Antibiotic Prophylaxis

Fentanyl

• • Max dose: 100 mcg

VTE Prophylaxis

• • considerations with epidurals – Heparin 5000 U SC after epi-dural

Reverse Trendelenburg intubation, if realistic

Peep

• • High of 6-8, if realistic

Permissive hypercapnia, if realistic

TAP blocks

• • Bilateral subcostal; 0.25% Bupiv c Epi – 20 ml each side

  • Placed under ultrasound guidance, after induction, prior to incision

LR

• • Infuse 1L during case

If case length is extended or hypotension

• • Bolus with 12.5% albumin

Maintain Normothermia (Temp > 36)

Humified, warm CO2

• • For insufflation (Air Seal), if available

Minimize insufflation

• • pressure to 15mmHg if possible

Intraop Opioids

• • Avoid / limit (consideration for epidurals, TAP blocks)

Blood Glucose Monitoring

• • For all diabetic patients, continue PAA Glycemic control order set

    • • Check FSBG Q1hr

  • For non-diabetic patients, check FSBG within 60 min after induction

    • • Goal blood glucose between 100-180 mg/dl

      • Check FSBG Q2hr

      • If FSBG >180, initiate PAA Glycemic control order set

Minimize gas insufflation

• • For leak test with endoscope (or consider CO2)

  • Or mini-mize liquid insufflation for leak test with saline

Ketorolac 15 mg IV

• • Hold for renal dysfunction or significant intraop bleeding

PONV prophylaxis

• • Ondansetron 4mg IV at emergence

Local injection

• • By surgeon: .25% Bupivacaine 20mL

Complete lung expansion

• • Prior to extubation to remove intraabdominal gas

Reverse Trendelenberg extubation

Minimize tubes, lines, drains

• • Foley for gastric bypass – out at end

Ensure ALL fluids given intraop are documented