Revised (aapa) anesthesia pre-op lab orders

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:
Diabetes Mellitus patients: glucose on DOS (may use Accu-check)

2) Patients undergoing minor procedures under MAC (ONLY) anesthesia:

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
4) Potassium:
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. 6) Hemoglobin
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
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. ____________________________________ _____________________________________



aDivision of Toxicology, Albert Einstein Medical Center, 5501 Old York Road,bThomas Jefferson University Hospital, Philadelphia, PA 19141, USAcChildren’s Hospital of Philadelphia, Philadelphia, PA 19141, USAdPhiladelphia Poison Control Center, Philadelphia, PA 19141, USAThe term salicylate refers to any of a group of chemicals that are derivedfrom salicylic acid. The best known is acet

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