413 BROWLIFT

    set up same as FACELIFT.

    may include Facelift, Upper and/or Lower Blepharoplasty

    may include resection of glabellar musceles - ASK

                                                                                                                               updated January 4, 2017 Page 1

 

OPERATIVE TIME

2½ hours UNDER LOCAL if done alone;

6 hours total if done with facelift, usually under GENERAL ANESTHESIA

 

ANESTHESIA NOTES



Note: for general anesthesia use ENT position on regular OR table

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


General Anesthesia: SCD’s, Foley catheter,

✔ regular OR table in ENT position - 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 68O 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

 

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 x 2

Bovie 20/20 pure w/ flat silver tip.

Bi-polar with cord, disposable green bipolar forceps set to 15.

[2] bovie holsters.

SUCTION x 2

[2] suction tubing: Saf-T-Vac and baby 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

NEEDLES: [4] 25g 1½", [4] 27g 1¼ ", [4] 30g ½”

SYRINGES: [4] 10cc syringes, [4] 3cc syringes


[2] 25g 1½" needles placed on [2] 10cc syringes ➤Solution F

[2] 27g 1¼ " needles placed on [2] 10cc syringes ➤Solution F

[4] 30g ½” needles placed on [4] 3cc syringes ➤Solution E-2

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

LOCAL ANESTHETIC &

SOLUTIONS

Solution F: buffered Lidocaine 0.5% w/epi 50cc + NaBicarb 8.4% 5cc

Solution E-2: mix 50cc 1% lidocaine w/ epi + 50cc 0.5% Marcaine w/epi

MEDICATIONS

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

[2] Bactroban ointment tubes

BSS, Surgilube for eyes

Decadron 8 mg IVPurelube ophthalmic ointment

 

413 BROWLIFT

   Page 2


 

3 SETS TO OPEN

[1] Facelift set, [2] Plastic set, [3] bleph fine facial set - Hold

–>NOTE: ask if doing glabella muscles, if not, DO NOT OPEN BLEPH SET

INSTRUMENTS [3] Mayo stands; [2] Basin stands

1st MAYO – Opening and dissection

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

3rd MAYO – Closure instruments

     FORCEPS

01 - 05 - 08 Adsons, Smooth Adson,

[for glabella add –> Bishop Harmon smooth]

     SCISSORS

regular super cut Metz, str Metz, mini-Metz, str mayo, Gorney

[for glabella add –> Stevens tenotomy, Gradles, baby, mama and papa bears]

     NEEDLE HOLDERS

[4] Mayo Hagar NH, [4] Aesculup Crile Wood NH

     RETRACTORS

Maxwell facelift, narrow Freeman facelift, [2] large facelift, Senn, Chin retractor

     KNIFE | BLADES

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

     FOR GLABELLA ADD –>

Bishop Harmon smooth

Stevens tenotomy, Gradles, baby, mama and papa bears

 

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

● Tegaderm for eyes, cut ½

● [8] surgical marker pens

● Mastisol (hold for general)

● magnetic pad

● [4] blue plastic bowels

● Plastic Yankauer

● [3] med glasses

● Purelube ophthalmic ointment

SPONGES

[4] Raytec, [1] Lap

 

 

No

Type

SN

status

SUTURES

[ 4 ]

3-0 Nylon PS-1

16631

open

 

[ 4 ]

0 Stratafix CP-2, 26mm

SXPD2B-415

open

 

[ 2 ]

3-0 Stratafix FS, 26mm

SXMD2B-412

open

 

[ 4 ]

3-0 Chromic PS-2

1638

open

 

[ 2 ]

4-0 Chromic

1637

open

 

[ 1 ]

0 Ethibond CT1 - General only

hold

 

DRAINS

 NONE, unless doing facelift at same time

DRESSINGS on MAYO

● [1] Bactroban ointment

● tongue blade

● [2] 4x4's

● [1] ABD

● only [1] 18x3 Vaseline gauze

● [2] Kerlix

● 4" Ace

● Lister’s bandage scissors

 

POSTOPERATIVE


Cold compress, gauze soaked in ice saline, for eyes

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

 

DATES MODIFIED

Jun 2006, Aug 2007, Mar 2008, Dec 2008, May 2009, Mar 2011, Aug 2011, Mar 2012, Jul 2013, Nov 2013, Sep 2014, Aug 2016, Jan 2017