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Inch pebbles and nudges: management of change
Published in Emma Stanton, Claire Lemer, MBA for Medics, 2021
Looking atTable 11.1, it is possible to see how to proceed. First, identifying change that works both from materials available from the NHS Institute for Innovation and Improvement; then to elucidate and express the goal: creating a one-stop shop and streamlined care pathway for cataracts; in addition, creating a real-time focus by communicating to the local GPs that this is St Anywherés vision. In addition, the order of events becomes important: first, streamline pre-operative care, so that visits include measurements for surgery; pre-assessment by anaesthetics and consent all happen in one short visit rather than multiple seemingly unending visits.
Surgical Facilities, Peri-Operative Care, Anesthesia, and Surgical Techniques
Published in Yuehuei H. An, Richard J. Friedman, Animal Models in Orthopaedic Research, 2020
Alison C. Smith, M. Michael Swindle
Preoperative care procedures and health monitoring will vary with the species utilized and the requirements of the experiment. All protocols should require the use of healthy and relatively young animals. Knowledge of the times of closure of various growth plates for the species utilized is often a determining factor for selecting the age range for the species to be ordered for orthopaedic research.7-10
Special considerations: Alzheimer’s disease
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Christopher G. Sinon, Sona Shah Arora, Amy D. Rodriguez, Paul S. García
Alzheimer’s disease is increasing in prevalence in our operating rooms. The mechanisms involved in the progression of this neurodegenerative disease overlap with cellular pathways important for our anesthesia drugs. After identifying at-risk patients—such as geriatric patients with or at risk of AD—anesthesiologists can take steps to limit PPNDs. Although further research is necessary, it appears that educating patients about the perioperative experience and introducing a geriatrician to the preoperative care team may be helpful. From a pharmacologic standpoint, limiting the use of drugs such as benzodiazepines and anticholinergics that have an association with delirium already may reduce its incidence. Since polypharmacy is a risk factor for PPNDs, continuous reevaluation of a geriatric patient's overall medication regimen may allow anesthesiologists to eliminate unneeded agents and to have a greater appreciation of possible negative synergistic effects.
Sixth Annual Enhanced Recovery After Surgery Symposium highlights: work in progress or standard care?
Published in Baylor University Medical Center Proceedings, 2023
Lucas Fair, Elizabeth Duggan, Evan P. Dellinger, Nicole Bedros, Kimberly Godawa, Cynthia Krusinski, Rachel Curran, Charlette Hart, Alex Zhu, Walter Peters, James Fleshman, Alessandro Fichera
There are challenges with interpretation of the available literature as it pertains to enhanced recovery pathways for nonelective, emergency abdominal surgeries. When considering the existing literature, the data pertaining to ERAS after emergency general surgery has demonstrated associations with reduction in postoperative complications, mortality, and length of stay.41 However, there are difficulties in applying protocolized recovery pathways to the wide variety of abdominal surgical pathologies and to the acutely ill emergency general surgery patient in the nonelective setting. Recently, guidelines for preoperative care in emergency laparotomy were published by the ERAS Society. These guidelines included strong recommendations for early resuscitation and correction of physiologic derangements, validated sepsis scores, early imaging, early surgery and source control of sepsis, validated risk assessments, age-related evaluations of frailty and cognitive function, reversal of antithrombotic medications when indicated, appropriate assessment of venous thromboembolism risk, avoidance of preoperative sedatives, multimodal analgesia, preoperative nasogastric tube intubation, and shared decision making with patients and families.41 In conclusion, while enhanced recovery has certainly seeded itself as the standard of care in the management of the elective surgical patient, despite its extrapolated potential benefits to the emergency general surgery patient, more investigation and insight is needed.
Factors influencing intraoperative blood loss and hemoglobin drop during laparoscopic myomectomy: a tailored approach is possible?
Published in Journal of Obstetrics and Gynaecology, 2022
Giovanni Delli Carpini, Stefano Morini, Dimitrios Tsiroglou, Valeria Verdecchia, Michele Montanari, Valentina Donati, Luca Giannella, Luca Burattini, Stefano Raffaele Giannubilo, Andrea Ciavattini
The results of the present study highlight how preoperative ultrasound evaluation is a crucial step in presurgical evaluation. Indeed, since the number of fibroids and their localisation at preoperative ultrasound can be used to predict blood loss, a tailored approach could be proposed to optimise preoperative Hb values, particularly in those women in which a higher blood loss is expected. On the other hand, women with low preoperative Hb values who need urgent intervention or to be scheduled shortly and who cannot wait for interventions to restore adequate Hb values could benefit from intramyometrial injection of epinephrine to further reduce blood loss. The choice to use or not this haemostatic agent could therefore be planned before surgery, during the preoperative care, and adequate counselling could be offered to the patient.
Factors associated with failure of Enhanced Recovery After Surgery (ERAS) in colorectal and gastric surgery
Published in Scandinavian Journal of Gastroenterology, 2019
Yunpeng Zhang, Yufang Xin, Peng Sun, Daqing Cheng, Ming Xu, Ji Chen, Jue Wang, Jianling Jiang
In fact, preoperative care was very different in different countries [10]. Despite the known benefits of ERAS programs, concerns have been raised regarding its use in special situations. For example, characteristics including poor nutritional status, anemia, complex comorbidities and female sex may contribute to delayed recovery and increased morbidity following surgery [11]. Elderly patients may have more postoperative complications and require a longer hospital stays [12]. Although we have a relatively detailed ERAS program, there are still some patients who encountered difficulties halfway. In this study, we aimed to find out the statistical characteristics of drop-out patients and anticipated to design a risk assessment system upon the high-risk patients from the present ERAS pathway .In the perioperative period, a policy to select a program which fits automatically into this special group is much more likely to be beneficial than implementation of a unified algorithm.