Pectus Excavatum Repair

Pectus Protocol:

POD #0:


Gabapentin Load

Robaxin 25-44kg 250mg q6hr

45-70kg 500mg q8hr

>70kg 750mg q8hr


Ketamine gtt at 2mcg/kg/hr

High Thoracic Epidural Catheter

Opiates as indicated in OR.

Relistor Dose:

0.15mg/kg SC <40kg

8mg SC 40-60kg

12mg SC 50-110kg

PACU and Postop:

Diet: Clears Advance as tolerated

Naloxone gtt at 1mcg/kg/hr (opioid related side effects)

Ketorolac 0.5mg/kg (max 30mg) q6hr

IV vs Oral Tylenol 15mg/kg to max of 1000mg

Robaxin 25-44kg 250mg q6hr

45-70kg 500mg q8hr

>70kg 750mg q8hr

PCA: Hydromorphone Demand only 4mcg/kg to max of 0.2mg demand q10 with 0.4mg NB q1hr

(If we find nightly usage under 5mg will convert to a nursing PRN)

Ativan 1-2mg IV q4hr prn anxiety/agitation/spasm

Clonidine TTS Patch per Protocol

No Foley catheter required by Regional Anesthetic. Placement/Removal per Team

POD 1:

Full diet

Ketamine on, Regional Anesthetic continue

Patient works with PT/OT twice daily

DC PCA start Oxycodone 100mcg/kg to max of 7.5mg q4hr prn

DC Narcan gtt and dose with Restoril SC q48hr while inpatient

Bowel Regimen per Primary Team

Continue Robaxin Scheduled

Convert Ativan to Valium 2-4mg q6hr PRN Spasm, Anxiety, Agitation

Toradol OFF. Naproxyn 500mg BID initiated.

IV Tylenol converted to SCHEDULED PO Tylenol

Neurontin TID per protocol

Trial PVT Catheter vs Epidural Catheter (OFF but in place)

POD #2:

Remove PVT/Epidural Catheter

Schedule Oxycodone and have additional PRN breakthrough q4hr dose

Stop Ketamine gtt vs Turn down depending on assessment of patient

Neurontin TID

Robaxin to PRN

Stop Valium PRN

Dispo Planning if able

POD 3: Discharge Medications:

Ketamine Off

Stop Neurontin with discharge

Remove Clonidine Patch with discharge

PRN only Oxycodone with Discharge

Scheduled Tylenol until off Oxycodone then set Tylenol to prn

Scheduled Naproxen at discharge until off Tylenol then PRN

PRN Robaxin for Home

Dispo Planning if able