Anesthesia/Sedation Preoperative Care and Preparation Clinical Pathway, Inpatient and Emergency Department

Scheduled Medications Prior to Anesthesia

Prescribed/ordered medications are recommended to be taken as directed, except for the medications listed below.
- The chart below is not an exhaustive list of all possible medications.
- Contact front line provider if an ordered medication is not referenced in the table.
Administer essential scheduled medications prior to transport or send medication with child to procedure area.
Do not convert scheduled enteral medications to IV formulation when NPO.
Contact Anesthesia Provider on call for remaining questions.

Preoperative Considerations for Scheduled Medications

Scheduled Medications Prior to Procedure	Perioperative Considerations
Enteral Medication Plus Flush Volume Thresholds Discuss with front-line provider	< 1 yr: > 10 mL ≥ 1 yr: > 50 mL
Medication in Sprinkle Form	Mix with water ice or Jell-O No applesauce or pudding
Transdermal Patch Scopolamine Birth control Clonidine Fentanyl	Leave in place Note: review MRI compatibility
Stress Steroids	Pathway for the Child at Risk for HPA Suppression Stress Steroid Dosing and Weaning Recommendations
Subacute Bacterial Endocarditis (SBE)	SBE Prophylaxis

Medications to Consider Holding Prior to Procedures

Review: Perioperative Medication Management for Inpatients and Outpatients Job Aid for complete list.

Category	Medications to Consider Holding	Considerations
Cardiology	ACE inhibitors Captopril Enalapril Lisinopril Angiotensin receptor blockers Losartan Valsartan
Anticoagulants	Coumadin Aspirin Enoxaparin Heparin	Review anticoagulation plan determined by Hematology and surgical provider
Endocrine	Oral type 2 diabetes medications Metformin GLP-1agonists	Whenever possible, oral diabetes medications should be transitioned to shorter-acting insulin coverage plans in consultation with Endocrinology American Society of Anesthesiologists Consensus GLP-1 Receptor Agonists
GI	Stool softeners Laxatives Polyethylene glycol Calcium salts
Metabolism	Amino acids Antioxidants Carnitine	Discuss with metabolism
Pulmonary	Montelukast Zafirlukast
NSAIDS	Aspirin Ibuprofen	Discuss with front line provider and surgeon/proceduralist
Nephrology and Hematology	Erythropoietin Calcium acetate Calcium carbonate Calcitriol, paricalcitol Growth hormone
Nutrition	Vitamins and mineral supplements Herbal and dietary supplements Melatonin Fish oil St. John’s Wort
Topical	Rubs and gels	Hold after pre-op bath

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Anesthesia/Sedation Preoperative Care and Preparation Clinical Pathway, Inpatient and Emergency Department

Scheduled Medications Prior to Anesthesia

Preoperative Considerations for Scheduled Medications

Medications to Consider Holding Prior to Procedures

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Anesthesia/Sedation Preoperative Care and Preparation Clinical Pathway, Inpatient and Emergency Department – Scheduled Medications Prior to Anesthesia

Anesthesia/Sedation Preoperative Care and Preparation Clinical Pathway, Inpatient and Emergency Department

Scheduled Medications Prior to Anesthesia

Preoperative Considerations for Scheduled Medications

Medications to Consider Holding Prior to Procedures