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					Regulatory Reference: JCAHO Standards              Policy # SS R007
Responsible Reviewer: Chair Dept. Anesthesiology   Originated: 1/90
                                                   Reviewed: 9/00
                                                   Revised: 9/98,12/99,2/00,5/00,12/00,
                                                   4/01
                                                   Next Review Date: 2/03
                                                   Page 1 of 4




1. DEPARTMENT OF ANESTHESIOLOGY PREOPERATIVE SCREENING
   PROTOCOL

2. MEDICATION ALERTS FOR PATIENTS RECEIVING ANESTHESIA

3. NPO POLICY FOR SURGICAL SERVICES
                                 Department of Anesthesiology
                                        Preoperative Screening Protocol
                                Recommended guidelines for Asymptomatic Patients
                   Additional Tests for Symptomatic Patients should be according to the physician
            TEST                                                     TYP E OF PATI ENT
Hi story and Physical
Valid for 30 days                   All Patients
                                  Male patients age 65 and older
                                  Female patients age 10 and older
                                  Pediatric patients less than 6 months
HGB/HCT
                                  Patients that fit the following criteria:
Valid 30 days if normal
                                 Recent autologous blood donation, surgic al procedures whic h have the potential for
                                 significant blood loss, history of anemia, polycythemia, canc er, abnormal bleeding, renal
                                 disease, use of anticoagulants
                                    Ages 50+
                                    Any age with chest pain
EKG                                 History of cardiac disease
Valid for 1 year if normal          Treat ed for hypertension
Valid for 1 month if abnormal       Morbid obesity
                                    History of congestive heart failure
                                    Diabetic patients
                                    Patients continuing to take Propulsid within 1 week of surgery
                                    New onset of res piratory symptoms including dyspnea, orthopnea, wheezing or
                                     hemoptysis.
                                    Exacerbation of chronic pulmonary diseas e proc esses, including obstructive or
                                     reactive airway disease, or exacerbation of congestive heart failure within 2 mo. of
CXR
                                     surgical date (this would include increased use of medication).
CXRs are recommended
                                    Pneumonia within 2 months of the planned surgical procedure.
based on these Clinical
                                    Room air pulse oximetry of <92%. The decision to obtain a CXR would be made by
Criteria
                                     the patient’s primary physician, surgeon, or anesthesiologist based on clinical
                                     criteria.
                                    No age or pack-year tobacco requirement
                                    Cardio-thoracic surgical patients should have CXRs per Surgeon
BMP Basic Metabolic
Panel                               Ages 65+
(carbon dioxide, chloride,          Diabetic patients
creatinine, glucose,                  Must be within 30 days
potassium, sodium, urea             Dialysis patient
nitrogen, calcium)                    Post-Dialysis if on Hemodialysis
Must be within 30 days              Patient on diuretics
                                    Per physician order or guided by clinical history, last menstrual period or uncertain
Pregnancy Testing
                                     pregnancy history.
Type & Screen                       Per physician order or clinical pathway
                                              SPECI AL X-RAY STUDI ES
                                    Severe Rheumat oid Arthritis Patients
C-Spine Flexion/
                                    Being treated with prolonged or current therapy with steroids, gold, or methot rexate
Extension X-rays
                                    Has had a joint replacement because of rheumatoid arthritis

                                           OPHTHALMOLOGY SURGERY
Patients who are scheduled for operative procedures of the orbit (ey e), its' contents, and supporti ng structures, (except
retina surgery) utilizing Monitored Anesthesia Care (MAC) will not be required to have routine testing.

                             AICD (A UTOMATIC IMPLANTABLE CARDIOVERTER-D EFIBRILLATOR)
Please contact the cardiologist to confirm that arrangements have been made t o deactivate and reactivate A ICD in the
immediat e perioperative period.

