Major liver resection

baseline Review the pathway, the fasting clock, pain plan, and who to call.

baseline Start prehabilitation when there are at least 2–4 weeks before surgery: walking, breathing, and protein.

baseline Hemoglobin is below the pathway threshold. Work it up and give IV iron if time allows.

baseline One carbohydrate drink, about 400 mL, finished by the stop-drinks time. ASA 2023 supports this in healthy adults.

baseline Clear liquids until 2 hours before anesthesia. The patient sheet uses the earlier of that time and 2 hours before arrival.

baseline Stop solids 6 hours before surgery. Stop fried or fatty meals 8 hours before.

baseline Do not give a long-acting sedative or benzodiazepine premedication.

path_open Open approach: document why a minimally invasive approach was not used, and prefer a neuraxial or field block.

baseline Scheduled acetaminophen unless the liver plan says otherwise.

baseline Give a scheduled NSAID or COX-2 unless a safety rule holds it. Do not tell every patient to stop NSAIDs for 7 days.

baseline Single-dose dexamethasone for analgesia and nausea, unless a rule modifies it.

baseline Use the procedure-specific block.

Thoracic epidural for an open abdomen

baseline Prophylaxis follows the Apfel score and the Fourth Consensus Guidelines.

Apfel 2 (Non-smoker, Postoperative opioids expected). Give 2 agents: dexamethasone and ondansetron.

path_liver_fluids Low central venous pressure during transection. Restore volume after the specimen is out.

baseline Active warming. Keep core temperature at or above 36°C.

baseline Treat hyperglycemia. Non-diabetic patients need a check only when clinically indicated.

safe_cancer_vte Cancer surgery: extend pharmacologic VTE prophylaxis to 28 days when bleeding risk allows.

After neuraxial anesthesia, delay the first prophylactic dose. For enoxaparin that is usually at least 12 hours after the needle, once hemostasis is secure.

baseline Use a low central venous pressure technique during parenchymal transection, then resuscitate.

baseline Start oral intake as soon as the patient is awake, unless a surgical rule restricts it.

baseline Start enteral feeding early. Do not wait for flatus by habit.

baseline Mobilize the day of surgery or on postoperative day 1.

baseline Remove the urinary catheter on postoperative day 1 unless the operation requires it to stay.

path_drains A drain may be selective for this operation. It is not routine, and it needs a reason.

baseline Do not leave a nasogastric tube in by routine.