CO-EXISTING DISEASES

1. ▪ Usually none

PREOPERATIVE ASSESSMENT

1. ▪ Studies: none

2. ▪ Premed: weigh against brevity of procedure

3. ▪ PO/PR midazolam 0.5 mg/kg

4. ▪ Acetaminophen 10–20 mg/kg PO

5. ▪ NPO: std

PROCEDURAL CONSIDERATIONS

1. ▪ Supine

2. ▪ Ophthalmologist probes & irrigates lacrimal duct to verify patency.

3. ▪ Surgical stimulation mild

4. ▪ IV recommended: see risks

5. ▪ Monitors: std

6. ▪ Risks: Oculocardiac reflex due to pressure on globe; results in bradycardia; laryngospasm

7. ▪ Irrigation fluid may pass into pharynx via the nasal passages & cause laryngospasm if pt in light plane of anesthesia.

8. ▪ May use nasal suction during irrigation to decrease fluid into larynx

ANESTHETIC PLAN

1. ▪ Std inhalation or IV induction

2. ▪ Use face mask or LMA.

3. ▪ ETT only if dictated by clinical scenario

4. ▪ Maintenance: inhalation agent in O2/N2O with spontaneous Vent

5. ▪ Maintain adequate depth of anesthesia until irrigation completed.

6. ▪ Suction pharynx if large amount of irrigation required.

7. ▪ Awaken in OR.

PAIN MANAGEMENT

1. ▪ Acetaminophen

PACU/POSTOPERATIVE CONSIDERATIONS

1. ▪ Analgesia: continue acetaminophen and/or nonsteroidal

LAPAROSCOPY

CO-EXISTING DISEASES

1. ▪ Any intra-abdominal process

PREOPERATIVE ASSESSMENT

1. ▪ Std fasting & premed

2. ▪ Labs: T&C for neonates/infants

PROCEDURAL CONSIDERATIONS

1. ▪ Neonatal/infant viscera & blood vessels may be punctured with blind insufflation.

2. ▪ CO2 absorption across peritoneal cavity with increased CO2 elimination

3. ▪ Hypercarbia will stimulate SNS with tachycardia, hypertension & arrhythmias.

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