Embedded Files
Pectus Protocol:
POD #0:
Preop:
Gabapentin Load
Robaxin 25-44kg 250mg q6hr
45-70kg 500mg q8hr
>70kg 750mg q8hr
Intra-Op:
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
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