Prior to Incision

  • 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

  • Decadron 10 mg (slow IV push)

  • Ketamine 0.2 – 0.5 mg / kg

  • Haldol 2 mg IV

  • Forced Air warming after draping

  • SCD placement