All ACBs are to be done in Pre-Op. Circulating RN will give you a 10cc syringe of Exparel. It is your decision how much Bupivacaine to mix with for your ACB.
Block cart & U/S are available in Pre-Op, as well as the Pre-Op RN to assist.
For EPIC, please log in to EPIC in Pre-Op computer, attach patient to monitors, and click event "Anesthesia Start" prior to starting block. At the end of your block, please click event "Anesthesia Pause" so that EPIC stops pulling from the Pre-Op monitors when you transfer to the OR. In the OR, click event "Start Data Recording" to start pulling vitals from OR anesthesia monitors.
General Anesthesia
Relaxation usually necessary
No protocol yet on what meds to use for general
Spinal Anesthesia
No Duramorph
Minimal amount of spinal buipivicaine to prevent POUR and prolonged PACU stay
Positioning
Nurse will put boots on patient
Arm on side of surgery to be padded and taped across chest for MAKO knees
Pre-Incision Timeout
Patient is under : GA vs. SPINAL
Allergies
Antibiotics given
Decadron & Zofran?
Contraindications to Tranexamic Acid? If so, suggest topical acid if ok
Starting Hb - if below 13 then suggest additional dose of IV acid
Creatinine & GFR : if abnormally elevated, suggest no Toradol
Special issues for the patient on the Line-up list
IN Dexmedetomidine
0.7 mcg/kg of IN dexmedetomidine with a minimum dose of 50 mcg per patient. e.g. in a 60 kg person, the calculation comes out to be 42 mcg. Please use 50 mcg.
For patients under general anesthesia please give the dose after induction. For patients under spinal anesthesia please give the dose at the end of the case.
Foley Catheter/Bladder Scan
Unless patient requests urinary catheter or it is agreed upon pre-operatively, NO FOLEY catheter at start of anesthesia. Bladder scan will be performed and if scan shows bladder volume of 300mL or greater, straight cath or indwelling foley (anesthesiologist's decision) to be placed.
