Technician Brief for Craniotomy Default Setup on wall in Theatre 1 anaesthetic room Applies to all cases where list

contains procedure Craniotomy or Clipping of Cerebral Aneurysm Any additions or subtractions to be specified by Anaesthetist Theatre Setup Marquet Table Reverse Orientation anaesthetic room Machine off side-wall boom Sevofluorane requested head towards

closest to recovery unless propofol TCI

Endotracheal Tube Oral RAE, Standard (neck flexed or prone), Corrugated connector, Hypofix Tegaderm to eyes IV Prefer 16g (+/- other) 0.9% NaCl normal giving set + /- warmer IAL Left radial, calibrate to circle of willis/ level of ear, splint often used alternatively R) radial, consider L) femoral If lateral or prone site intraoperative side closest to machine Transducers (2) IAL + CVL secure to bed about half way to feet Extension sets for CVL Intermittent sample ABG, Glu, Hb, Establish ETCO2 : PaCO2 gradient Syringe drivers (3) at least one with PK program by patients feet Vasopressor, Remifentanil, (+/-Phenytoin, Propofol, NMB) Mini bore extensions 152 + 84cm for all Ultrasound Central line trolley set up other specified IV frusemide and Phenytoin (1500mg) FAWD/ Bair Hugger feet (PNS) triple lumen arrow unless

by patients

( Datex device Right hand. Calibrate asleep prior to NMB)

Anaesthetic microscope screen may be used SCD IDC with temp probe Hourly measure Stealth (if applicable)

Process 1. In Anaesthetic Room In addition to other checks TEDS IAL Volume line L) arm L) arm0.9% saline 1000ml via normal giving set

2. Transfer to theatre Bed 3. Anaesthetic Induction Surgeon balancing microscope Nurses setting up trolleys

Expect a busy and demanding time. Try not to leave theatre again until ABG during draping for surgery Secure monitoring Anaesthetist 1 scrubs for CVL IV induction Oral Rae ETT Hypofix Bite-block Corrugated Connector Tegaderm for eyes Anaesthetist 2 manages airway then

Anaesthetist 2 Anaesthetist 1 monitoring patient Insert CVL IV cephazolin may be requested Minimal head down Seldinger/ Ultrasound guided Attach transducer (brown)/ Remi (blue)/ Metaraminol (white) Patient 10-15o head up following insertion Nurse place IDC concurrently. Full body bair hugger. 4. Head available to surgeons Anaesthetist 1 will monitor patient Anaesthetist 2 will guard airway Head onto horseshoe/ into pins Neurosurg Reg supports head Substitute bed ends. Consultant Surgeon confirms stability. Anaesthesia doublecheck. Anaesthetic machine repositioned. Machine drape clamp from nurses. Mayo table positioned. Last opportunity for good access to patient to check lines and positioning.

Stealth set up and calibration if applicable 5. Scrub Trolleys into theatre Surgeons scrub Prep and drape patient Phenytoin (if requested) infusion commenced. Undiluted over 60 mins. Baseline ABG. Note ETCO2 when sampling 6. Start Surgery Nurses draping microscope Surgeon may request IV frusemide when dura exposed Major Blood loss possible particularly during tumour surgery 7. End Surgery Closing head approx 30 mins Commence sevofluorane washout Continue Remifentanil Reverse NMB Rationalise lines and monitoring. Aspirate and flush CVL lumens Head out of pins/ +/- off horseshoe Neurosurg Reg supports head Anaesthetist 1 monitor patient Anaesthetist 2 guard airway Cons surgeon substitute ends/ confirm bed stable Emerge and extubate on theatre table unless specified (Transition on basis of offset of remifentanil) Transfer to ward bed and PACU Most craniotomy patients return to ward or HDU.

This material is designed as a guide only for the anaesthetic care of patients at Waikato Hospital. It does not replace decisions tailored to individual patients by the clinicians responsible for their care.

Revised Nov 2010