Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issuesRecognising that the method required to insert these new cannulaeprecludes certain techniques (such as ‘through and through punctureand withdrawal’), which are particularly important for patients withvery difficult peripheral venous access, or in paediatric patients, therewill continue to be available a small number of non-safety cannulasfor use in clinically indicated situations. Should you need to use anon-safety cannula ensure that you comply with all relevant guidanceon the disposal of your sharps.Laparoscopic cholecystectomy[Dr Robin Correa, appraised January 2010]This guideline applies where the patient is either an inpatient orreceiving 23-hour care.PremedicationConsider:Induction and maintenanceInductionagentMusclerelaxantMaintenanceParacetamol 2 g orally.Gabapentin 600 mg orally (shown to decreasepostoperative analgesic requirements).H 2-receptor antagonist or proton pump inhibitor (ifneeded).Propofol 2.5 – 3 mg kg -1Any short acting non-depolarising muscle relaxantOxygen + nitrous oxide + isoflurane or desflurane orsevoflurane (remember increased risk of PONV withsevoflurane).206 Anaesthetists Handbook January 2010