505 Reconstructive Rhinoplasty Complete, Adult or Adolescent

        with or without Septoplasty, Turbinectomy, Cartilage graft, Porex implant

This is a major nasal procedure, not cosmetic, done in main OR.

May include septoplasty, turbinectomy, cartilage grafts, Porex implants.

                                                                                                                  PAGE 1/3 updated July 17, 2016

 

ANESTHESIA NOTES

General, regular ETT, not RAE, long circuit, straight connector

Tranexamic Acid , 10mg/kg up to 1 gram

   Give at beginning of case and repeat dose at 2 hours

PATIENT POSITION | SETUP

Close gap on table, full round gel headrest, rolled terry cloth towel under shoulders, tuck arms side of bed, Baer hugger

TABLE POSITION

rotate 180° counter clockwise after intubation

ROOM SETUP

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

 

EQUIPMENT

Headlight and light source on north wall by music

Coblator II Surgery System Machine w/ pedals - next to Bovie

SPECIALS

■ Porex implants

■ Doyle intranasal silastic splints #1524050 - [hold]

■ Thermasplint nasal splint, Medtronic ref 1529010

■ ReFlex Ultra 45 Plasma Wand ref#EIC4845 - available [hold]

■ Arthrocare Septal Stapler #601-00100 - available [hold]

PREP

PCMX, 4x4, cotton applicators. Prep face and nose.

DRAPING

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 10/10 pure,

Colorado tip and Megadyne 0018A needle tip

SUCTION

[2] suctions: with 7fr Frazier tip, baby Yankauer,

 

SOLUTIONS | IRRIGATION

Saline irrigation. Water irrigation.

Kefzol/TXA irrigation: MIX

           500mg Kefzol in 500cc NS + 500mg tranexamic acid

NEEDLES

SYRINGES

[2] each: 27g 1½", 30g 5/8", 14g angiocath

[2] each: 10cc, 5cc, 3cc, 30cc

LOCAL ANESTHETIC

Place on separate Mayo stand

Keep all locals separated

Do not mix

For packing fill and label [2] plastic cups with:

   ■ Neosynephrine drops, [1] vial “extra strength”

   ■ 4% Cocaine 8cc (Dr. C will mix and dip neuro paddies)

For injection >>>>> Dr. C to mix and draw:

   ■ 2% lidocaine w/ epi in 3cc syringe, 30g needle

   ■ 0.5% marcaine w/ epi for mixing

   ■ Mix Lidocaine and Marcaine in 10cc syringe, 27g needle

MEDICATIONS

■ methylene blue in prep cup w/ 30g needle mosquito

■ Bacitracin ointment, 1-2 small packets for end

■ Kefzol 1gm for irrigation

■ 2% lidocaine w/ epi (50cc)

■ 0.5% marcaine w/epi (50cc)

■ 0.5% Neosynephrine nose drops - [1] vial

■ 4% cocaine, [2] vials, 8cc total

■ 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)

505 Reconstructive Rhinoplasty PAGE 2/3

 

SETS TO OPEN

Fine plastic cleft set, rhinoplasty set

(open heart white towel pack)

INSTRUMENTS USED ON 3 MAYO STANDS - one stand for solutions, dressings, splint

     FORCEPS

Bayonet, Adsons 05 & 03, Adson dissectors, smooth Adsons, CV eyelid .5 & .3, Adson-Brown, angled Debakey, packing

     SCISSORS

Iris curved & straight, Gradle, Baby-Mama-Papa bears,

Metz cvd, Joseph, Reynolds, str Mayo, str metz

     NEEDLE HOLDERS

Crile Wood, sm and serr Webster, Castro Viejo, super fines

     RETRACTORS | SKIN HOOKS

Tiemanns self retainer, Converse, Senn, Ragnell, Bunnel,

2mm-5mm-10mm double skin hooks, Blue Kasdan, Tebbetts

     KNIFE | BLADES

[1] 30° super blade, [2] No.15 BP, [2] No. 10 BP

ELEVATORS

Joseph, Tebbetts, Freer, McCullough

     OTHER

■ Speculums - short and medium, black coated, silver

■ Osteotomes - 2mm and 4mm

■ Mallet

■ Rasp - 3/4

■ Carmalt clamps

■ White cutting board, blue silastic pad

■ Blue and yellow silastic prep cups

■ Vessel loops red

 

