403 FACELIFT (includes Mayo stand setup)

May include Upper and/or Lower Blepharoplasty, Browlift, Chin implant, Extended Temporal Lift

Usually under Local Anesthesia; ✔ note differences under General Anesthesia

updated March 25, 2017 PAGE 1/3

 

OPERATIVE TIME:

4 hours facelift only, 3 hours for limited, 5-6 hours with blepharoplasty or browlift

 

ANESTHESIA NOTES



Note: for general anesthesia use ENT position

Local Anesthesia: patient receives preop Valium, Demerol, and Clonidine. Moderate sedation protocol. Nasal O2 cannula with CO2 monitor

General Anesthesia: SCD’s, Foley catheter,

✔Skytron OR table in ENT position w narrow headpiece

 - rotate clockwise after induction

✔ Dr. C to sew in tube with 0-Vicryl CT1, needle holder, scissors

✔ Accordion extension, ✔ straight connector, ✔ long circuit , ✔ regular ET tube

PATIENT POSITION | SETUP

Holding Area: On Stryker eye bed. Start IV on right side. Baer hugger.

   Apply warm Bovie pad, EKG pads, wrist restraints, etc. in holding.

   Give IV Kefzol, Zofran, Decadron and ½ to 1 mg Versed.

   Warm blankets, kisses and hugs.

In OR: Position patient bed flat, pillow under knees, terry cloth towel, gel pad, towels for headrest. [2[ blue Chux under head, blankets to tuck arms.

Rotate clockwise 135O. Nasal prongs with CO2 monitor.

- Aquaphor to lips. - Kerlix roll wrist restraints.

- Hair ties, comb and shaver box - extra pillow in room for end of case

ROOM SETUP

Warm room to 70O, then lower to 66O after patient. draped

Warm up Bovie grounding pad and EKG leads in warmer [for local]

[2] ring stands for dirty sponges; [1] Double ring stand for ice bath

[3] Mayo stands, [1] large back table

Bovie machine at foot of bed; bipolar foot pedal taped to floor

 

FOR

GENERAL ANESTHESIA

ONLY

✔ On Skytron OR table, ENT position w/ Navarro narrow head piece attachment

✔ SCD’s ✔ Foley 12 fr,

✔ 0-Ethibond NH, scissors - Dr. C to sew ETT to mouth

✔ [2] sterile small Tegaderm for eyes [general only]

NO mastisol. NO Kerlix. NO head set-up. NO steri-strips

 

EQUIPMENT

Headlight w/ [2] light sources, Gwen’s foot pad, [2] white hydraulic pump up stools

PREP

Chlorxylenol (PCMX), 4x4 sponge box - do not add water.

Prep lightly to face, eyelids, forehead, neck, hair

DRAPING

Head sheet w/ 2 towels, 1000 drape, split sheet

CAUTERY

note [4] tips

✔ Valleylab flat short silver tip (E1450-X)

✔ Valleylab silver extended needle tip (E1452-6)

✔ Megadyne needle tip (0118A); ✔ Megadyne pencil tip (0013A)

✔ Safe-t-Vac, ✔ [2] holsters, ✔ Bovie 20/20 pure

✔ Disposable bipolar cord (#10-4001), Bipolar setting @ 10

✔ insulated Bayonet bipolar forceps

SUCTION

[2] blue 3/16" suction tubing for Saf-T-Vac & Yankauer

 

SOLUTIONS | IRRIGATION

[3] liters NS irrigation, [2] Asepto syringes, [1] saline bowl

COLD SALINE BATH SETUP: get crushed ice in cooler,

place ice into large basin on double ring stand, cover with warmer drape,

place small sterile basin on top of warmer drape, pour saline in sterile basin

NEEDLES | SYRINGES

[10] 22g long Quincke spinal needles (405181); [10] 25g 1½" needle

[10] 20cc syringes ➤ for solution C

[10] 10cc syringes ➤ for solution F

[2] 5cc syringes ➤ for 0.25% marcaine w/epi

[2] 16g angiocath [2] 30cc syringes ➤ for Gwen irrigation

LOCAL ANESTHETIC &

SOLUTIONS


Solution C: 200cc mixture of

   2% lidocaine w/epi 50cc + 0.5%Marcaine w/epi 50cc + Normal Saline 100cc

Solution F: Lidocaine 0.5% w/epi 100cc + NaBicarb 8.4% 10cc

Marcaine: 0.25% w/epi 30cc

MEDICATIONS (for local)

[4] Versed; [4] Fentanyl; [1] Zofran; [1] Kefzol;

[2] Bactroban ointment tubes

 

403 FACELIFT

 PAGE 2/3

 

SETS TO OPEN

Dr C Facelift & Dr. C Special Plastic set

INSTRUMENTS USED ON 3 MAYO STANDS:

  ► 1st MAYO – Opening and dissection

      ► 2nd MAYO – Local infiltration, syringes and needles; then dressings or bleph/brow

         ► 3rd MAYO – Neck and face closure

     FORCEPS

01's Adsons, 08's 6" Adsons, smooth Adson, 9" Debakey, 7" Debakey,

Dressing forceps, Cushings

     SCISSORS

short Freemans, long Freemans, Large ceramics, short ceramics, ceramic Metz, Stille stealth black, gold TC curved defatting, str Metz, str Mayo, Reynolds

