scholarly journals EFEKTIVITAS PREEMTIF KETAMIN SUB DOSIS DALAM MENGURANGI KEBUTUHAN OPIOID INTRAOPERATIF DAN LAMA WAKTU EKSTUBASI

2021 ◽  
Vol 10 (2) ◽  
pp. 88-98
Author(s):  
Rizky Bagoes Septyawan
Keyword(s):  
Patient Outcomes ◽  
Low Dose ◽  
Perioperative Management ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
P Value ◽  
Preoperative Fasting ◽  
Postoperative Patient ◽  
Fentanyl Administration ◽  
Single Blind

Surgical perioperative management undergoes updates to support postoperative patient outcomes. The concept of longer preoperative fasting times, cleansing ofthe gastrointestinal tract, and re-feeding after 3-5 days after surgery has begun to be abandoned which is then formulated into a new protocol called ERAS(Enhanced Recovery After Surgery) including preoperative counseling, optimization of nutrients, the use of standard anesthesia and analgesy drugs, as well asearly mobilization using the concept of preemptive analgesia. The use of low-dose ketamine for postoperative analgesia has evolved in part due to nmdaantagonistic properties that reduce central sensitization and opioid tolerance but are still controversial. This study aims to study the effects of low-dose ketamineas a preemptive and evaluate the total needs of opiods, as well as the length of time extubation with single blind experimental research. Patients with label A gotpreemptive therapy of subdose ketamine while label B got perioperative standard analgesia therapy. Analgesia in groups A and B is administered before surgery.Treatment control is done with single blind control that is the patient does not know the type of drug given. The comparison of the amount of fentanyl in the controlgroup and treatment in this study was significantly different (p=0.044). The old comparison of extubation in both groups obtained a significant p value (<0.0001).Preemptive administration of subdose ketamine effectively decreases the amount of fentanyl administration used during surgery and shortens the extucation time. Keywords: Preemptive; Ketamin subdose; Fentanil; Extucation Time.

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.

Observations from Implementation of the ERAS Protocol after DIEP Flap Breast Reconstruction

2021 ◽  
Author(s):  
Nicholas T. Haddock ◽  
Ricardo Garza ◽  
Carolyn E. Boyle ◽  
Sumeet S. Teotia
Keyword(s):  
Breast Reconstruction ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Compliance Rate ◽  
Fluid Management ◽  
Control Group ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Eras Protocol

Abstract Background The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and obstacles for its implementation at a single academic institution. Methods This is a retrospective study looking at patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction from January 2016 to September 2019. The ERAS protocol was implemented on select patients early 2017, with patients from 2016 acting as a control. Thirteen points from the protocol were identified and gathered from the patient's electronic medical record (EMR) to evaluate compliance. Results Two hundred and six patients were eligible for the study, with 67 on the control group. An average of 6.97 components were met in the pre-ERAS group. This number rose to 8.33 by the end of 2017. Compliance peaked with 10.53 components met at the beginning of 2019. The interventions most responsible for this increase were administration of preoperative medications, goal-oriented intraoperative fluid management, and administration of scheduled gabapentin postoperatively. The least met criterion was intraoperative ketamine goal of >0.2 mg/kg/h, with a maximum compliance rate of 8.69% of the time. Conclusion The introduction of new protocols can take over a year for full implementation. This is especially true for protocols as complex as an ERAS pathway. Even after years of consistent use, compliance gaps remain. Staff-, patient-, or resource-related issues are responsible for these discrepancies. It is important to identify these issues to address them and optimize patient outcomes.

Preoperative fasting abbreviation (Enhanced Recovery After Surgery protocol) and effects on the metabolism of patients undergoing gynecological surgeries under spinal anesthesia: A randomized clinical trial

Nutrition ◽  
2020 ◽  
Vol 77 ◽  
pp. 110790
Author(s):  
Gisele Vissoci Marquini ◽  
Francisco Edes da Silva Pinheiro ◽  
Alfredo Urbano da Costa Vieira ◽  
Rogério Melo da Costa Pinto ◽  
Maria Gabriela Baumgarten Kuster Uyeda ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Spinal Anesthesia ◽  
Randomized Clinical Trial ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Preoperative Fasting

scholarly journals Comparative Effectiveness of Enhanced Recovery After Surgery Program Combined With Single-Incision Laparoscopic Surgery in Colorectal Cancer Surgery: A Retrospective Analysis