                             Please direct any questions to ANESTHESI A COORDINATOR
                                     Thomas N. Lewis, M.D., Chairman, April 2001
                                   MEDICATION ALERTS

                       FOR PATIENTS RECEIVING ANESTHESIA

1. Phentermine : (Adipex, Fastin, Ionamine, Obenix, Oby-Cap, Oby-Trim)
    Phentermine alone may not need to be stopped prior to anesthesia.
    Consult an Anesthesiologist


2. Metformin Hydrochloride: (Glucophage, Glucovance) Discontinue 12 or more hours
   prior to receiving anesthetic agents. (Metformin should also be discontinued temporarily in
   patients undergoing surgery that is associated with restricted food or fluid intake) Not required
   to be discontinued in Minor Surgery where there is no restriction on food or fluid.
    For urgent or emergency surgery, glucophage should be discontinued for as long as
     possible prior to surgery.
    Case will be canceled if elective surgery

3. Monoamine Oxidase Inhibitors: Nardil (Phenelzine sulfate), Parnate (Tranylcypromine
   sulfate), Isocarboxizide.
     Discontinue use 2 weeks prior to receiving anesthetic agents, unless contraindicated by
      patient condition.
     Consult an Anesthesiologist
4. Coumadin: To be discontinued at the direction of the Surgeon or Primary Physician.
    If the patient is to receive a Regional Anesthetic, a normalized INR must be documented
      prior to surgery. Otherwise lab work is per the surgeon’s order.


5. Cisapride: (Propulsid) Discontinue at least one week prior to elective surgery.
    An ECG will be required preoperatively if the patient remains on Propulsid


6. Herbal Medicines: Patients should be encouraged to discontinue all herbal medicines for as
   long as possible prior to surgery.



                 Please direct any questions to the Anesthesia Coordinator
                                         April 2001
                    N.P.O. POLICY FOR SURGICAL SERVICES

POLICY:
     To provide written guidelines for N.P.O. status for surgical patients.

GUIDELINES:

1.     Patients age 5 and older:
       a.     ELECTIVE CASES, PREADMITTED (Inpatients)
               Solids: NPO after midnight the night before surgery.
               Liquids: Clear liquids up until 4 hours prior to surgery. Clear liquids are
                 defined as water coffee without cream, tea without cream, soft drinks
                 and pulp-less fruit juices.

       b.      ELECTIVE CASES SEEN ON THE DAY OF SURGERY
                Solids: No solid food for 8 hours prior to surgery.
                Liquids: Clear liquids up until 4 hours prior to surgery. These fluids are
                 defined in section A.

       c.      OTHER CONSIDERATIONS:
               The following patients will be exempt from the above schedule. Their fast
               will be determined by the anesthesiologist on an individual basis.

               1.     Diabetic Patients (See Diabetic NPO Pathway)
               2.     Morbidly Obese Patients
               3.     Patients with G.I. Motility Disorders
               4.     Pregnant and Postpartum Patients

2.     THE FOLLOWING APPLIES TO CHILDREN LESS THAN AGE FIVE:

       a. Children under age 5 must cease the intake of solid food 8 hours prior to
          surgery.
       b. The children are permitted the intake of clear liquids (limit 8 oz.) until 2 hours
          prior to surgery.
       c. Infants less than 6 months may have breast milk up until 4 hours prior to
          surgery or formula until 6 hours prior to surgery.

3.     MEDICATIONS: Generally all medications except for those that are
       contraindicated for anesthesia may be taken with a sip of water. (See page 3 of
       this policy, Medication Alerts for Patients Receiving Anesthesia.) For questions
       contact the Department of Anesthesia.

4.    DIABETIC PATIENTS: Place diabetic patients on the Diabetic NPO Pathway.


Policy Distribution: SS P&P Manual, OR Reference Books, Department of Anesthesiology P&P Manual,
Emergency Services, Nursing Services, Shepherd Center c/ o Tracy Reed, Program Director, MD Office
Manual

				
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