Anesthesia

These cases are done under moderate sedation in the OR. As soon as anesthesia has the patient sedated, they are ready to position. 

Positioning

Keep patient on stretcher, no need to transfer them to the OR table.

Lateral with right side up. Be sure to put a pillow between the knees and flex the knees up to the chest. 

Placing the Catheter

This is done like a lumbar drain. Use the Tuohy needle to access the intrathecal space. Make sure the bevel of the needle is turned up, to the ceiling, when you are accessing the intrathecal space. Once the needle is intrathecal and you have verified flow of CSF, turn the bevel up so that it is facing towards the patient's head. 

Pass the catheter until the 4th mark is below the skin edge. Remove the Tuohy needle. Verify flow of CSF from the catheter. 

Attach the blue-and-yellow Luer lock attachment to the catheter. Make sure the catheter is all the way in place, then push the yellow sleeve towards the catheter until it clicks and locks the catheter in place. 

Securing the Catheter

Remove the backing on the white sponge to expose the sticky underside, then place on the skin just lateral to the catheter exit site. Push the catheter into the groove in the white sponge. Make the surrounding skin sticky with Mastisol, then loop the catheter and stick it to the skin before taking it out laterally to the patient's side. 

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Use big Tegaderms to secure the catheter to the patient's back along its length (exit site, loop, and lateral trail). 

Postop Orders

• Admit to Dr. Moossy's service, monitored floor bed.
• Reduce home opiate dosage by 50%
• IT opiate should be either morphine or Dilaudid. If patient is on home morphine use the same intrathecally. 
• Place the intrathecal analgesia order "Intrathecal Analgesia Pre-Implantation Trial PowerPlan"
  • Leave all pre-checked boxes checked, then check either morphine or Dilaudid    
  • You will be asked for a intrathecal opiate flow rate in mL/hr    
  • Calculate the daily mg dose of intrathecal opiate. This should be 1/30th of the daily dose of PO morphine or 1/10th of PO Dilaudid
  • The concentration of pump morphine is 0.1 mg/mL. The concentration of pump Dilaudid is 0.01 mg/mL
  • Last, calculate the mL hourly dose of intrathecal opiate.