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

Preoperative Preparation – Anesthesia Providers

Review child’s medical history day before admission
Order appropriate equipment using a level II form in preoperative navigator
Order medications using Anesthesia PHL General Requisition Order Set
See CHOP Formulary for dosing based on age and weight

Room Preparation	Utilize Preoperative Navigator Level II Forms Infant setup when applicable 2 age-appropriate LR IV bags available Microdrip/buretrol as infusion carrier with 4 stopcocks at distal end of IV near the T-piece connection 2-D ultrasound (Sonosite) for arterial line and vascular access 2 infusion pumps Point-of-care-testing Glucometer for children less than 1 mo Prone pillow for larger children (blue pillow or headrest with mirror, per attending preference) Bair Hugger (under body, lower body, and upper body depending on child size)
IV Bolus Medications	Utilize Anesthesia PHL General Requisitions Order Set Acetaminophen: 10-15 mg/kg/dose depending on age and weight (max dose 1,000 mg)
Infusions	Hypnotic/Analgesic Agents Propofol: 100-250 mcg/kg/min See Epic propofol dosing guide pictured below © 2024 Epic Systems Corporation Remifentanil: 0.1-0.2 mcg/kg/min Determine concentration using infusion ordering guide pictured below © 2024 Epic Systems Corporation Vasoactive Agents: Not typically needed

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

Preoperative Preparation – Anesthesia Providers

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Tethered Cord Evaluation and Perioperative Management — Preoperative Preparation – Anesthesia Providers — Clinical Pathway: Inpatient and Primary Care

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

Preoperative Preparation – Anesthesia Providers