Harvard University



Gynecologic Laparoscopy CarePathGynecologic Hysteroscopy CarePathGoalReduce PACU length of stay and increase patient satisfaction by reducing post-op pain, PONV, sedation and time to void by minimizing opioids and maximizing alternative medications and techniques.To whom it appliesAll Gyn patients (OP, SDA, IP) who are getting a laparoscopic or hysteroscopic procedures. As always check contraindications and precautions for specific drugs before ordering or administering.NPO guidelinesPatient should not eat any solid food after midnight but they may have limited clear liquids (less than 12 ounces) up until 2 hours before the arrival time at the hospital. This approach allows for potential changes in scheduling. Order meds Previous evening in POEGabapentin 300-600mg PO x 1 OR Pregabalin 75mg PO x 1.Acetaminophen 1000mg PO x 1 NO Scopalamine PatchCelebrex 400mg PO. IF it is expected Toradol cannot or will not be administered.NO GabapentinoidsAcetaminophen 1000mg PO x 1 NO Scopalamine PatchCelebrex 400mg PO. IF it is expected Toradol cannot or will not be administered.Holding area HuddlePreop Mini-discussion between Anesthesia, Gyn Team members and the Patient addressing:Inform GYN and patient of pre-meds ordered/received, so that maximum daily acetaminophen dosing is not exceeded.Discuss what analgesic prescriptions the patient is going home on, so that PACU orders can be coordinated.Gyn to handover scripts to relative and inform holding area RN.Any issues with Med Reconcilliation brought up by Gyn and/or patient (e.g when to restart anticoagulants)Consider consenting for post-op TAP block if there is possibility for converting to open procedure. Preop Mini-discussion between Anesthesia, Gyn Team members and the Patient addressing:Inform GYN and patient of pre-meds ordered/received, so that maximum daily acetaminophen dosing is not exceeded.Discuss what analgesic prescriptions the patient is going home on, so that PACU orders can be coordinated.Gyn to handover scripts to relative and inform holding area RN. Any issues with Med Reconcilliation brought up by Gyn and/or patient (e.g when to restart anticoagulants)InductionDexamethasone 10mg IV SLOW. Dexamethasone 4mg IV SLOW.Intraop (surgeon)Surgeon to infiltrate port sites with local anesthetic, before placement and before closure.Instill 100 cc of fluid in bladder before removal of Foley.Intraop (Anesthesiologist)Ketorolac 30mg IV at beginning of vaginal cuff closure/~1 hour prior to end of case. Ondansetron 4mg IV x 1 with removal of instrumentsJudicious use of IV fluids. Judicious use of opioids. Short acting (Fentanyl or Dilaudid in low doses) preferable.Consider using:Esmolol Infusion in place of opioids. 10 mcg/kg/min and can be adjusted 5-15 mcg/kg/min based on HR.? Start during induction and end with removal of airway devicePACU NursingVoiding Protocol per guidelinePO Opioid when able to tolerate PO.IV opioid (fentanyl or dilaudid in low doses) until tolerating PO. NO Voiding protocolPO Opioid when able to tolerate PO.IV opioid (fentanyl or dilaudid in low doses) until tolerating PO. ................
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