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| | [[File:ERAS-LITE updated Aug 2022.docx|thumb]]''' ''' |
| |'''Weeks prior to surgery'''
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| | '''Appointment to discuss operation if applicable '''
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| o '''Book case as “ERAS-LITE” on S3'''
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| '''Pre-operative nurse appointment'''
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| '''Appointment with anesthesia if otherwise indicated'''
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| '''Lab-work and imaging'''
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| '''Smoking cessation'''
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| '''Nutrition appointment'''
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| '''Preoperative marking with wound care if applicable'''
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| '''Walking/Exercise program'''
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| |'''Days prior to surgery'''
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| | '''Stop ASA/NSAIDS five days prior to surgery (may continue aspirin if stent or severe coronary artery disease)'''
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| '''Blood thinner: Surgeons’s discretion'''
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| '''ACE and ARBs to be held the day of surgery'''
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| '''Diuretics to be held the day of surgery (unless CHF)'''
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| '''Beta-blockers should be taken day of surgery'''
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| '''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'''
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| '''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'''
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| '''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.'''
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| |'''Day of Surgery'''
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| '''Chlorhexidine shower the morning of surgery'''
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| '''Bring home medications list and CPAP'''
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| '''Bring Sugarless Chewing Gum'''
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| |'''Pre-operatively'''
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| | '''Premedications'''
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| o '''PO Celecoxib 200mg x 1'''
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| o '''PO Pregabalin 75 mg x1'''
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| o '''PO Tylenol 975mg x 1'''
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| o '''IV Versed 2mg x1 Prior to OR'''
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| '''History of PONV'''
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| o '''Consider PO Emend 40mg'''
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| o '''Consider Scopalamine Patch'''
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| '''Antibiotics: Per surgeon'''
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| '''IV in non-operative limb'''
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| o '''LR at KVO'''
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| '''Hair removal done in pre-op holding area'''
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| '''Regional Anesthesia as indicated'''
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| o '''Hold Heparin/Lovenox SQ until after neuraxial/regional'''
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| |'''Intra-operatively'''
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| | '''Positioning Devices as Indicated'''
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| '''Normothermia/Bair Hugger'''
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| '''Targeted fluid therapy'''
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| '''Induction'''
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| o '''Ketamine 0.2-0.3 mg/kg'''
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| o '''Lidocaine 1-1.5 mg/kg'''
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| o '''Propofol as indicated'''
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| o '''Sympathtic blunting agent;'''
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| ▪ '''Esmolol 0.3-0.5 mg/kg'''
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| ▪ '''Fentanyl 0.5-2 mcg/kg'''
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| o '''NMBA as indicated'''
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| o '''Dexamethasone 0.1mg/kg'''
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| ▪ '''Max dose 8 mg'''
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| '''Maintenance'''
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| o '''Volatile Anesthetics as indicated'''
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| o '''Pain Adjuncts as indicated'''
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| ▪ '''Propofol gtt'''
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| ▪ '''Lidocaine gtt'''
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| ▪ '''Magnesium bolus/gtt'''
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| ▪ '''Dexmedetomidine bolus/gtt'''
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| o '''Opioids as indicated'''
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| '''Ondansetron 4mg IV'''
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| '''Surgeon administered long acting local anesthetic wound infiltration'''
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| |'''Post-operatively/PACU'''
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| | '''PACU Medications'''
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| o '''Ketamine 20mg IV q15min PRN First line for pain if not tolerating PO'''
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| o '''Tramadol 50-100mg PO x1 PRN First line for pain if tolerating PO'''
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| o '''Ondansetron 4mg IV x1 PRN'''
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| o '''Midazolam 2mg IV x1 PRN Anxiety'''
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| o '''Hydromorphone 0.2-0.4 mg IV PRN Second line for pain'''
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| '''LR at 75 mL/hr'''
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| '''Clear liquids when awake if no aspiration risk'''
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| '''PACU X-Ray as indicated'''
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| |'''POD#0 (Inpatient)'''
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| | '''Pain Meds:'''
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| o '''PO Acetaminophen 975mg q8h timed from preop dose'''
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| o '''PO Celecoxib 200mg 12 hours following preop dose'''
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| o '''PO Tramadol 50-100 mg PO q6h prn pain'''
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| o '''PO Oxycodone 5-10mg q4h PRN Breakthrough Pain (first line)'''
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| o '''IV Hydromorphone 0.4mg x1 PRN Breakthrough Pain (second line)'''
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| '''Bowel Regimen'''
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| o '''Colace 100mg BID PRN'''
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| '''Antiemetic'''
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| o '''Ondansetron 4mg q4h PRN'''
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| '''Advance diet as tolerated'''
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| '''Ambulating 2-3 times/day outside of room'''
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| '''PT/OT consult if Required'''
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| '''Wound Care consult if required'''
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| '''Consider foley removal'''
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| |'''Ward POD#1 (Inpatient)'''
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| | '''POD 1 labs: CBC and BMP/Mag/Phos'''
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| '''Start VTE prophylaxis after first CBC'''
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| o '''Lovenox 40 mg SQ daily'''
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| o '''Heparin 5000 U TID if bleeding concerns or renal insufficiency'''
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| o '''Heparin 5000 U BID if older than 75 year of age'''
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| '''Pain Meds'''
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| o '''If needed, add PO Pregabalin 150mg qDay'''
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| o '''If needed, add oral Valium 5 mg q8h prn muscle spasm'''
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| '''Consider removal of foley if in situ'''
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| '''Continue to advance diet'''
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| '''Discontinue IVF once tolerating > 500 mL orally'''
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| '''Ambulate TID'''
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| '''ICS 10x/hr'''
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| '''Discharge Planner to See'''
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| |'''Ward POD #2 & Onward (Inpatient'''
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| | '''Out of bed 8 hours'''
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| '''Consider discharge once meets criteria'''
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| '''Discharge Medications as below:'''
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| |'''POD#0 (Outpatient)'''
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| | '''Discharge Meds'''
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| o '''Acetaminophen 975mg q8h'''
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| ▪ '''63 Tabs (7 days)'''
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| o '''Naproxen 500mg q12h'''
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| ▪ '''14 Tabs (7 days)'''
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| o '''Oxycodone 5mg q4h PRN'''
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| ▪ '''5-15 Tabs (1-2 days)'''
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| o '''Colace 100mg BID PRN'''
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| ▪ '''14 tabs (7 days)'''
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| o '''Zofran 4mg q4h PRN'''
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| ▪ '''30 tabs (5 days)'''
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| |} | |
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| ''' ''' | |