Tethered Cord Evaluation and Perioperative Management Clinical Pathway — Inpatient and Primary Care

Preoperative Anesthesia Evaluation (PAE): Anesthesia Resource Center (ARC)

ARC completes preoperative assessment within 14 days of surgery date.

Determine if face-to-face visit is necessary:

  • If complex and no prior anesthesia at CHOP, prefer face-to-face.
  • If already previously received anesthesia, it may be appropriate for NPV (non-pre-visit) call.
Components of ARC Preoperative Visit for All Children
  • Standard pre-anesthesia evaluation (PAE) with focus on:
    • Review of all letters from consulting services no later than 48 hrs in advance
    • Ensure plan in chart if needed for specialty (e.g., Endocrine, etc.)
    • Review medications:
      • Confirm plan for anti-coagulation therapy with surgeon and prescribing physician
    • History of difficult IV access
    • For all children, ARC evaluates:
      • Need for cardiac anesthesia
      • If general anesthesia, Special Cardiac Care Team vs. General Anesthesia Team
      • A surgery date should not be scheduled until a review is complete
      • If very complex will determine if child requires pre-assigned anesthesia provider
    • Any inpatient who is scheduled for surgery: Inpatient Anesthesia Consult needed
  • ARC will order labs based on Neurosurgery booking plan in pre-surgical visit
  • Neurosurgical NP will place MRI order
  • ARC NP coordinates scheduling lab work with family
  • Standard labs:
    • Simple: CBC
    • Complex: CBC without differential, Type & Screen ≤ 6 mos of age within 72 hrs before surgery
Vascular Access
  • Utilize Vascular Access Assessment tool, use dropdown menu in ARC Evaluation
  • Discuss any questions about vascular access with the PICU Team
  • PICU post-op disposition:
    • Place 2 PIV’s
    • Arterial line per anesthesia recommendation