Preop Planning Template

Operation / Patient Hx

Positioning needs, preop interview/exam, airway, chronic pain regimen, neuro deficits, bedside echo

Positioning

Prone, lithotomy, lateral — arm placement, proneview, extenders, padding, eye protection

Plan Overview

GETA, MAC/Regional, Spinal, Epidural, Combined Spinal/Epidural

Monitors

Standard ASA, A-line, SedLine/BIS, TEE, CVP, PA pressures, cerebral oximetry, neuromonitoring

IV Access

PIV, central line, PICC

Premedication

Midazolam, lorazepam, anxiolytics as appropriate

Induction

Standard IV induction, RSI, mask induction

Airway Management

ETT (standard, oral RAE, nasal RAE, DLT, bronchial blocker, NIM), DL Mac/Miller, GlideScope, FOB, LMA

Maintenance

Inhaled (sevo, iso, des) vs TIVA (propofol ± remi)

Emergence / Dispo

Extubate awake, extubate deep, to ICU intubated

Hemodynamics

Rate, rhythm, preload, afterload, contractility — define targets

PONV Prophylaxis

Dexamethasone, ondansetron, scopolamine patch, droperidol

Analgesia

Opioid boluses/infusion, ketamine infusion, ITM, regional

Fluids / Blood Products

Goal-directed fluid therapy, maintenance rate, insensible losses, T&S/crossmatch, Belmont

Sample Cases

Anesthetic Goals

The pillars of a balanced anesthetic:

Amnesia

Hypnotic depth

Analgesia

Response to stimulus

Akinesia

Surgical field immobility

Your plan starts with what the surgery and patient require in each category.

Hemodynamic Planning

Consider what the surgery and patient require — and when during the operation you need those goals.

Surgical Examples

NSGYSBP <140 to mitigate intra/postop bleeding
CEASBP >170 pre-reperfusion (collateral perfusion) → <140 after
CardiacSBP ~90 during aortic cannulation to prevent dissection

Targets & Agents

RateBeta blockers, anticholinergics, pacemaker
RhythmPads on to cardiovert if needed
PreloadAugment with volume, venodilators
AfterloadVasopressors (neo, vaso, epi)
ContractilityInotropes (milrinone, dobutamine, epi)

Positioning

Prone

Proneview, circuit extenders, chest rolls, arms tucked or out, eye protection

Lateral

Axillary roll, bean bag, arm board for dependent arm, padding between legs

Lithotomy

Allen stirrups, avoid peroneal compression, time limit, compartment syndrome risk

General Checks

Pressure points padded, head/neck alignment, arm abduction ≤90°, safety strap