Sremick: Replaced content with "thumb''' '''"

2023-01-23T19:58:05Z

Replaced content with "thumb''' '''"

Sremick at 13:31, 1 September 2022

2022-09-01T13:31:03Z

← Older revision		Revision as of 06:31, 1 September 2022
Line 1:		Line 1:
			[[File:ERAS-LITE updated Aug 2022.docx\|thumb]]
	{\| class="wikitable"		{\| class="wikitable"
	\|'''Weeks prior to surgery'''		\|'''Weeks prior to surgery'''

Sremick: created page

2022-09-01T13:27:57Z

created page

New page

{| class="wikitable"
|'''Weeks prior to surgery'''
|    '''Appointment to discuss operation if applicable '''

o '''Book case as “ERAS-LITE” on S3'''

   '''Pre-operative nurse appointment'''

   '''Appointment with anesthesia if otherwise indicated'''

   '''Lab-work and imaging'''

   '''Smoking cessation'''

   '''Nutrition appointment'''

   '''Preoperative marking with wound care if applicable'''

   '''Walking/Exercise program'''
|-
|'''Days prior to surgery'''
|    '''Stop ASA/NSAIDS five days prior to surgery (may continue aspirin if stent or severe coronary artery disease)'''

   '''Blood thinner: Surgeons’s discretion'''

   '''ACE and ARBs to be held the day of surgery'''

   '''Diuretics to be held the day of surgery (unless CHF)'''

   '''Beta-blockers should be taken day of surgery'''

   '''For patients without type 2 dependent diabetes: ENSURE pre-surgery drink: 2 bottles the night before surgery and 1 bottle at 0400 the day of surgery'''

   '''For patients with type 2 diabetes not requiring insulin: Ensure pre-surgery drink: 2 bottles the night before surgery and 1 bottle at 0400 the day of surgery. Check blood sugar on day of surgery and use sliding scale insulin as needed to adjust glycemic levels preoperatively'''

   '''For patients with type 2 diabetes requiring insulin: No ensure presurgery drinks. Drink 16-20 ounces of water or other sugar free/calorie free liquid the night before surgery and 8-10 ounces of water or other sugar free/calorie free liquid 4 hours before scheduled surgery start.'''

|-
|'''Day of Surgery'''
|

   '''Chlorhexidine shower the morning of surgery'''

   '''Bring home medications list and CPAP'''

   '''Bring Sugarless Chewing Gum'''
|-
|'''Pre-operatively'''
|    '''Premedications'''

o '''PO Celecoxib 200mg x 1'''

o '''PO Pregabalin 75 mg x1'''

o '''PO Tylenol 975mg x 1'''

o '''IV Versed 2mg x1 Prior to OR'''

   '''History of PONV'''

o '''Consider PO Emend 40mg'''

o '''Consider Scopalamine Patch'''

   '''Antibiotics: Per surgeon'''

   '''IV in non-operative limb'''

o '''LR at KVO'''

   '''Hair removal done in pre-op holding area'''

   '''Regional Anesthesia as indicated'''

o '''Hold Heparin/Lovenox SQ until after neuraxial/regional'''
|-
|'''Intra-operatively'''

|    '''Positioning Devices as Indicated'''

   '''Normothermia/Bair Hugger'''

   '''Targeted fluid therapy'''

   '''Induction'''

o '''Ketamine 0.2-0.3 mg/kg'''

o '''Lidocaine 1-1.5 mg/kg'''

o '''Propofol as indicated'''

o '''Sympathtic blunting agent;'''

▪ '''Esmolol 0.3-0.5 mg/kg'''

▪ '''Fentanyl 0.5-2 mcg/kg'''

o '''NMBA as indicated'''

o '''Dexamethasone 0.1mg/kg'''

▪ '''Max dose 8 mg'''

   '''Maintenance'''

o '''Volatile Anesthetics as indicated'''

o '''Pain Adjuncts as indicated'''

▪ '''Propofol gtt'''

▪ '''Lidocaine gtt'''

▪ '''Magnesium bolus/gtt'''

▪ '''Dexmedetomidine bolus/gtt'''

o '''Opioids as indicated'''

   '''Ondansetron 4mg IV'''

   '''Surgeon administered long acting local anesthetic wound infiltration'''
|-
|'''Post-operatively/PACU'''
|    '''PACU Medications'''

o '''Ketamine 20mg IV q15min PRN First line for pain if not tolerating PO'''

o '''Tramadol 50-100mg PO x1 PRN First line for pain if tolerating PO'''

o '''Ondansetron 4mg IV x1 PRN'''

o '''Midazolam 2mg IV x1 PRN Anxiety'''

o '''Hydromorphone 0.2-0.4 mg IV PRN Second line for pain'''

   '''LR at 75 mL/hr'''

   '''Clear liquids when awake if no aspiration risk'''

   '''PACU X-Ray as indicated'''
|-
|'''POD#0 (Inpatient)'''
|    '''Pain Meds:'''

o '''PO Acetaminophen 975mg q8h timed from preop dose'''

o '''PO Celecoxib 200mg 12 hours following preop dose'''

o '''PO Tramadol 50-100 mg PO q6h prn pain'''

o '''PO Oxycodone 5-10mg q4h PRN Breakthrough Pain (first line)'''

o '''IV Hydromorphone 0.4mg x1 PRN Breakthrough Pain (second line)'''

   '''Bowel Regimen'''

o '''Colace 100mg BID PRN'''

   '''Antiemetic'''

o '''Ondansetron 4mg q4h PRN'''

   '''Advance diet as tolerated'''

   '''Ambulating 2-3 times/day outside of room'''

   '''PT/OT consult if Required'''

   '''Wound Care consult if required'''

   '''Consider foley removal'''

|-
|'''Ward POD#1 (Inpatient)'''
|    '''POD 1 labs: CBC and BMP/Mag/Phos'''

   '''Start VTE prophylaxis after first CBC'''

o '''Lovenox 40 mg SQ daily'''

o '''Heparin 5000 U TID if bleeding concerns or renal insufficiency'''

o '''Heparin 5000 U BID if older than 75 year of age'''

   '''Pain Meds'''

o '''If needed, add PO Pregabalin 150mg qDay'''

o '''If needed, add oral Valium 5 mg q8h prn muscle spasm'''

   '''Consider removal of foley if in situ'''

   '''Continue to advance diet'''

   '''Discontinue IVF once tolerating > 500 mL orally'''

   '''Ambulate TID'''

   '''ICS 10x/hr'''

   '''Discharge Planner to See'''
|-
|'''Ward POD #2 & Onward (Inpatient'''
|    '''Out of bed 8 hours'''

   '''Consider discharge once meets criteria'''

   '''Discharge Medications as below:'''
|-
|'''POD#0 (Outpatient)'''
|    '''Discharge Meds'''

o '''Acetaminophen 975mg q8h'''

▪ '''63 Tabs (7 days)'''

o '''Naproxen 500mg q12h'''

▪ '''14 Tabs (7 days)'''

o '''Oxycodone 5mg q4h PRN'''

▪ '''5-15 Tabs (1-2 days)'''

o '''Colace 100mg BID PRN'''

▪ '''14 tabs (7 days)'''

o '''Zofran 4mg q4h PRN'''

▪ '''30 tabs (5 days)'''

|}

''' '''

ERAS Lite - Revision history

Sremick: Replaced content with "thumb''' '''"

Sremick at 13:31, 1 September 2022

Sremick: created page