Anyone have experience with these, positive or negative? I've posted Duke's colorectal protocol below (Anesth Analg. 2014 May;118(5):1052-61) - not sure if they're still using Voluven since the FDA warning came out:
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DUKE Anesthesia Colorectal Enhanced Recovery Guidelines Intervention Protocol
Thoracic epidural
T8-T12 region
5000 U subcutaneous heparin can be given after placement
Hydromorphone 0.4 to 0.6 mg before induction of anesthesia
Lidocaine 2% bolus at least 10 min preincision (40–100 mg)
Run infusion of 0.25% bupivacaine throughout case (3–6 mL/h)
No intraoperative IV opioids after induction without discussion with the attending anesthesiologist
Switch to bupivacaine 0.125%/hydromorphone 10 mcg/mL in epidural pump before leaving for PACU at end of case.
•Settings: infusion 4 to 6 mL/h; 2 mL bolus every 30 min
Goal-directed fluid therapy
1000 mL LR bolus–commenced in preoperative holding area to be infused during induction and then finished.
LR infusion for rest of case based on lean body weight (max 80 kg)
•5 mL/kg/h for open cases using an infusion pump (max 400 mL/h)
•3 mL/kg/h for laparoscopic cases using an infusion pump (max 240 mL/h)
Esophageal doppler placed after induction.
Record initial stroke volume (SV)
After incision (after pneumoperitoneum for laparoscopic cases) give a 250 mL colloid bolus over <15 min (suggest five 50 mL syringe pushes).
•If SV increases by >10%, repeat bolus.
•If SV increases by <10%, patient does not require a further bolus.
•Record peak value achieved.
•If still hypotensive, consider phenylephrine infusion.
•Give a further colloid bolus when SV drops 10% from peak value.
•Repeat cycle.
Max Voluven dose 50 mL/kg
Reduce LR to 2mL/kg/h before transfer to PACU.
--------------------------------------------------------------------------------------------------
DUKE Anesthesia Colorectal Enhanced Recovery Guidelines Intervention Protocol
Thoracic epidural
T8-T12 region
5000 U subcutaneous heparin can be given after placement
Hydromorphone 0.4 to 0.6 mg before induction of anesthesia
Lidocaine 2% bolus at least 10 min preincision (40–100 mg)
Run infusion of 0.25% bupivacaine throughout case (3–6 mL/h)
No intraoperative IV opioids after induction without discussion with the attending anesthesiologist
Switch to bupivacaine 0.125%/hydromorphone 10 mcg/mL in epidural pump before leaving for PACU at end of case.
•Settings: infusion 4 to 6 mL/h; 2 mL bolus every 30 min
Goal-directed fluid therapy
1000 mL LR bolus–commenced in preoperative holding area to be infused during induction and then finished.
LR infusion for rest of case based on lean body weight (max 80 kg)
•5 mL/kg/h for open cases using an infusion pump (max 400 mL/h)
•3 mL/kg/h for laparoscopic cases using an infusion pump (max 240 mL/h)
Esophageal doppler placed after induction.
Record initial stroke volume (SV)
After incision (after pneumoperitoneum for laparoscopic cases) give a 250 mL colloid bolus over <15 min (suggest five 50 mL syringe pushes).
•If SV increases by >10%, repeat bolus.
•If SV increases by <10%, patient does not require a further bolus.
•Record peak value achieved.
•If still hypotensive, consider phenylephrine infusion.
•Give a further colloid bolus when SV drops 10% from peak value.
•Repeat cycle.
Max Voluven dose 50 mL/kg
Reduce LR to 2mL/kg/h before transfer to PACU.
Gotta build that professorship somehow.
