Preoperative Preparation – Anesthesia Team
Anesthesia team should review the adolescent’s medical history the day before admission, formulate a plan and order appropriate equipment using a level II form in the preoperative navigator and medications using the Anesthesia PHL General Requisitions Order Set.
Room Preparation
| Utilize the Level II Forms in Preoperative Navigator |
- LR macrodrips x 2
- Microdrip/Buretrol® as infusion carrier with 4 stopcocks at distal end of IV near the T-piece connection
hotline
- A-line set-up (single transducer)
- 2D ultrasound for arterial line and vascular access
- Vascular access tray
- Radial arterial catheter kit available
- Children and adolescents > 30 kg: 3 Fr x 5 cm
- Discuss with attending before opening the kit. Use of an angiocatheter may be preferred as the arterial line is typically removed at conclusion of the case.
- Note: large, flat arm boards available for arterial line placement (located outside OR 11 by the ice machine in the central hallway)
- 5 infusion pumps
- Point-of-care-testing
- i-Stat® and HemoCue®
- Consider sending confirmatory blood gas to laboratory for lactate level
- Prone pillow (blue pillow or headrest with mirror, per attending preference)
- Bair Hugger™ (lower body, upper body and under-table)
|
IV Bolus Medications
| Utilize the Anesthesia PHL General Requisitions Order Set |
- Acetaminophen
- Tranexamic Acid
- 30 mg/kg over 10 min, max 2,000 mg
- Methadone
- Dispensed as a 10 mg/ml syringe
|
Infusions
| Analgesic Agents |
- Propofol
- 100-250 mcg/kg/min
- See Epic dosing guide pictured below
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- Remifentanil
- 0.1-0.2 mcg/kg/min
- Determine concentration using infusion ordering guide, pictured below
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- Fentanyl
|
| Vasoactive Agents |
- Nicardipine
- Phenylephrine
- 0.1-1 mcg/kg/min, titrate to desired effect
|
| Other |
- Tranexamic acid
- 100 mg/ml infusion
- 10 mg/kg/hr
|