PRE-OP

• Identify patient as ERAS

• Clearfast ***DOCUMENT IN DIMENSIONS***

  • • CONFIRM patient drank 3 hrs before scheduled surgery time

• PONV screening ***DOCUMENT PONV SCORE IN DIMENSIONS***

  • • Ordered by anesthesia if needed/high risk

    • Scopolamine patch (high risk only)

      • • Hold for >65 years of age

        • Hold for h/o acute angle glaucoma

• Multimodal analgesia-ordered by surgeon

  • • Gabapentin 600 mg PO x1

      • • HOLD Gabapentin for >65 years of age: exception if already taking as home med

        • If on Gabapentin at home, patient to receive usual dose of Pregabalin or Gabapentin x1 dose

    • Celecoxib 400 mg PO

      • • Avoid if CrCl <30ml/min; adjust dose if moderate renal dysfunction is present.

        • Do not use if significant risk for MI or stroke – unstable angina or tenuous coronary stents

        • Avoid if active or recent PUD; not possible cross reaction with sulfa allergic pts

***If any of the above medications are not ordered, or not ordered correctly, contact surgeon ASAP for correction (contact anesthesia if surgeon not available)***

• VTE/DVT prophylaxis

  • • Heparin 5000 units SC (if epidural, 2 hrs after epidural placement)

• IV insertion, but no fluids administered

• SCD

  • • Usage while in bed or chair until discharge

• No preop sedation

• Epidural placement

  • • For open procedures

    • Thoracic epidural – targeted level: T9

    • Standard ERAS infusion of 0.0625% bupivacaine

    • Infusion at 6 - 10 ml/hr

• Hand Off

  • • Confirm with CRNA ALL medications given in pre-op for safety precautions and to ensure no double dosing occurs