Alexandre Rasouli, MD 

PA Olivia Greenwald (818) 264-6800

(Spine)

  • Patients are called the night before.  Chart reviewed. Additional orders if needed preoperatively.(Gabapentin/Tylenol/Emend). ERAS spine protocol (review NPO/ Medication guidelines ). Important to identify chronic pain patients. 

  • Preoperative evaluation via primary MD 

  • Two rooms with 6am start for 1st room(4-5 cases split between 2 rooms) 

  • Entry for 2nd room at designated time. PA closes and Dr Rasouli will be available to start surgery. If more time is needed for preparedness, bring patient in earlier in an effort to expedite case starting. Positioning via Rasouli or PA. Communicate with other room to guide in starting your case in case of any changes in timing. 

  • Apply Spine ERAS protocol for cases which fit criteria (cervical, lumbar, sacral fusion surgeries with a posterior component)

  • Motor evoked potentials (MEPs) —NO Paralytics after intubation (SUX administered unless there is a contraindication) 

  • For XLIFS, allow paralytic to wear off after induction.  No paralysis for lateral portion (Use TIVA), then full paralysis for posterior portion of surgery.

  • Foley Catheter cases >3 hours. Bladder scan patients and follow current guidelines for catherization guidelines if no foley in place. 

 

OR Preferences: 

  1. Reduce alarm volumes to lowest setting which will alert you. Avoid allowing alarms to continue without silencing or correcting problem.

  2. No talking unless directed conversation regarding patient. If you are AIC you must schedule for someone else to cover.

  3. No Music

  4. No Lateness

  5. SBP below 100 at incision to decrease bleeding. Elevate SBP when spinal cord is being manipulated.

  6. No movement during the case (referring to anesthesiologist manipulation of patient) 

  • Rapid turn over: Limit time from procedure end to PACU admission within 10 minutes of procedure end. Evaluate next patient upon leaving PACU. 

  • PACU sign out: Relay any concerns. Contact hospitalist regarding any concerns.  Include pain management consultation (call Dr Ghandehari personally).

  • Follow POUR protocol for Outpatients.

  • Please relay any information that you feel will be pertinent to expediting throughput.

  • TAP blocks with Exparel per surgeon request.  Typically for ALIFs and XLIFs you will be asked.