     NEEDLE HOLDERS

[4] 6" smooth Crile Wood NH

[1] 6" Debakey NH

[1] 9" Debakey NH

[2] Mayo Hagar NH

[8] Aesculup serr NH

     RETRACTORS

Breast, Maxwell, Freeman facelift, 3-prong chin hook, 3/8" baby Deaver,

L-shaped retractor, Weider cheek

     KNIFE | BLADES

[8] No. 10 blades; 3 round knife handles

     OTHER

Titanium spoon, kidney basins, insulated Bayonet bipolar forceps,

pediatric suction, plastic Yankauer suction

 

STERILE SUPPLIES

● 1000 Steri-drape

● [2] needle counters

● cotton balls for ears

● ½" steri-strips (hold for general)

● Disposable bipolar cord #10-4001

● warmer plastic drape for iced saline

● [8] surgical marker pens

● Mastisol vial (hold for general)

● magnetic pad

● [4] blue plastic bowels

● Plastic Yankauer

● [3] med glasses

General : add [2] Tegaderm for eyes, NO steri strips, NO Mastisol

SPONGES

[6] Raytec, [1] Lap

 

 

No

Type

SN

status

        SUTURES  

[ 1 ]

0 Ethibond CT1 - General Only

 

hold

[ 8 ]

3-0 nylon PS-1

1663

open 8

 

[ 5 ]

2-0 Vicryl SH

J417

open 3

hold 2

[ 2 ]

5-0 Monocryl P-3

Y493

open 2

 

[ 4 ]

3-0 Chromic PS-2

1638

open 2

hold 2

[ 8 ]

4-0 Chromic PS-2

1637

open 4

hold 4

[ 6 ]

5-0 Chromic P3

687

open 2

hold 2

[ 2 ]

5-0 Prolene PC-3

8635

open 2

 

[ 2 ]

5-0 Plain P3

686

open 4

 

[ 2 ]

3-0 Stratafix FS-2, 19mm

SXMD2B-408

 

hold 2

[ 2 ]

2-0 Stratafix FS, 26mm

SXPD2B-420

 

hold 2

 

DRAINS

[2] 7mm flat Blake drains - with connectors and bulbs cat#2211 full fluted

DRESSINGS

place on Mayo stand

start setup after injections over

● Knife blade to cut rubber bands

● [2] Bactroban ointment tubes

● tongue blade

● [2] packs 4x4's soft sponges

● [1] Abd pad

● Lister bandage scissors

● [1] 4" Ace

● [2] 3x18 Vaseline gauze

● [2] Kerlix

● [2] Safety pins

● Dr. C sterile gloves

 

POSTOPERATIVE

Remove head cushion, put 2nd pillow under head

 

DATES MODIFIED

Nov 2006, Aug 2007, Oct 2007, Nov 2007, March 2008, August 2008, May 2009, July 2009, Sept 2009, Oct 2009, Mar 2010, Nov 2010, March 2012, May 2012, July 2012, Dec 2012, Jan 2013, Apr 2013, Jun 2013, Feb 2014, Mar 2014, Jun 2014, Jan 2015, Jun 2015, Jul 2015, Jul 2016, Jan 2017, Mar 2017


1st MAYO – Opening and dissectionPAGE 3/3

 

Knife handles [3] Round w/ [8] #10 blades


Cautery tips

     Valleylab/Covidien flat short silver tip

     Valleylab/Covidien silver extended needle tip

     Megadyne green needle tip (18A)

     Megadyne green crayon tip (13A)

     Insulated bayonet bipolar w/ foot pedal

Retractors

     Maxwell facelift

     Weider cheek

     Breast retractor

     3-prong chin hook

     Freeman narrow facelift

     Baby Deaver

     L-shaped retractor

Scissors

    Freemans scissors TC

    Long Freemans scissors TC

    De-fatters curved scissors TC

    Ceramic scissors short

    Ceramic Gorney scissors big

    Ceramic Metz scissors

    Stille stealth scissors black


Suture Scissors

     Straight Mayo scissors TC

     Straight Metz scissors TC

     Reynolds scissors 

 

Tissue forceps

     01's Adsons forceps

      Smooth Adsons

     81's, 83's – 6" long Adsons forceps

     6" Dressing forceps

      7" Debakey forceps

      9" Debakey forceps

Other

    Pediatric suction

    Plastic Yankauer suction

    Marking Pens

    Titanium Spoon

    Raytecs folded into 2" x 8", 1" x 16"

2nd MAYO – Local infiltration: syringes and needles, then dressings

 

Solution C:

     [10] 20cc syringe w/ 22g spinal Quinke needle


Solution F - Lidocaine 0.5% w/epi and bicarb:

     [10] 10cc syringe w/ 25g 1½” needle mixed with NaBicarb (1:10)


Marcaine 0.25% w/ epi for end of case:

     [2] 5cc syringe w/ 25 g 1½” needle


Smooth Adson, cotton balls, ½” Steri-strips, Mastisol, moist and dry sponges.


Note: after local dissection, change local Mayo stand to bleph setup or dressings

3rd MAYO – Neck and Facelift closure instruments and sutures

 

Neck dissection and platysma repair:

     [1] 6" Debakey needle holder loaded with 2-0 Vicryl

     [1] 9" Debakey needle holder (empty)

     7" Debakey tissue forceps, 9" Debakey tissue forceps, 7" Cushings forceps


Facelift closure needle holders and suture

     [4] Aesculup needle holders loaded with 3-0 Nylon for drain and traction sutures

     [2] Mayo-hagar needle holders loaded with 2-0 Vicryl for cheek SMAS

     [2] Aesculup needle holders loaded with 3-0 Quill

     [2] Aesculup needle holders loaded with 3-0 Chromic and 4-0 Chromic

     [4] Crile-Wood needle holders loaded with 5-0 Chromic, 5-0 Plain, 5-0 Prolene