Enhanced Recovery After Surgery: Standardized Postoperative Instructions in Hand Surgery

Background: Enhanced Recovery After Surgery (ERAS) is a standardized approach to care of the surgical patient. Postoperative patient instructions, an aspect of ERAS protocols, are difficult to standardize in hand surgery because of the diversity of procedures. The aim of this study was to determine the effect of standardized hand surgery postoperative instructions on the number of unscheduled postoperative patient encounters. Methods: The study was an institutional review board-approved prospective cohort in which all hand surgery patients from 6 surgeons at a single, hospital-based academic institution were included. For a 6-month period, both before and after establishing a standardized postoperative instructional handout, data were collected on unscheduled postoperative encounters within 14 days of surgery. Results: There were 330 patients in the control group versus 282 who received standardized postoperative instructions. Trauma comprised 24.6% of cases in comparison to 75.4% elective. Individual surgeons did not significantly influence whether patients had an encounter. Overall, patients who received standardized instructions were just as likely as the control group to have unscheduled encounters (41.5% vs 43.9%, respectively). Notably, elective patients were significantly more likely to have encounters (46%) versus trauma patients (33.1%; P = .007); however, the standardized instructions did not influence the number of encounters for either group. Conclusions: This study did not demonstrate a difference in unscheduled postoperative encounters after initiation of standardized postoperative instructions for hand surgery patients. These findings may help providers save time and resources by tailoring the use of ERAS in this distinct patient population.

Allergic Contact Dermatitis Due to Cervical Collar

Cervical collars are routinely applied in neurosurgical units following trauma or cervical spine operations. We describe a case of florid allergic contact dermatitis that developed as a complication following collar application in a postoperative patient.

The Implementation of Modified ERAS Protocol in Laparoscopic Radical Cystectomy: An Outcome at Universitas Gadjah Mada Urological Institute

Background: Enhanced recovery after surgery (ERAS) protocol is multimodal perioperative care designed to achieve enhanced postoperative outcomes. Unfortunately, all these elements are not always fully applied due to each center’s limitations. In this study, the ERAS protocol was modified and implemented in patients with bladder cancer who underwent laparoscopic radical cystectomy (LRC). This study aimed to evaluate the outcomes of the modified ERAS protocol in LRC surgery. Methods: The retrospective study design was used to evaluate 35 patients (27 males and 8 females) who underwent LRC with the application of the perioperative modified ERAS protocol. All information relating to perioperative, intraoperative, and postoperative patient data was obtained from medical records. All complications that occurred were classified according to the Clavien-Dindo classification.Results: The mean age in this study was 58.3 ± 9.2, and the most common pathological finding was urothelial carcinoma. Intraoperative blood loss was 318.5 ± 112.5 cc with those requiring intraoperative blood transfusion of 4.8 ± 2.0 patients. The mean first diet was 2.1 ± 1.2 days. For bowel activities, the first flatulence was 1.6 ± 0.8 days. The mean mobilization with first sitting was 1.8 ± 0.9 days. Seventeen percent of patients experienced intraoperative complications and postoperative complications were encountered in 28.6% of patients. According to the ClavienDindo classification, most complications were grades 1-2 (17.1%). There was no incidence of mortality in this study.Conclusions: These promising results, including the postoperative recovery and complications rates, require validation with multi-center and randomized studies to confirm the benefits of the modified ERAS protocol in minimally invasive procedures, especially LRC surgery

The Role of Electrical Impedance Tomography for Management of High-Risk Pulmonary Embolism in a Postoperative Patient

Electrical impedance tomography (EIT) is a non-invasive, radiation-free and bedside imaging tool that is widely used for real-time monitoring of lung ventilation. Recently, it has been proposed for use in quantitative assessment of regional lung perfusion with hypertonic saline bolus injection and consequently for pulmonary embolism (PE) detection. Here, we present a case of high-risk PE in a postoperative patient, in which EIT monitoring provided us with useful information for diagnosis and decision-making, especially with the challenge of anticoagulation and risk of bleeding.

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

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.

Music Intervention to Orthopedic Patients: A Possible Alternative Solution to Control Pain

Aims and Objective. Pain is a common problem associated with postoperative orthopedic patients; the current study is aimed at evaluating music intervention as an alternative method to control pain. Methodology. The experimental design of the current study was comparative, descriptive, and quasi-experimental. 38 postoperative orthopedic patients were equipped with pocket-size MP3 players with prerecorded music tracks (instrumental and lyrical) in Hindi, English, and Urdu. After that, pre-post-pain scores were recorded with the help of designed brief patient logs. Ultimately, a satisfactory survey was completed at discharge. Major Findings. It was found that during the intervention of music, the pain was significantly reduced from 5.40 to 2.98. There was a slight relationship between listening time and pain relief. It was also found that the feedback was extremely positive and each patient suggested the use of music to others with 96.6% recommendation. Conclusion. From the current study, it was found that music intervention can be beneficial to postoperative patient pain control. Further, it is hoped that the findings of the current experimental work will lead to improvements in the care of postoperative patients.