Post on 20-Jan-2020
transcript
Perioperative Care Pathway designed to achieve early recovery
• Reexamined traditional surgical/anesthesia practices and replaced them with evidence-based best practices
• Comprehensive and Multidisciplinary Approach to Perioperative Care
• Reduce patient’s stress response, optimize physiologic function, and facilitate recovery
Perioperative Techniques proven to Decrease Length of Stay (30%) Decrease Perioperative Complications (50%) Decrease Nausea/Vomiting Decrease Postoperative Pain Decrease Time to Return to Baseline Function Improve Patient Satisfaction
Varandhan, KK et al. The enhanced recover after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized trials. Clin. Nutr 2010.
International Journal of Surgical Research2014; 3(1): 1-6 doi:10.5923/j.surgery.20140301.01 Cytokines and Postoperative Hyperglycaemia: From Claude Bernard to Enhanced Recovery after Surgery
Enhanced recovery protocol after radical cystectomy for bladder cancer. Daneshmand S, Ahmadi H, Schuckman AK, Mitra AP, Cai J, Miranda G, Djaladat H. J Urol. 2014 Jul;192(1):50-5. doi: 10.1016/j.juro.2014.01.097. Epub 2014 Feb 8. PMID: 24518775
Preoperative
o Alvimopan (Urology) o Gabapentin 600mg PO (Urology) o Acetaminophen 1000mg PO (Urology) o Heparin 5,000 sq (Urology)- given prior to induction o 12 oz of Gatorade up to 2 hours prior to induction.
(PAT/Urology)
o Avoid Midazolam
o use fentanyl, if needed, for epidural placement
Intraoperative
o Ropiv 0.2% @ 3-5cc/hr via epidural o Vigileo for Goal Directed Fluid Therapy o 5% Albumin for Fluid Bolus o Maintain normothermia
o No NGT (OG Tube, intraop only)
o Maintenance 1-3cc/kg/hr Crystalloid
Postoperative
o Ropiv 0.1% or Ropiv/Sufenta via epidural x 72hrs o Maintenance fluids per Urology
Set up Vigileo
With patient on controlled ventilation, record SVV/ SV(Afib)
Start Plasmalyte at 1-3cc/kg/hr (max 400cc/hr)
Is SVV >13 or
SV increased by >10% with fluid
bolus??
Monitor SVV or SV
Give colloid (5%Albumin) bolus
of 250cc
YES
Is Pt hypotensive?
Consider starting vasopressor
NOO
NOO YES
Advanced Hemodynamic Monitoring: The Flotrac Sensor. Retrieved from https://www.edwards.com/eu/products/mininvasive/Pages/strokevolumevariationwp.aspx