Difference between revisions of "ERAS Lite"
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Revision as of 06:27, 1 September 2022
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) |