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Fast Track Anesthesie Protocol Algemeen
 

Fast Track Anesthesie Protocol Algemeen

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    Fast Track Anesthesie Protocol Algemeen Fast Track Anesthesie Protocol Algemeen Document Transcript

    • FAST-TRACK (OPEN & SCOPIC) Preop-assessment Fast-track talk, discussing epidural anaesthesia Pre-operative fasting Last meal: 6 h before operation Last clear drink: 2 h before operation and 2 units nutridrink Pre-op® Pre-medication Evening before the operation: lorazepam 1 mg The day of operation: no premedication Thrombo-embolic Pre-op: Fraxiparine® 2850 E s.c.; prophylaxis 20.00 h Post-op: Fraxiparine® 2850 E s.c.; 20.00 h Anesthesia protocol Epidural anesthesia T 9-10 ± 1 - Test dose: 3 ml bupivacaine 0.25% - Top-up: bupivacaine 0.25 or 0.5% with sufentanil /fentanyl - No pre-surgical block testing - Insufficient pain relief at PACU: block testing by using 10 ml lidocaine 2% and performing pin- prick and temperature testing, in case of failure new attempt. Epidural in combination with general
    • anesthesia using propofol or volatile anesthetics; fentanyl or sufentanil;a muscle relaxant and if necessary antagonized at the end of the procedure (TOF-guided!) Nasogastric tube To be removed before extubation Urinary drainage Supra-pubic catheter Intra-operative Infusion of warmed fluids and use of temperature upper-body forced-air heating cover management Intra-operative fluid 1.Maintenance with Ringer’s lactate a. 1e hr.: 20 ml/kg BW management b. 2e etc. hrs: 6 ml/kg BW 2.Blood-loss management: a. Starting 500 ml Voluven® b. Blood loss ≥ 500 ml: 2e 500 ml Voluven® c. Blood loss ≥ 1.000 ml: 3e 500 ml Voluven® d. Blood loss ≥ 1.500 ml: than PC guided by Hb; i. Patient < 70 yrs: Trigger Hb = 5.0 mmol/l ii. Patient ≥ 70 yrs: Trigger Hb = 5.5 mmol/l e. when the first Voluven® was given ≥ 6 h. before, a 4th Voluven® can be given, otherwise per 2 E PC’s, 1 E ESDEP will be infused.
    • No extra fluid loading Vasopressors should be considered for the intra-operative management of epidural- related hypotension -metaraminol -phenylephrine -norepineprine PONV-prophylaxis - Odansetron 4 mg (first choice) - Kytril 1mg (second choice) - Droperidol 0.625 mg - Haloperidol 1 mg Post-operative analgesia Epidural analgesia: PCEA bupivacaine 0.1% + fentanyl 2.0 mcg/ml + background infusion or continuous infusion bupivacaine 0.125% + sufentanil 1 mcg/ml for 48 hrs. Remove on day POD 2 In combination with Paracetamol 4 x 1 g Add NSAID after removal of epidural catheter Post-operative fluids Day 0: first oral drinks; 2 h post- surgery, infusion of RL 1.5 l/24 h Day 1: infusion will be stopped, iv. canula will be left behind. Oral intake 2 litres Day 2: iv. canulla will be removed at the time epidural catheter will be removed.
    • Post-operative nutrition Day 2: normal diet Bodyweight Patients must be weighted on a daily basis