408 UPPER and/or LOWER BLEPHAROPLASTY

      * see below for 408a trans-conjunctival lower approach *

updated September 21, 2016

page 1

 

OPERATIVE TIME: 1½ - 2 hours

USUAL LOCATION: KASEMAN

ICD9 CODE: V50.1 ELECTIVE COSMETIC, 743.9 EYELIDS

CPT CODES:15822 UPPER BLEPH, 15820 LOWER BLEPH

 

PREOP HOLDING AREA

Holding Area:

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

Patient receives preop PO Valium, Demerol, and Clonidine

Nasal O2 cannula with CO2 monitor

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.

PATIENT POSITION | SETUP

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.

✔ extra pillow in room for end of case

ROOM SETUP

Warm room to 70O, then lower to 68O after pt draped [call x1690]

Warm up Bovie grounding pad and EKG leads in warmer

NO Bair hugger

 

EQUIPMENT

Headlight and extension box, [2] light sources, [2] stools

PREP

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

DRAPING

Head sheet, 1000 drape, split sheet, 4 towels,

[2] rigid bovie holsters, [2] packs green towels

Custom ENT pack #315360

CAUTERY

Colorado needle tip, Bovie 8/8, [2] holsters

SUCTION

none

 

SOLUTIONS | IRRIGATION

BSS with 22g angiocath, plain saline

MINI COLD SALINE BATH SETUP: get crushed ice in cooler,

place ice into emesis basin, cover with 1000 drape,

place small sterile basin on top, pour saline in to sterile basin

use to soak gauze, Raytec and 4x4 cover sponges

NEEDLES | SYRINGES

[2] 27g 1" needle on [2] 10cc syringe

[2] 30g ½" needles on [2] 3cc syringes

22g angiocath for BSS

LOCAL ANESTHETIC

if doing upper and lower: use solution E2. Mix 50/50:

     1% lidocaine w/ epi 1:100,000 - 1 vial

     0.5 % marcaine w/epi 1:100,000 - 1 vial

if ONLY doing upper or lower: use Solution E1

     1% lidocaine w/ epi - 1 vial, buffered 1:10 with HCO3

MEDICATIONS

Purelube ophthalmic ointment

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

 

STERILE SUPPLIES

1000 drape, needle box, magnetic pad

[4] No 15 scalper blades

SPONGES

[2] packs Raytec, 10ea.

NON-STERILE SUPPLIES

[2] Purelube ophthalmic ointment

408 UPPER and/or LOWER BLEPHAROPLASTY

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SETS TO OPEN

Dr. C Bleph Fine Facial Set

INSTRUMENTS USED ON MAYO STAND

     FORCEPS

05 Adson, .5mm silver CV, .5mm gold CV, Lister fixation,

blue titanium CV (CV=Castroviejo)

     SCISSORS

Kaye bleph, Gradles, fine ribbon (short and long baby bear, mama bear and papa bear), Wescott

     NEEDLE HOLDERS

[4] Castroviejo, [1] Webster SMOOTH

     RETRACTORS

#3, #2 Demars, 5mm double skin hook, 4-prong mini

     KNIFE | BLADES

[2] No. 15 blades on blue round handles

     OTHER

 

 

SUTURES

No

Type

SN

status

 

For uppers only >

[ 4 ]

6-0 Prolene P1

8697

open

 

[ 4 ]

5-0 Prolene PC3 (MEN)

8635

 

hold

Add for lowers >


 

[ 1 ]

4-0 Nylon P3

699

open

 

[ 2 ]

6-0 Prolene P1

8697

 

hold

[ 2 ]

6-0 Monocryl P1

Y489

open

 

[ 2 ]

5-0 Monocryl TF

Y433

 

hold

[ 2 ]

6-0 Fast Gut

1916

open

 

 

DRESSINGS

4x4 soft cover sponge soaked in iced saline to place on eyes

POSTOPERATIVE

Remove head cushion, put 2nd pillow under head, lift head of bed

DATES MODIFIED

Nov 2007, April 2008, May 2009, July 2009, Sept 2009, May 2012, July 2012,

Dec 2012, May 2013, Nov 2014, Dec 2014, Jan 2015, Jul 2015, Jan 2016, Sep 2016



 

408a TRANS-CONJUNCTIVAL LOWER LID BLEPHAROPLASTY

In this limited procedure, an incision is made on the inside of the lower eyelid.

Setup is same as for conventional bleph with the following exceptions:

 

LOCAL ANESTHETIC

Tetracaine ophthalmic solution 0.5%

Tobradex ophthalmic solution

1% lidocaine w/ epi 1:100,000 - 1 vial, buffered 1:10 with HCO3

NEEDLES | SYRINGES

[4] 3cc syringes with [4] 30g needles

SUPPLIES

Disposable eye shields or thin Silastic sheet

Short Q-tips

SETS TO OPEN

Dr.C bleph/fine facial

INSTRUMENTS

Scissors: Gradles, all bears

Forceps: .5mm CV forceps. 05 fine Adson

Retractors: 4-prong, all Demars, 5mm hooks

Other: mosquito clamps

SUTURE

[2] 5-0 nylon for traction suture [2] 6-0 Fast Gut