POSTOP ORDERS / POD1 / POD2
Strict NPO
D5 LR at 100-150mL/hr
Dilaudid PCA
standard monitoring, NC 2L/min all times
Pepcid 20mg IV q12h
SCDs
Heparin 5000units SQ q8h.
Discuss with attending timing of first dose.
Zosyn 4.5g IV q8h x 2 doses postop
ICS 10x q1h while awake
Continuous pulse oximetry ALL PATIENTS
ok to be off while walking
If OSA on CPAP,
Use home CPAP in PACU and while asleep
FBG q6h if pre-diabetic. Insulin SS if diabetic
CBC in PACU, 6 hours later, and in am
NO SLEEPERS EVER
Includes benzos, restoril, ambien, benadryl
NO NSAIDS INDEFINITELY
HOLD ACEI and ARBs
HOLD diuretics
CONTINUE BBlockers with IV metoprolol protocol if on beta blockers preoperatively. / d/c Foley at 6am. Bladder scan then call HO if patient does not void after 6 hours.
clears 60mL po q1hour. tea ok.
Lortab elixir 15-30mL po q6h prn pain
d/c PCA 20 min after first dose of Lortab elixir. First dose of Lortab now.
saline lock IV when po > 200 mL total
d/c pepcid. omeprazole open capsule 20mg po daily
nutritionist consult
pharmacist consult
pill crusher to bedside
restart reconciled home medications. Change metoprolol to po or home beta-blocker. Note: pharmacist will reconcile home meds and communicate plan to 443-0939.
Guidelines for restarting home medications:
Convert all extended release to short-acting
Crush all medications for 3 months
In diabetics, do not restart secretogogues:
glyburide
glipizide
glimepiride
nateglinide
repaglinide
pramlintide
In diabetics, ok to resume metformin
In diabetics, ok to resume thiazolidinediones (Actos)
In diabetics, restart basal insulin at ½ dose
If on oral KCl, change to liquid formulation
Discontinue all NSAIDS for life
Resume diuretics per surgeon
(postop patients have higher risk of dehydration) / d/c JP drain
d/c home
HOME MEDICATIONS
ALL MEDICATIONS CRUSHED FOR 3 MONTHS
lortab elixir 15-30mL po q6h prn pain (480mL, 2 refills)
omeprazole 20mg open capsules po daily (#30, 3 refills)
Rogers: 4 months
Posselt and Carter: indefinitely
ursodiol 300mg po BID x 6 mths for pts with a gallbladder (#60, 5 refills)
Trader Darwin’s Chewable High-Potency MVI, 2 tabs po daily for life
Calcium citrate chewable, 500mg + 200IU vit D, 1 tab po TID for life
(needs to be taken separately from MVI and iron)
FeSO4 325mg (contains 65mg elemental iron) 1 tab po daily for life
Vitamin C 500mg po daily with iron
Vitamin B12 500 mcg po daily for life
d/c instructions
send patient home with copy of “Your Weight Loss Surgery”
diet instructions
liquids for 2 weeks, then gradually introduce solid foods into diet.
“Your Weight Loss Surgery” spells it all out.
follow-up
RTC with surgeon in 1-2 weeks
LapBand PATHWAY
POSTOP ORDERS / POD1
Clears 60cc po q1 hour
D5 LR at 100-150ml/hour
Lortab elixir 15-30mL po q6h prn pain
Pepcid 20mg IV q12h
SCDs
Heparin 5000units SQ q8h
Discuss with attending timing of first dose
ICS 10x q1h while awake
Continuous pulse oximetry ALL PATIENTS
ok to be off while walking.
If OSA on CPAP,
Use home CPAP in PACU and while asleep
FBG q6h if pre-diabetic. Insulin SS if diabetic
OOB walking tonight
NO SLEEPERS EVER
Includes benzos, restoril, ambien, benadryl
HOLD ACEI and ARBs
HOLD diuretics
CONTINUE BBlockers with IV metoprolol protocol if on beta blockers preoperatively / d/c Foley at midnight. Bladder scan then call HO if patient does not void after 6 hours.
saline lock IV when po > 200 mL total
d/c pepcid
nutritionist consult
pharmacist consult
restart reconciled home medications. Note: pharmacist will reconcile home meds and communicate plan to 443-0939.
HOME MEDICATIONS
ALL MEDICINES CRUSHED FOR 3 MONTHS
lortab elixir 15-30mL po q6h prn pain (480mL, 2 refills)
omeprazole 20mg open capsules po daily x 4 months (#30, 3 refills)
ursodiol 300mg po BID x 6 mths for pts with a gallbladder (#60, 5 refills)
Trader Darwin’s Chewable High-Potency MVI, 1 tab po daily for life
Calcium citrate chewable, 500mg + 200IU vit D, 1 tab po TID for life
d/c instructions
send patient home with copy of “Your Weight Loss Surgery”
follow-up
RTC with surgeon in 1-2 weeks
last reviewed 3/2010 JTC SJR AMP JPC EM HW DK MY KL