2022 ◽  
Vol 11 ◽  
Author(s):  
Changgang Wang ◽  
Haoran Feng ◽  
Xiaoning Zhu ◽  
Zijia Song ◽  
You Li ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Retrospective Study ◽  
Perioperative Management ◽  
Single Incision ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Single Incision Laparoscopic Surgery ◽  
Group A ◽  
Group B

BackgroundRecently, enhanced recovery after surgery (ERAS) has been widely used in the perioperative management of colorectal cancer (CRC). This study aimed to evaluate the safety and feasibility of ERAS combined with single-incision laparoscopic surgery (SILS) in CRC surgery.MethodsThis was a retrospective study of patients with CRC who underwent surgery between April 2018 and April 2020 in Ruijin Hospital(North), Shanghai Jiaotong University School of Medicine. The patients were divided into three groups: group A (n=138), patients who underwent traditional multiport laparoscopic colectomy with conventional perioperative management; group B (n=63), patients who underwent SILS; and group C (n=51), patients who underwent SILS with ERAS.ResultsOverall, 252 participants were included in the retrospective study. The median operation time (min) in group B and group C was shorter than that in group A (group A 134.0 ± 42.5; group B 117 ± 38.9; group C 111.7 ± 35.4, p=0.004). The estimated surgical blood loss (ml) was lower in groups B and C than in group A (group A 165.1 ± 142.2; group B 122.0 ± 79.4; group C 105.2 ± 55.8, p=0.011). The length of surgical incision (cm) was shorter in groups B and C than in group A (group A 7.34 ± 1.05; group B 5.60 ± 0.80; group C 5.28 ± 0.52, p&lt;0.001). The time before first flatus (hours) in group C was shorter than in groups A and B (group A 61.85 ± 21.14; group B 58.30 ± 20.08; group C 42.06 ± 23.72; p&lt;0.001). The days prior to the administration of free oral fluids in group C was shorter than in groups A and B (group A 4.79 ± 1.28; group B 4.67 ± 1.11; group C 2.62 ± 0.64; p&lt;0.001). The days of prior solid diet was less in group C than in groups A and B (group A 7.22 ± 3.87; group B 7.08 ± 3.18; group C 5.75 ± 1.70; p=0.027). The postoperative length of stay (LOS) was less in group C compared with that in groups A and B (group A 9.46 ± 4.84 days; group B 9.52 ± 7.45 days; group C 7.20 ± 2.37 days; p=0.023). The visual analog scale (VAS) scores on day 0, 1, and 2 in groups B and C were lower than those in group A (day 0, p&lt;0.001; day 1, p&lt;0.001; day 2, p=0.002), while the VAS score on day 3 showed no differences in the three groups (group A 1.29 ± 1.38; group B 0.98 ± 1.24; group C 0.75 ± 0.64, p=0.018).ConclusionThe findings suggest that SILS combined with ERAS may be a feasible and safe procedure for CRC surgery because it provides favorable cosmetic results, early dietary resumption, shorter hospital stays, and appropriate control of postoperative pain without increases in complications or readmission rates compared to conventional perioperative care with SILS or conventional laparoscopic surgery(CLS) of CRC. Further prospective randomized controlled studies are needed to enhance evidence-based medical evidence.

Enhanced recovery after surgery (ERAS): a literature review of implications for ostomates and stoma care nurses

2020 ◽  
Vol 18 (1) ◽  
pp. 32-37
Author(s):  
Jenny Marsden
Keyword(s):  
Patient Education ◽  
Literature Review ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Hospital Service ◽  
Patient Support ◽  
Elective Patient ◽  
Added Benefit ◽  
Stoma Care

This article explores the rationale behind enhanced recovery after surgery (ERAS), and the implications for both patients and stoma care nurses (SCNs). ERAS is used for many elective patient surgical pathways worldwide. The aim is to reduce hospital stay, maximise patient outcomes and minimise complications, with the added benefit of reducing cost for the hospital service provider. The literature demonstrates that centres adhere to the various modalities of the ERAS pathway differently; however, the outcomes follow similar trends. The SCN plays a key role in the education of stoma patients on the ERAS pathway. With intensive pre- and postoperative training, the need for patient education in stoma self-care should not delay discharge. The SCN also needs to be easily accessible for patient support and review, preventing unnecessary readmission to hospital. When asked, patients are happy with their pathway and level of support received from the SCN.

