Life in the laparoscopic fast lane: evidence‐based perioperative management and enhanced recovery in benign gynaecological laparoscopy

2021 ◽  
Author(s):  
Alison Bryant‐Smith ◽  
Sawsan As‐Sanie ◽  
Jillian Lloyd ◽  
Maggie Wong
Keyword(s):  
Perioperative Management ◽  
Enhanced Recovery ◽  
Evidence Based ◽  
Gynaecological Laparoscopy ◽  
Fast Lane

Buprenorphine management: a conundrum for the anesthesiologist and beyond - a one-act play

2020 ◽  
Vol 45 (8) ◽  
pp. 656-659
Author(s):  
Shilen Thakrar ◽  
Josh Lee ◽  
Caitlin E Martin ◽  
John Butterworth IV
Keyword(s):  
Patient Outcomes ◽  
Perioperative Management ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Local Level ◽  
Evidence Based ◽  
National Guidelines ◽  
Evidence Based Guidelines ◽  
One Act ◽  
Patient Centric

We have witnessed a worldwide upsurge of streamlined enhanced recovery after surgery (ERAS) pathways advocating for consistency and compliance within their guidelines. At a recent national conference, two experts defended their institutional policies on perioperative management of buprenorphine, one defending its continuation, while the other suggesting its discontinuation. The moderator diplomatically proclaimed the need to have guidance at the institutional level and following it for favorable patient outcomes. Unfortunately, perioperative management of buprenorphine remains an understudied topic with a lack of national guidelines leading to variations at a local level despite its increased use nationally in the current opioid crisis. Although the moderator made a valid statement, we demonstrate via our one-act play the importance of recognizing a subset of the population within an ERAS pathway that necessitates multidisciplinary discussion, communication, and patient-centric care to formulate a perioperative plan coordinating a patient’s care. More robust research is needed to minimize variability in current practices and to further develop comprehensive evidence-based guidelines that encompass risk factors and anticipated postsurgical and peripartum pain for patients on buprenorphine.

Craniectomy with microvascular flap reconstruction in a patient taking infliximab for vasculitis

2020 ◽  
Vol 13 (12) ◽  
pp. e238614
Author(s):  
Ogonna N Nnamani Silva ◽  
Audrey B Nguyen ◽  
William Y Hoffman
Keyword(s):  
Diabetes Mellitus ◽  
Latissimus Dorsi ◽  
Perioperative Management ◽  
Large Cell ◽  
Evidence Based ◽  
Flap Reconstruction ◽  
Biologic Drugs ◽  
Temporal Arteries ◽  
Immune Mediated ◽  
Microvascular Flap

For patients whose vasculitis is managed with biologic medications, no reports or evidence-based guidance exists regarding the perioperative management of microvascular flaps. We present a case of a 78-year-old patient with Takayasu’s arteritis (TA) and diabetes mellitus who was taking infliximab and underwent wide local excision of squamous cell carcinoma, craniectomy and reconstruction with a latissimus dorsi flap. TA, an immune-mediated large cell vasculitis characterised by granuloma formation, tends to affect larger vessels and aortic branches. The typical localisation of this condition raises concerns about potentially compromised pedicle and recipient vessels (ie, superficial temporal arteries), which could hinder postoperative flap success. Discontinuation of infliximab 4 weeks before surgery and resumption 6 weeks after led to favourable results. This case addresses the gap in the literature concerning stopping and restarting biologic drugs in the perioperative setting and documents a successful course of a microvascular procedure in a patient with vasculitis.

Perioperative management of acetabular and pelvic fractures: evidence-based recommendations

2021 ◽  
Author(s):  
Ramakanth R. Yakkanti ◽  
Neil V. Mohile ◽  
Wayne B. Cohen-Levy ◽  
Sagie Haziza ◽  
Matthew J. Lavelle ◽  
...  
Keyword(s):  
Perioperative Management ◽  
Pelvic Fractures ◽  
Evidence Based

scholarly journals Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

2020 ◽  
pp. 5-77
Author(s):  
Juan Antonio Margarit ◽  
Maria Azucena Pajares ◽  
Carlos Garcia Camacho ◽  
Mario Castaño Ruiz ◽  
Maria Gómez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Critical Care Unit ◽  
Cardiovascular Surgery ◽  
Enhanced Recovery ◽  
Scientific Evidence ◽  
Evidence Based ◽  
Scientific Societies ◽  
Clinical Process ◽  
Consensus Document

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.

