- Preoperative orders:
- NPO / Void on Call
- TED stockings to be fitted the day before surgery and worn by the
patient to the operating room;
-
Decadron 10 mg as a single PO dose 12 hrs preop
or
Solumedrol 40 mg IM q6hr
beginning 12 hrs before the procedure;
- if the patient is on anticonvulsants, they are continued parentally
thru the preoperative period;
Note:
- level of consciousness is the single most sensitive indicator of
neurological comprimise;
- look for change in pupillary reaction or vital signs;
- Postoperative Orders:
- NPO for 12 hrs postop;
- elevate head of bed to 30 deg, unless contraindicated (SBP > 90);
- Steroids: all patients following craniotomy, unless contraindicated by
ulcer disease, are to be given steroids;
-
Decadron 4 mg IV/PO q6hr (or Solumedrol 40 mg IV q6hr) x 5 days
- Depomedrol 40 mg IM on the 4th postop day;
- Maalox 30 cc down the NG tube if pt is comatose (q2hr x 6 days)
- Zantac or Tagament x 6 days
-Tylenol w/ Codeine
-
Narcotics are not to be administered to postoperative craniotomy pts,
with the exeception of small to moderate doses of codeine for HA;
- Sedatives are not given until several days following surgery;
- if the patient has been on anticonvulsants, continue them
after surgery;
- for pts on Tegertol have anesthesia
place an NG tube at surgery and keep this patient until PO's
can be taken;
