Limit or eliminate opioid administration

Antibiotic prophylaxis

TIME OUT for TAP block procedure:

• • OPEN CASES ONLY: 4 Quadrant TAP Blocks: 0.25% Bupiv cc̅1:400,000 Epi (If case converts in OR from Laparoscopic to Open, notify anesthesiologist so as to complete at end of case)

  • 15 mL each quadrant

  • Placed under ultrasound guidance in OR after induction

  • Parallel process: allow circulating RN to perform foley placement during TAP block

Decadron 10 mg IV – PONV prophylaxis

Ketamine 0.5mg/kg IV

Goal Directed Fluid Therapy (GDFT) per protocol

• • Document SV, SVV, CI PRIOR to incision and then per protocol

Forced air warming after draping

Goal Directed Fluid Therapy (GDFT) per protocol if case posted for > 2 hours in duration

• • Document SV, SVV, CI PRIOR to incision and then per protocol

DO NOT USE CHEETAH (GDT) IF CASE IS POSTED FOR ≤ 2 HOUR IN DURATAION

• • Minimally Invasive: If no GDT, LR infusion (ON PUMP) at 3 mL/kg/hr, max rate of 240 mL/hr

  • Open Case: If no GDT, LR infusion (ON PUMP) at 5 mL/kg/hr, max rate of 300 mL/hr

  • Bolus as needed, being mindful of zero balance goal

Avoid/limit introp opioids (consideration for TAP blocks)

• • Max of 100 mcg Fentanyl (discussion with anesthesiologist if further dosing needed)

Maintain normothermia (Temp >36 °C)

Esmolol 0.5 mg/kg IV bolus for tachycardia/hypertension

Ketorolac 15 mg IV AT END OF CASE – DISCUSS WITH SURGEON

Blood glucose monitoring

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

    • • Check FSBG Q1hr

  • For all 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 tubes, drains, lines

AT END OF CASE: Ondansetron 4mg IV at emergence – PONV prophylaxis

Confirm ALL fluids both input and output are documented

Identify patient as ERAS

Ensure to relay ALL medications given to PACU RN as to safeguard against double dosing