “Lapotrac” scope holder and clamp

ENT scope and camera: 4mm, 0o Endoscope, camera,

    light cord.

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

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

CAUTERY

Bovie 8/8 pure, [2] #0118A Megadyne needle tip

[1]# 0120 Magadyne angled needle tip, holster

SUCTION

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

 

SOLUTIONS | IRRIGATION

Kefzol irrigation 500mg/500cc NS, 30cc syringe with 14g angiocath, saline, water

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

NEEDLES | SYRINGES

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

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

MEDICATIONS

■ Kefzol

■ Bacitracin ointment

 

213 REPAIR ANTERIOR HARD PALATE w/ vomer flaps


page 2

 

SETS TO OPEN Dr. C Cleft Palate Set

 

INSTRUMENTS USED (ON 2 MAYO STANDS)

     FORCEPS

Packing forceps, [3] Cushings

     SCISSORS

Reynolds (long Stevens), short Stevens, str metz

     NEEDLE HOLDERS

[4] Sontec gold angled

     RETRACTORS

Dingman mouth gag retractor

     KNIFE | BLADES

[1] No. 15 BP, [1] No. 12 BP

     ELEVATORS

McCullough, hockey stick, McIndoe

OTHER

NO DRILL, NO OSTEOTOME

VIDEO and SCOPES on MAYO

Camera, light cord, 4mm ENT scopes 0°,

Omni LapoTract

 

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

■ tip wipes

NON-STERILE SUPPLIES

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

 

 

NO

TYPE

SN

STATUS

SUTURES

[ 10 ]

4-0 Chromic P-3

1654

open 6

 

[ 10 ]

4-0 Chromic RB-1

U203

open 4

 

[ 1 ]

2-0 Silk SH

K 833

open

 

 

DRAINS

none

DRESSINGS

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

 

POSTOPERATIVE

■ call for pediatric crib (6th floor)

■ 2 warm blankets in corral shape

■ charge and connect IV infuser before moving baby

■ oxygen for transport

NOTES

WRITE ON CARD: “REMOVE PHARYNGEAL PACK”, GIVE TO ANESTHESIA..

May or may not have PE tubes. All cases will have video monitoring. Separate mayo stand for video equip

 

COMMENTS

Usually done at 6 months old

DATES MODIFIED

Dec 2012, Jan 2013, May 2013