Retrospective Review of Perioperative Multimodal Analgesia for Orthopedic Patients in a Veterans Affairs Setting

2021 ◽  
Vol 36 (8) ◽  
pp. 397-408
Author(s):  
Christine M. Vartan ◽  
Nayma Moya Romero ◽  
Sandra L. DiScala ◽  
Abigail Brooks ◽  
John Melendez-Benabe ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Enhanced Recovery ◽  
Medical Center ◽  
Multimodal Analgesia ◽  
Veterans Affairs ◽  
Internal Quality ◽  
Evidence Based ◽  
Quality Audit ◽  
Secondary Objective ◽  
Hip Arthroplasties

OBJECTIVES: To determine adherence of perioperative knee/hip arthroplasties and hip fracture repairs to the American Pain Society (APS) guideline recommendations for perioperative pain control. One secondary objective was to perform an internal quality audit on the use of enhanced recovery after surgery (ERAS) protocols; another secondary objective was to design an evidence-based, multi-modal perioperative quick-order menu (if warranted). DESIGN/PATIENTS: A retrospective quality improvement (QI) review of uncomplicated knee/hip replacement and hip fracture repairs from January 2018 through March 2018. SETTING: West Palm Beach Veterans Affairs Medical Center (WPB VAMC) including acute care, subacute rehabilitation, and outpatient setting. MAIN OUTCOME MEASURE: Analgesic use in the perioperative setting via electronic health record review. RESULTS: Forty-seven patients were retrospectively reviewed. Perioperative multi-modal analgesia was used in 85% of patients. Eighty-seven percent were discharged on multi-modal analgesia. There was a 67% response rate to the internal quality audit on ERAS protocol usage from the orthopedic team. CONCLUSION: A retrospective QI review completed approximately two years after APS guideline publication showed that compliance with these recommendations for multi-modal analgesia (consisting of the use of at least two medication classes) at the WPB VAMC in the postoperative setting for knee/hip arthroplasties and hip fracture repairs was 85%. This indicated potential for improvement in achieving a pharmacologic multimodal and ERAS intervention. The authors developed an evidence-based quick-order menu to further reinforce adherence to the APS perioperative guidelines.

The efficacy of Enhanced recovery after surgery (ERAS) for elderly patients with intertrochanteric fractures received surgery: study protocol for a randomized, blinded, controlled trial

2020 ◽  
Author(s):  
Mengchen Yin ◽  
Yinjie Yan ◽  
Zhaoxiang Fan ◽  
Niankang Fang ◽  
Hongbo Wan ◽  
...  
Keyword(s):  
Western Medicine ◽  
Intertrochanteric Fracture ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Care Pathway ◽  
Controlled Trial ◽  
Intramedullary Fixation ◽  
Perioperative Outcomes ◽  
Evidence Based ◽  
Randomized Controlled

Abstract Background: Intertrochanteric fracture (ITF) is increasing with the rapid increase in the aging population, often causes a high mortality rate in old patients and increases the economic burden of the family and society. ERAS (Enhanced Recovery after Surgery) is a powerful guarantee for patients to accelerate their recovery after surgery. TCM (traditional Chinese medicine) promote repair of injured tissues and eliminate traumatic aseptic inflammation. Therefore, this prospective randomized controlled clinical trial aims to evaluate the clinical effect of the evidence-based ERAS pathway of integrating TCM with and western medicine on perioperative outcomes in ITF patients undergoing intramedullary fixation, and provide reliable evidence-based data for applying the program to clinical practice. Methods/design: We will conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of ERAS care pathway with traditional care pathway, and to investigate whether the ERAS care pathway can improve the perioperative outcome in ITF patients undergoing intramedullary fixation. A total of 60 patients with ITF will be enrolled and treated with the two care pathway, respectively. Length of stay, economic indicators, Harris score, VAS score, time get out of bed, 30-day readmission rates, postoperative transfusion rates, discharge to home and mortality will be evaluated. Any signs of acute adverse reactions will be recorded at each visit during treatment. Discussion: Although an evidence-based process using the best available literature and Delphi expert-opinion method has been used to establish an ERAS pathway of integrating TCM with western medicine. But, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of ERAS pathway Trial registration: Registered on 12 Oct 2019; Trial number is ChiCTR190t0026487 Keywords: intertrochanteric fracture; enhanced recovery after surgery; perioperative period; integrating TCM with and western medicine; randomized controlled trial

Preoperative assessment in coronary bypass surgery

2021 ◽  
pp. 155-160
Author(s):  
Daniel Sellers ◽  
George Djaiani
Keyword(s):  
Enhanced Recovery ◽  
Coronary Revascularization ◽  
Coronary Bypass ◽  
Preoperative Assessment ◽  
Recovery Process ◽  
Normal Function ◽  
Evidence Based ◽  
Care Givers ◽  
Revascularization Surgery

Coronary revascularization surgery has become extremely safe over the past 50 years, in terms of absolute mortality. However, in an era where quality of care and recovery are increasingly scrutinized, complications such as stroke, cognitive impairment, prolonged ventilation, renal impairment, wound infection, and even blood transfusion are increasingly important, with rapid recovery to normal function routinely expected by patients, care givers, and healthcare systems alike. These complications are ideally prevented or mitigated preoperatively, with a thorough system of preassessment, targeted evidence-based therapies to reduce morbidity, and careful risk assessment as part of a coherent perioperative approach. This chapter reviews the potential for each of these interventions to improve postoperative outcomes, in addition to an enhanced recovery process, and summarizes them in a schema ready to be introduced into practice.

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