scholarly journals Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial

2019 ◽  
Vol 130 (5) ◽  
pp. 1680-1691 ◽  
Author(s):  
Yuan Wang ◽  
Bolin Liu ◽  
Tianzhi Zhao ◽  
Binfang Zhao ◽  
Daihua Yu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Perioperative Management ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Tertiary Care ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Complication Rates ◽  
Safety And Efficacy ◽  
Eras Protocol

OBJECTIVEAlthough enhanced recovery after surgery (ERAS) programs have gained acceptance in various surgical specialties, no established neurosurgical ERAS protocol for patients undergoing elective craniotomy has been reported in the literature. Here, the authors describe the design, implementation, safety, and efficacy of a novel neurosurgical ERAS protocol for elective craniotomy in a tertiary care medical center located in China.METHODSA multidisciplinary neurosurgical ERAS protocol for elective craniotomy was developed based on the best available evidence. A total of 140 patients undergoing elective craniotomy between October 2016 and May 2017 were enrolled in a randomized clinical trial comparing this novel protocol to conventional neurosurgical perioperative management. The primary endpoint of this study was the postoperative hospital length of stay (LOS). Postoperative morbidity, perioperative complications, postoperative pain scores, postoperative nausea and vomiting, duration of urinary catheterization, time to first solid meal, and patient satisfaction were secondary endpoints.RESULTSThe median postoperative hospital LOS (4 days) was significantly shorter with the incorporation of the ERAS protocol than that with conventional perioperative management (7 days, p < 0.0001). No 30-day readmission or reoperation occurred in either group. More patients in the ERAS group reported mild pain (visual analog scale score 1–3) on postoperative day 1 than those in the control group (79% vs. 33%, OR 7.49, 95% CI 3.51–15.99, p < 0.0001). Similarly, more patients in the ERAS group had a shortened duration of pain (1–2 days; 53% vs. 17%, OR 0.64, 95% CI 0.29–1.37, p = 0.0001). The urinary catheter was removed within 6 hours after surgery in 74% patients in the ERAS group (OR 400.1, 95% CI 23.56–6796, p < 0.0001). The time to first oral liquid intake was a median of 8 hours in the ERAS group compared to 11 hours in the control group (p < 0.0001), and solid food intake occurred at a median of 24 hours in the ERAS group compared to 72 hours in the control group (p < 0.0001).CONCLUSIONSThis multidisciplinary, evidence-based, neurosurgical ERAS protocol for elective craniotomy appears to have significant benefits over conventional perioperative management. Implementation of ERAS is associated with a significant reduction in the postoperative hospital stay and an acceleration in recovery, without increasing complication rates related to elective craniotomy. Further evaluation of this protocol in large multicenter studies is warranted.Clinical trial registration no.: ChiCTR-INR-16009662 (chictr.org.cn)

scholarly journals Does Implementation of Enhanced Recovery after Surgery (ERAS) Protocols in Colorectal Surgery Improve Patient Outcomes?

2019 ◽  
Vol 32 (02) ◽  
pp. 109-113 ◽  
Author(s):  
Julia Berian ◽  
Clifford Ko ◽  
Kristen Ban
Keyword(s):  
Colorectal Surgery ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Process Measures ◽  
Improved Outcomes ◽  
Preoperative Carbohydrate Loading ◽  
Eras Protocol ◽  
Implementation Data ◽  
Improve Patient

AbstractEnhanced Recovery after Surgery (ERAS) protocols are multimodal perioperative care pathways designed to accelerate recovery by minimizing the physiologic stress of a surgical procedure. Benefits of ERAS implementation in colorectal surgery include reduced length of stay and decreased complications without an increase in readmissions. Though there is evidence associating individual ERAS protocol elements (e.g., preoperative carbohydrate loading, judicious perioperative fluid administration, and early initiation of postoperative nutrition) with improved outcomes, ensuring high compliance with all elements of an ERAS protocol will maximize benefits to the patient. After ERAS implementation, data collection on protocol process measures can help providers target education and interventions to improve protocol compliance and patient outcomes.

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