Setting the stage for optimal management...

General Surgery

Laparotomy (Small Bowel Obstruction)

Est. Duration: 2 - 3 hours

Summary

Last Updated: April 2025

General Anaesthesia

Airway:

Technique:

IV Induction RSI TIVA

Block:

Procedure:

Arterial Line Central Venous Catheter Line Epidural NG Tube Spinal

Last Updated: April 2025

Pre-Op

Calculate NELA Score +/- ACS NSQIP Risk
Confirm clotting + valid G&S
Consider pre-oxygenation strategy (e.g. anticipated difficult airway / high BMI)

Block

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Neuraxial Block
CSE
heavy marcain + morphine

Spinal: 0.5% bupivacaine + 8% glucose ( 2.2ml ) + morphine ( 0.2mg )
Check for contraindications of neuraxial block

Induction

Pre-Induction

Procedure Arterial Line
Procedure Ryles Tube + Suction
Consider cricoid pressure

Drugs (RSI)

fentanyl ( 150mcg )
propofol ( 2.5mg/kg )
rocuronium ( 1.2mg/kg )
metaraminol ( As required )

Other

Airway
ETT

Post-Induction

Procedure Central Venous Catheter Line

Intra-op

Maintenance

propofol ( TCI )
remifentanil ( TCI )

Infusions

metaraminol ( 0.5mg/ml )

Analgesia

morphine ( 0.1mg/kg )
magnesium sulphate ( 5g )
clonidine ( 15mcg/ml )
ketamine ( 10mg/ml )
paracetamol ( 1g )
diclofenac ( 75mg )
Local anaesthetic infiltration by surgical team

Anti-emetics

ondansetron ( 4mg )
dexamethasone ( 6.6mg )

Other

Antibiotics as required

Post-op

Analgesia (if NBM)

morphine ( PCA )
Paracetamol ( 1g )
Local anaesthetic infusion via epidural / rectus sheath catheters

Anti-emetics

ondansetron ( 4mg )
cyclizine ( 50mg )