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# System prepended metadata

title: Example Clinical Pathway

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# Example Breast Surgery Clinical Pathway

## Preoperative

### NPO Guidelines

![icon](https://pathways.stanes.link/static/img/vector-1.svg)

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- Example text added by Alex in March
- Stop full liquids 8 hrs prior to surgery
- Stop water 2 hrs prior to surgery
- Consider allowing breast patients who arrive early to pre-op for lympho or mammography to drink water until 2 hrs prior to surgery

### Labs

![icon](https://pathways.stanes.link/static/img/vector-2.svg)

- Example text in bulleted form. 
- b-HCG for females patients under 66.
- Lorem ipsum dolor sit amet, consectetur adipiscing.
- Sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. 
- Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. 

### Cardiac considerations

![icon](https://pathways.stanes.link/static/img/vector-2.svg)

- Example text in bulleted form. 
- b-HCG for females patients under 66.
- Lorem ipsum dolor sit amet, consectetur adipiscing.
- Sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. 
- Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. 

### Pain Medications

![icon](https://pathways.stanes.link/static/img/vector-3.svg)

Non-opioid analgesia adjuncts to consider:

- Example text in bulleted form. 
- Acetaminophen 1000mg (caution with hepatic disease)
- Gabapentin 1200mg

### PONV Prophylaxis Medications

![icon](https://pathways.stanes.link/static/img/vector-2.svg)

Sed do eiusmod tempor incididunt ut labore et dolore magna aliqua:

- Sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. 
- Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. 

## Intraoperative

### Monitors

![icon](https://pathways.stanes.link/static/img/vector-2.svg)

- Standard monitors plus SEDline EEG for TIVA cases
- Recommend core temperature monitoring for cases >4 hrs 
- Tetragraph TOF for cases utilizing paralytics

### Additional Medications

![icon](https://pathways.stanes.link/static/img/vector-1.svg)

- Ketamine: 0.5mg/kg bolus +/- 2-5mcg/kg/min
- Dexmedetomidine: consider  bolus and/or infusion
- IV acetaminophen: if acetaminophen not given in pre-op or >6 hours from pre-op dose
- Ketorolac 10-30mg: if Celecoxib not given in pre-op and when surgeons approve
- **Bold example text selection:** 
- Consider methadone 0.1-0.2mg/kg for flaps
- _Italic example text to choice from_

### Monitors

![icon](https://pathways.stanes.link/static/img/vector-2.svg)

- Standard monitors plus SEDline EEG for TIVA cases
- Recommend core temperature monitoring for cases >4 hrs 
- Tetragraph TOF for cases utilizing paralytics

### Additional Medications

![icon](https://pathways.stanes.link/static/img/vector-1.svg)

Non-opioid adjuncts to consider. Sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat:

- Ketamine: 0.5mg/kg bolus +/- 2-5mcg/kg/min
- Dexmedetomidine: consider  bolus and/or infusion
- IV acetaminophen: if acetaminophen not given in pre-op or >6 hours from pre-op dose
- Ketorolac 10-30mg: if Celecoxib not given in pre-op and when surgeons approve

**Bold example text selection:**

- Consider methadone 0.1-0.2mg/kg for flaps 

_Italic example text to choice from:_

- Dexamethasone 0.1mg/kg IV prior to incision
- Ondansetron 4mg IV 
- Haloperidol 0.5-1mg or droperidol 0.625-2.5mg (assess QTc)

## Postoperative

### Post-op Analgesia

![icon](https://pathways.stanes.link/static/img/vector-3.svg)

- Fentanyl +/- hydromorphone IV PRN: decrease doses in setting of OSA or respiratory compromise
- Oxycodone PO

### PONV Treatment

![icon](https://pathways.stanes.link/static/img/vector-3.svg)

Select rescue medications from drug classes not previously employed intraoperatively
- Prochlorperazine
- Promethazine
- Haloperidol