Anaesthetists Handbook - MEDICAL EDUCATION at University ...

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Pain management and postoperative careCODEINE PHOSPHATE – Moderate pain with paracetamol and/or NSAID(may go straight to morphine sulphate)Birth –1year1–16yearsCommentsOral / IM/ SCTheseroutesonly500µg/kg6hourly500 µg -1mg/kgMaximumdose60mg4-6 hourlyMaximum daily dose 240mg. IM onlyunder anaesthesiaSyrup contains 2.1%v/v alcoholNote opioid thus may cause respiratorydepression104 Anaesthetists Handbook January 2010
Pain management and postoperative careMORPHINE SULPHATE – moderate to severe pain with paracetamol and/orNSAIDSEEK ADVICE IF PAIN NOT ADEQUATELY CONTROLLED- PAIN TEAM,SENIOR PAEDIATRIC OR ANAESTHETIC STAFF MAY INCREASE DOSE orFREQUENCY NOTE NO CEILING DOSE FOR MORPHINE FOR PAINRELIEFChildren prescribed IV/ SC morphine for acute pain should have naloxoneprescribed 10µg/kg to be repeated as necessarySeek senioradvice forbabies under3monthsBirth – 1month1 – 3monthsMonitor closely: widevariation in response3- 6months 6months –1 year12 years12-16years ifless than50kg12 – 16years ifmore than50kgOral100 µg/kg4 hourly200 µg/kg4 hourly200 µg/kg4 hourly200 µg/ kg4 hourly200 – 400µg/kgMax 10mg10 – 15mg2 hourly3 hourlyIV bolus 25-100µg/kg4 hourly50-100µg/kg4 hourly100 µg/kg4 hourly200 µg/kg4 hourly200 µg/kgMax 10mg3 hourly5 – 10mgMax 10mg2 hourlyIV infusionLoad withbolus doseInstructionsnext sheetStart 10µg/kg/hup to20µg/kg/hStart 10µg/kg/hup to30µg/kg/hStart 10µg/kg/hup to30µg/kg/hStart 20µg/kg/hup to30µg/kg/hStart 20µg/kg/hup to30µg/kg/hStart 20µg/kg/hup to30µg/kg/hSC BolusNotrecommended150 µg/kg 150 µg/kg 150 µg/kg 200 µg/kg 5 – 20mgPCA may be available. Seek guidance from pain control team / pharmacy andsee separate guidelinesAnaesthetists Handbook January 2010 105
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Department of AnaesthesiaAnaestheti
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Document control for approved clini
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ContentsTrauma list anaesthetist (t
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ContentsStudy leave 81Junior doctor
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ContentsIndications for investigati
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ContentsRenal patients - clinical g
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Introduction and scope of guideline
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Introduction and scope of guideline
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Airway assessmentManaging difficult
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Managing difficult airways• Flexi
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Managing difficult airways• Manuj
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Resuscitation - advanced life suppo
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Resuscitation - advanced life suppo
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Duties of the on call anaesthetists
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Getting senior helpGetting senior h
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On call casesGetting senior helpYou
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Supervision for sick patientsGettin
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Calling the senior resident anaesth
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Perianaesthesia Care Unit (PACU)PAC
Page 53 and 54: PACUThe surgical team responsible f
Page 55 and 56: PACU6. Oxygen and intravenous thera
Page 57 and 58: Integration with the critical care
Page 59 and 60: Inter-hospital transfersInter-hospi
Page 61 and 62: Inter-hospital transfersConsultant
Page 63 and 64: Signing onAdministrative issuesYour
Page 65 and 66: Administrative issuesMobile phones
Page 67 and 68: Administrative issuesobstetrics, we
Page 69 and 70: Administrative issuesMain theatre r
Page 71 and 72: CLWrota processes• To complete ca
Page 73 and 74: Security rules:• Do not put confi
Page 75 and 76: Education and trainingthe Royal Col
Page 77 and 78: Education and trainingthe necessary
Page 79 and 80: Education and trainingarrive in the
Page 81 and 82: Education and traininginformation c
Page 83 and 84: Education and trainingexamination i
Page 85 and 86: Education and trainingAll consultan
Page 87 and 88: Presenting at seminars• Bring har
Page 89 and 90: Presenting at seminarsDOI advise yo
Page 91 and 92: Clinical adverse event reportingCli
Page 93 and 94: Clinical auditClinical audit[Apprai
Page 95 and 96: Clinical auditYour presentation sho
Page 97 and 98: Pain management and postoperative c
Page 103: Pain management and postoperative c
Page 121 and 122: Signs and symptomsAgitation, anxiet
Page 123 and 124: Epidural anaesthesia and analgesiaP
Page 125 and 126: Epidural anaesthesia and analgesiai
Page 127 and 128: Epidural anaesthesia and analgesiaS
Page 129 and 130: IndicationsEpidural anaesthesia and
Page 131 and 132: Epidural anaesthesia and analgesiaH
Page 133 and 134: Assessment and treatment optionsEpi
Page 135 and 136: Epidural anaesthesia and analgesia3
Page 137 and 138: Epidural anaesthesia and analgesia
Page 139 and 140: Epidural anaesthesia and analgesiaA
Page 141 and 142: Epidural anaesthesia and analgesiaG
Page 143 and 144: Allergies and adverse drug reaction
Page 149 and 150: Awareness during anaesthesiaPrevent
Page 151 and 152: Fractured neck of femur:management
Page 153 and 154: Fractured neck of femurGuidelines f
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Management of patients with diabete
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Patients who take insulinManagement
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Preoperative assessment and investi
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Indications for investigationsFull
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SevofluraneSevoflurane[Dr Mark Port
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Sevofluranemust be considered on it
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Gabapentin in acute painSide-effect
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Blood and blood productsBlood and b
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Blood and blood productsWhen the un
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Blood and blood productsCross match
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Blood and blood productsBlood Cool
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Blood and blood productsHaematology
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Blood and blood products25322 so th
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Blood and blood productsfactors, ha
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Day case anaesthesia6. Social crite
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ENT anaesthesiaENT anaesthesia{Dr C
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ENT anaesthesiaIntraoperative• In
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Miscellaneous issuesMiscellaneous i
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Miscellaneous issuesideally be cont
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Miscellaneous issuesinstruction man
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Miscellaneous issuesRemifentanilRem
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Miscellaneous issuesCentral neuraxi
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Miscellaneous issuesAnalgesia Fenta
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Miscellaneous issues• Diclofenac
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Miscellaneous issues• Associated
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Miscellaneous issues• Everyone wi
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Miscellaneous issues• If fasting
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Miscellaneous issueslabour ward ana
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Miscellaneous issuesThere is no cli
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Patient monitoring in and out of th
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Miscellaneous issuessuch as Hartman
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Miscellaneous issues• Abdominal a
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Miscellaneous issuesPrevention of p
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Miscellaneous issuesDifferent clini
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Recovery and patient handoverMiscel
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For afternoon list (pm)Diabetic Pat
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Miscellaneous issuestake part in th
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Miscellaneous issuesSee page 37 for
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Waiting list initiatives[Appraised
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Major Incident ProcedureStaff assem
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Major Incident Procedure• In coop
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Finding your way round theUniversit
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• Coffee room.• Quiet room (fiv
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Anaesthesia department lead clinici
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Trust organisational structureTrust
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Telephone numbersLabour ward……
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IndexIndexAabsence, 68adenotonsille
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Indexemergency department, 222emerg
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Indexmortality review, 93MRI scansa
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Indexstudy leave, 81applications, 6
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NotesAnaesthetists Handbook January
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NotesAnaesthetists Handbook January
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