Pre-op Anesthesia Orders for Ambulatory Surgery Centers Pre-operative Anesthesia orders after admission to facility
IV and IV fluids: Start IV with Lactated Ringers at TKO.
Patients on Dialysis: Normal Saline @ TKO.
Monitors: Patient must be placed on blood pressure and oximetry monitors with audible alarms if pre-operative sedation is ordered.
□ Apply Scopolamine patch behind ear. Instruct patient to remove on POD 3 unless blurry vision, dry mouth or presence of other side affects unacceptable to patient. Nursing Orders
May apply warm forced air blanket or garment for pre-procedure warming unless refused by patient (per facility protocol if applicable). Notify the Anesthesiologist immediately for further orders for the following current or recent conditions:
*Cold, * Fever * Cough *Chest Pain *Palpitations *Shortness of Breath *Tachycardia/Irregular Pulse *BP greater than 180/110 *SaO2 less than 93% (inpatients will be checked in holding room) *NPO less than (8) eight hours for solids and/or less than (2) two hours for clear liquids
Verify Beta Blocker status and document date and time of last dosage:
AM Admits: If patient on beta blocker but did not take the last scheduled dose; call the Anesthesiologist for beta blocker order
Hold all diuretics on the morning of surgery.
Medication Screen – Label front of chart if patient is taking the following: (Does not imply that case should be cancelled if still taking one of these medications).
Any metformin or metformin-containing medication
Warfarin (Coumadin), clopidogrel (Plavix), ticlopidine (Ticlid), fondaparinux (Arixtra) or any LMWH such as enoxaparin (Lovenox), daltaparin (Fragmin), etc.
Any MAO Inhibitors such as phenelzine (Nardil), isocarboxazid (Marplan), trancypromine (Parnate) or Selegiline patch (Emsam)
Herbal products, Phentermine (Qsymia, Pro-fast, Lonamin, Adipex-P) taken in the past 7 days.
Pre-Op Lab and Testing Orders:
1) Patients undergoing cataract surgery: exception: o
Diabetes Mellitus patients: glucose on DOS (may use Accu-check) 2) Patients undergoing minor procedures under MAC (ONLY) anesthesia: exception: o
Diabetes Mellitus patients: glucose on DOS (may use Accu-check) Indicated pregnancy test as outlined below 3) Fasting Glucose on DOS:
may be obtained via serum if patient is having other labs drawn or finger-stick
should be current within 30 days for patients on stable doses of digoxin, diuretics, potassium supplementation
obtain on DOS
for patients whose doses of digoxin, diuretics, or potassium supplementation has been altered in the past 30 days
for patient’s who have received a bowel prep for procedure
5) Basic Metabolic Panel (Na, K+, Cl, BUN, Cr)
obtain if there is a specific clinical concern per M.D.
if there is a possibility that the procedure will result in significant blood loss
if there is a specific reason to suspect a clinically significant acute anemia (any recent clinical conditions which have resulted in blood loss (dysfunctional uterine bleeding, spontaneous abortion, GI bleeding, etc…)
8) Heme 2 (Hgb, Hct, WBC, Plts)
patients who have had recent chemotherapy/are on chemotherapy
patients with a specific clinical reason to suspect thrombocytopenia
9) Pro-time/INR – DOS
obtain on all patients on Coumadin (including all patient’s who have discontinued therapy within the past 2 weeks) unless the preoperative INR obtained after the patient’s most recent dosing change has been documented to be less than or equal to 1.2.
patient with a history of liver failure, current within 30 days
10)Urine pregnancy (via lab or Point of Care urine pregnancy) on DOS. All menstruating females with a uterus under the age of 60.
11) 12 lead EKG (must provide actual EKG, not just report)
should be current within 6 months for asymptomatic patients with any of the following conditions:
heart disease including coronary ischemia, valvular heart disease, heart failure, arrhythmias
BMI>35 + any ONE of the following: smoking, DM, HTN, hyperlipidemia
OR per M.D. order For patient receiving regional anesthesia (blocks):
Have 1 - 2 mg midazolam (Versed) and 50 – 100 mcg fentanyl available for anesthesia team (to be administered under the direction of the anesthesiologist).
Continuous O2 per nasal prongs. Start at 2 L and titrate to keep SpO2 greater than 92%.
Continuous pulse oximetry and EKG and BP with audible alarms. Monitor alarms must remain audible to nursing staff at all times. Vital Signs must be documented every 5 minutes during the block procedure and for the first 15 minutes following the block.
A qualified individual must directly observe and monitor the patient for the first 15 minutes following the procedure. If the patient is stable after the first 15 minutes, the direct observation period may be discontinued at the RN’s discretion.
A RN must be available to immediately assess the patient and initiate emergency procedures if indicated.
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