Total knee arthroplasty

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.

note_prehab_strong Prehabilitation is strongly recommended because of age, frailty, or malnutrition.

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.

note_delirium Delirium risk: no benzodiazepines. Use the orientation, sensory, sleep, and mobility bundle.

safe_frailty_gaba Age, frailty, or a delirium history: do not give a gabapentinoid. Age 82. CFS 6

Do not give gabapentin or pregabalin.

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.

Spinal or general anesthesia, periarticular infiltration, adductor canal block

safe_ponv Apfel score is at the escalation threshold. Use 3–4 antiemetics and total intravenous anesthesia. Apfel 3 (Female, Non-smoker, Postoperative opioids expected).

Apfel 3 (Female, Non-smoker, Postoperative opioids expected). Give 3–4 agents and use total intravenous anesthesia. A typical set is dexamethasone, ondansetron, aprepitant, and a scopolamine patch.

baseline Aim for euvolemia. Avoid both liberal fluid and under-resuscitation.

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

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

baseline Mechanical prophylaxis plus pharmacologic prophylaxis once hemostasis allows.

baseline Give tranexamic acid unless a thrombotic contraindication is documented.

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

path_joint_day0 Mobilize on the day of surgery, the same day the block allows a safe stand.

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

baseline Do not place a drain by routine.

baseline Do not leave a nasogastric tube in by routine.

baseline Orientation, glasses, hearing aids, sleep, early mobility, and no benzodiazepines.

note_delirium Delirium risk: no benzodiazepines. Use the orientation, sensory, sleep, and mobility bundle.