Unique Plan Description: Anesthesia Perioperative Adult EKM
Plan Selection Display: Anesthesia Perioperative Adult
PlanType: Medical
Version: 2
Begin Effective Date: 12/31/2100 12:00 AM
End Effective Date: Current
Available at:	MMC

Perioperative     
Non Categorized
   	Subphase - Protocol Adult Peri-op(SUB)*
   	Subphase - Anesthesia Adult Perioperative(SUB)*
   	xxxSubphase - Anesthesia Ventilator Orders(SUB)*
Patient Care
   	Hypertension Treatment Parameters
    SBP greater than 180, and DBP greater than 100 (DEF)*
    SBP greater than ___, and DBP greater than ___
   	Hypotension Treatment Parameters
    SBP less than 100 (DEF)*
    SBP less than ___
   	Communication to Nurse
    T;N, Once, Nurse to discontinue Anesthesia Perioperative Adult powerplan once discharged from PACU.
   	Respiratory Monitoring Post-Procedure
    Patient needs to go to a nursing unit with Respiratory monitoring capabilities. POST-OP
   	Monitor
    Patient needs Obstructive Sleep Apnea monitoring for an additional 3 hours prior to their discharge.  If the patient has any episodes of airway obstruction, apnea or   persistent hypoxemia on room air, an additional 7 hours of observation or hospital admi
   	Temp Control (specify)
    PRN, Forced air warmer for temperature less than 36c
   	IV Fluids (Specify-nsg)
    POST-Op, 50 mL/hr
   	Notify (specify)
    Anesthesia Provider if heart rate is greater than 100bpm.
Consults/Referrals
   	PAN Task
Medications
If any add on medications are needed as part of this powerplan, remember to use "add to phase"(NOTE)*
PRE-OP(NOTE)*
   	ANESTHESIA ONLY - Acetaminophen TAB (PRE-OP)
    1,000 mg, Oral, Tab, Once, NOW (DEF)*
 Comments: In PRE-OP
    500 mg, Oral, Tab, Once, NOW
 Comments: In PRE-OP
   	ANESTHESIA ONLY - Midazolam IVPush (PRE-OP )
    2.5 mg, IVPush, Inject, PRN, PRN Anxiety, NOW (DEF)*
 Comments: Give initial dose as ordered for anxiolysis may repeat dose x 1 in 2 minutes if first dose ineffective.  Additional midazolam of 0.5-5 mg increments may be given per anesthesia orders for procedural sedation given in anesthesia provider's presence. (PRE-OP)
    1 mg, IVPush, Inject, PRN, PRN Anxiety, NOW
 Comments: Give initial dose as ordered for anxiolysis may repeat dose x 1 in 2 minutes if first dose ineffective.  Additional midazolam of 0.5-5 mg increments may be given per anesthesia orders for procedural sedation given in anesthesia provider's presence. (PRE-OP)
    2 mg, IVPush, Inject, PRN, PRN Anxiety, NOW
 Comments: Give initial dose as ordered for anxiolysis may repeat dose x 1 in 2 minutes if first dose ineffective.Additional midazolam of 0.5-5 mg increments may be given per anesthesia orders for procedural sedation given in anesthesia provider's presence. (PRE-OP)
    mg, IVPush, Inject, PRN, PRN Anxiety, NOW
 Comments: Give initial dose as ordered for anxiolysis may repeat dose x 1 in 2 minutes if first dose ineffective.Additional midazolam of 0.5-5 mg increments may be given per anesthesia orders for procedural sedation given in anesthesia provider's presence.  (PRE-OP)
   	ANESTHESIA ONLY -  Hydromorphone IVPush (PRE-OP)
    0.2 mg, IVPush, Inject, q5min, PRN See comment, NOW
 Comments: Nurse to use 0.2-0.8 mg IVPush PRN Pre-op Pain.  Up to a maximum dose of 2 mg (PRE-OP)
   	ANESTHESIA ONLY - Fentanyl IVPush (PRE-OP )
    25 mcg, IVPush, Inject, q5min, PRN See comment, NOW
 Comments: Nurse to use 25-50 mcg IVPush PRN Pre-op Pain.  Up to a maximum of 200 mcg (PRE-OP)
POST-OP(NOTE)*
Please UNSELECT Hydromorphone IVPush (POST-OP) if Morphine IVPush (POST-OP) is selected(NOTE)*
   	ANESTHESIA ONLY -  Hydromorphone IVPush (POST-OP)
    0.2 mg, IVPush, Inject, q5min, PRN See comment, NOW
 Comments: Nurse to use 0.2-0.8 mg IVPush PRN Pain up to a maximum of 3.5 mg (POST-OP)If both fentanyl and hydromorphone are ordered, hydromorphone to be used first.  Fentanyl is to be used if hydromorphone is ineffective.  POST-OP
   	ANESTHESIA ONLY - Fentanyl IVPush (POST-OP )
    25 mcg, IVPush, Inject, q5min, PRN See comment, NOW
 Comments: Nurse to use 25-50 mcg PRN Pain up to a maximum of 200 mcg.  If either hydromorphone or morphine is also ordered begin with hydromorphone or morphine, then proceed with fentanyl if hydromorphone or morphine is ineffective. POST-OP
   	ANESTHESIA ONLY - Morphine IVPush (POST-OP)
    1 mg, IVPush, Inject, q5min, PRN See comment, NOW
 Comments: Nurse to use 1-4 mg IVPush PRN Pain up to a maximum of 30 mg. If both fentanyl and morphine are ordered, morphine to be used first.  Fentanyl is to be used if morphine is not effective.  POST-OP
   	ANESTHESIA ONLY - Ketorolac IVPush (POST-OP )
    30 mg, IVPush, Inject, Once, PRN Pain, NOW (DEF)*
 Comments: May be used as a single agent or as adjunctive therapy with opioids or acetaminophen for mild, moderate, or severe pain. (POST OP)***Do not administer oral NSAIDs (i.e. ibuprofen) with IV ketorolac if both are ordered.Reduce dose to 15 mg for patients 65 or older or less than 45 kg.  Do not give if given in the last 4 hours.
    15 mg, IVPush, Inject, Once, PRN Pain, NOW
 Comments: May be used as a single agent or as adjunctive therapy with opioids or acetaminophen for mild, moderate, or severe pain. (POST-OP)***Do not administer oral NSAIDs (i.e. ibuprofen) with IV ketorolac if both are ordered.Do not give if given in the last 4 hours.
   	Subphase - Anesthesia Neuromuscular Blocker Reversal(SUB)*
System Auto-Generated
This PowerPlan should not be utilized in patients under the age of 16 years old that weigh less than 54 kg.(NOTE)*
   	Notification of Anesthesia Perioperative Plan

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase