- This is a DRAFT Document, dated Nov 11, 2013 by Maine Medical Partners Surgery, and distributed January 2014
- PreOp Assessment
- Admission Day of Surgery
- Anesthesia and IntraOperative Course
- PACU and Post-Op Management
draft 11.11.13 WHIPPLE
1. Patient will go to MMC designated pre-op facility to meet with anesthesia with attention to the following:
a. review of consultant records and preop eval (e.g. cardiology, pulmonary,etc...)
b. discussion about baseline pain control needs and expected plan for postop pain control
c. preop labs to include NEW type and screen and coagulation panel
2. Patient orders in ASU will include:
a. heparin sq and venodynes
b. normal saline at 100 cc/hr
c. cefotetan 2 gm to be adjusted for weight
d. epidural order
e. central line need to be determined by surgery team and anesthesia staff based on patient access given that most have received preoperative chemotherapy with limited access or mediport only.
f. Arterial line
3. Intra-op focus should be on limiting iv fluid. Goal iv fluid administration should be 2 liters unless patient has significant unexpected blood loss or hemodynamic change. There is no expected requirement for blood transfusion in this patient population. Approximately 1/3rd of the whipple patients require portal vein reconstruction. If there is a prolonged need for portal vein clamping then the patient may require bicarb administration.
4. PACU management revolves around GRADUAL fluid resuscitation with normal saline. It is expected that patients will transfer to COR unit for recovery after adequate pain control is achieved and initial resuscitation is completed. Pain control should be managed by pain service with epidural evaluation and addition of narcotic and toradol as needed. There is no contraindication to the use of toradol.
Patients will have the following per protocol:
a. NG to low intermittent suction
b. G tube to gravity
c. blake drains to bulb suction
d. foley catheter