 

STERILE SUPPLIES

■ Suction tubing

■ [2] ½" Steri-strips for eyes

■ ¼" Steri-strips

■ marking pens

■ blue bulb syringe

■ Doyle intranasal silastic splints

         #1524050 - [hold]

■ Vessel loops, red

■ Heart Towel Pack

SPONGES

[2] Raytec 4x4, 2" Kling throat pack

[1] pack 10ea. ½" x 3" cottonoid Neuro patties ref 8004007

 

 

No

Type

SN

status

SUTURES

link to suture list

[ 4 ]

5-0 Chromic P3

687

open

 

[ 2 ]

6-0 Chromic G1

796

open

 

[ 2 ]

4-0 Monocryl RB-1

Y 214

open

 

[ 2 ]

5-0 Monocryl P3

Y 493

 

hold

[ 2 ]

5-0 Monocryl TF

Y433

open

 

[ 4 ]

6-0 Monocryl P1

Y 489

open

 

[ 2 ]

6-0 Prolene P-1

8697

 

hold

[ 2 ]

7-0 Prolene P-6

8648

 

hold

 

DRESSINGS | PACKING

set up on Mayo stand

before end of case

■ Mastisol

■ 3x4 telfa

■ 4x4 gauze

■ Raytec sponges

■ [2] packs ½" steristrips

■ [2] packs ¼" steristrips

■ smooth forceps

■ large straight scissors

■ Thermasplint #1529010

■ hot water in thermos

■ crushed ice in thermos

■ nasal drip pad, cut dome mask

■ Doyle Splint #1524050 [hold]

■ 3-0 Nylon w/ needle holder [hold]

■ Gloves

■ bacitracin ointment

 

LAST MODIFIED

Jun 2008, Dec 2008, Sep 2009, Nov 2009, Oct 2010, Jul 2011, Dec 2011,

Jul 2012, Jun 2013, Aug 2013, Jun 2014, Jun 2015, Jun 2016, Jul 2016


RHINO MAYO STAND SETUP PAGE 3/3

1st MAYO – Local infiltration: syringes and needles, then dressings

                   Dr. Cuadros will draw up and mix

 

[4] Plastic Specimen Cups:

   2% Lidocaine w/epi

   0.5% Marcaine w/epi

   4% cocaine

   1% neosynephrine

Syringes:

   [2] 10cc syringes

   [2] 3cc syringes

   [1] 5cc syringe

Needles:

   [2] 27g 1" needles,

   [2] 30g ½ in needles

Instruments:

   bayonet forceps

   nasal speculum

   packing forceps

   Smooth Adson

Supplies

   2" Kling throat pack

   Raytec sponges

   marking pen

   cottonoids (cut strings)

Note: after local infiltration, change Mayo stand to splint and dressings (see above)

2nd MAYO – Opening and fine dissection; then closure

 

Knives

   [1] super blade

   [2] round knife handles

        w/ #15 blade, #10 blade

Scissors

   Gradles

   baby, mamma, papa bears

   black iris, straight & curved iris

   Stevens tenotomies

   Reynolds, Josephs

   long baby bears

   Wescotts

Tissue forceps

   Castor Viejo forceps .5 & .3

   05 Adsons

   Smooth Adson, angled Debakey

Needle holders

    Smooth Webster, super-fines

    Castro-Viejo


Retractors

   Converse nasal

   Casdan blue retractor

   Tebbetts retractor

   safety pin retractor

   4-prong

   2mm 5mm 7mm dbl skin

   Ragnell

   Bunnell

   Tiemanns self-retaining x2

Other

    Baby Yankauer

    Marking Pens

    Raytecs folded 4 x 8

    Cutting board, w/ blue silastic sheet

    Blue and Yellow silastic prep cups

3rd MAYO – rasps, osteotomes, rongeurs, etc.

 

Elevators

   Joseph

   Key

   Tebetts

   Freer

   Mccullough

   Aufricht

Bone

   3/4 rasp

   2mm & 4mm osteotomes

   mallet

Rongeurs

   Pituitary rongeurs

   Takahashi rongeur

   Jackson-Middleton rongeur


Other

   swivel knife

   Boies elevator, small and large