Standards and Positions

NPO Guidelines

• Clear liquids – 2 hrs (H2O, fruit juice without pulp, carbonated beverages, clear tea, black coffee plain)
• Breast milk – 4 hrs
• Infant formula – 6 hrs
• Non-human milk – 6 hrs
• Light meal – 6 hrs (dry toast and clear liquids)
• Regular meals – 8 hrs. (fatty foods)

Pre-Op Visit Recommendations

We recommend all patients undergo a screening prior to their day of surgery. This screening can be accomplished with a phone call in many cases. During this screening, a standardized protocol and scoring system will be utilized to determine if further work up or visit to the pre-op clinic needs to be obtained. If there are questions, concerns, or a need to postpone you will receive a phone call with details and potential next steps to ensure minimal delay.

Pre-Op Lab Recommendations

We recommend that you only obtain labs and tests that you will require prior to surgery to avoid an overuse of laboratory screening exams. Our protocols will determine which labs and or tests we will need to obtain prior to the day of surgery. This approach will minimize unnecessary labs and or tests and help to avoid unnecessary delays.

Pre-Op Medications Recommendations

We will make specific recommendations regarding which medications, dosage, and timing after review of the patients pre-op visit information and communicate this to the patients.

Recent URI Recommendations

Urgent and elective surgeries warrant an evaluation to weigh the relative risks associated with proceeding with surgery vs waiting until URI resolves. Severity of illness, symptoms, and treatment options will be part of the evaluation. In general, a patient’s airways will remain reactive for four to six weeks following a URI, increasing the patient’s risk for pulmonary complications. We recommend rescheduling elective procedures (or at least a direct conversation between the surgeon and anesthesiologist addressing the relative risks of proceeding vs waiting.)

Epidural Candidates

• Platelet count > 80,000
• Non-Septic Patient

General Anti-Coagulation Guidelines for Regional Anesthesia

• Platelet count > 80,000
• Stop at least 7 days prior to surgery:
• clopidogrel (Plavix)
• prasugrel (Effient)
• ticagrelor (Brilinta)
• Stop at least 72 hours prior to surgery:
• dabigatran (Pradaxa)
• fondaparinux (Arixtra)
• Stop at least 48 hours prior to surgery:
• apixaban (Eliquis)
• rivaroxaban (Xarelto)
• edoxaban (Savaysa)
• abciximab (Reopro)
• Stop at least 24 hours prior to surgery:
• Enoxaparin (Lovenox)
• dalteparin (Fragmin)
• aspirin/dipyridamole (Aggrenox)
• Stop at least 12 hours prior to surgery:
• Heparin 7500 SQ Q8H
• Warfarin (Coumadin) check INR < 1.5
• Consult with anesthesiologist for alteplase (TPA), tirofiban (Aggrastat), eptifibatide (Integrelin), argatroban, bivalirudin (Angiomax)
• Consult with anesthesiologist for any known coagulopathy or other extenuating circumstances