Preop Planning Template
Operation/Patient History:
Positioning: may need extra equipment prone means going to sleep on bed/gurney, proneview, accordion extender, arms out or tucked
Preop Interview/Exam:
Reaction to listed allergy
Airway exam (always) + chronic pain regimen, neuro deficits, bedside echo, anything that might influence your plan and can't find in chart (be specific… not "did you get cardiac clearance")
Positioning
Note position (e.g. prone, lithotomy), arm placement, special equipment like proneview, extenders, or padding.
Plan Overview:
GETA, MAC/Regional, Spinal, Epidural, Combined Spinal/Epidural
Monitors:
standard ASA monitors, A-line, SedLine/BIS, TEE, CVP, PA pressures, cerebral oximetry, Neuromonitoring (EEG, EMG, MEPs, SSEPs, etc)
IV Access:
PIV, central line, PICC
Premedication:
Midazolam, lorazepam, or other anxiolytics as appropriate
Induction:
Standard IV induction, Rapid Sequence Induction (RSI), mask induction
Airway Management:
ETT type and size (standard, oral rae, nasal rae, DLT, bronchial blocker, NIM tube) + laryngoscopy technique (direct Mac/Miller size, glidescope, fiberoptic bronchoscope (FOB)), LMA, native airway + adjuncts (OPA/nasal trumpet)
Maintenance:
inhaled vs TIVA
Emergence/Dispo:
extubate awake, extubate deep, to ICU intubated
Hemodynamics:
rate, rhythm, preload, afterload, contractility
PONV prophylaxis:
Dexamethasone, ondansetron, scopolamine patch, droperidol
Analgesia:
intermittent opioid boluses, opioid infusion, ketamine infusion, intrathecal morphine (ITM)
Fluids/Blood Products:
"Goal directed fluid therapy", maintenance rate, accounting for insensible losses, high blood loss case, belmont
Sample Cases
Simple Laparoscopic Case
Complex Abdominal Surgery
Complex Spine – Posterior Lumbar Fusion
Peds – Tonsillectomy
CABG Surgery
Anesthetic Goals
Remember the pillars of a balanced anesthetic
- Amnesia: hypnotic depth
- Analgesia: response to stimulus
- Akinesia: surgical field immobility
Your anesthetic plan starts with considering what the surgery and patient require in each of these categories
Hemodynamic Planning Tips
Again, consider what the surgery and patient require, and at what time during the operation, you have those goals
Examples
- NSGY - often need SBP < 140 to mitigate bleeding intaop and postop
- CEA - might need SBP > 170 prior to reperfusion to maintain cerebral perfusion through collaterals, and then SBP < 140 after reperfusion
- Cardiac surgeries on CBP - where CTS will cannulate the aorta, SBP goal ~90 to prevent aortic dissection
Think about goals/targets & what agents you plan to use
- Rate - beta blockers, anticholinergics, pacemaker
- Rhythm - pads on to cardiovert if needed
- Preload - augment with volume, euvolemia, venodilators
- Afterload - vasopressors
- Contractility - inotropes
Positioning
- Proneview, padding, circuit extenders
- Check arm placement, head/neck alignment
- Pressure point protection
- Eye protection for prone cases