Preventive analgesia and beyond: current status, evidence, and future directions
Pamela E Macintyre, Suellen M Walker, David J Rowbotham in Clinical Pain Management, 2008
Figure 9.1 depicts the eight possible treatment combinations of administering or not administering analgesics across the three perioperative phases (preoperative, intraoperative, and postoperative). The preoperative period encompasses interventions that begin days before surgery and up to those administered just minutes before skin incision. The intraoperative period includes interventions started immediately after incision to those initiated just prior to the end of surgery (i.e. skin closure). The postoperative period includes interventions started immediately after the end of surgery and may extend for days or weeks thereafter. Within each phase there is potential for extensive variability in the timing of administration of analgesic agents. While this potential is greatest in the pre- and postoperative phases (e.g. ranging from minutes to days or weeks) even within the intraoperative period, evidence shows that there are considerable interstudy differences in timing of the postincisional intervention (e.g. ranging from minutes to hours).
Perioperative issues
Neeraj Sethi, R. James A. England, Neil de Zoysa in Head, Neck and Thyroid Surgery, 2020
Within the oncogeriatric population, where (radical) surgery offers an important curative modality for head, neck and thyroid cancer, decision-making and perioperative care particularly challenges the surgeon. It is increasingly recognised that many perioperative complications experienced by older surgical patients are in fact medical and not necessarily related to the specific surgical procedure. This observation has generated authoritative guidelines and successful models of geriatrician-led preoperative optimisation and proactive, embedded surgical liaison [3–5]. These models of care probably represent a future surgical model whereby issues with surgical training [6] can be overcome by greater collaboration between surgical and medical teams. For now, perioperative medicine remains the responsibility of the surgical team, with support from perioperative physicians, most of whom remain anaesthetists.
Surgical Management of Placenta Accreta
Robert M. Silver in Placenta Accreta Syndrome, 2017
Other intraoperative and perioperative complications include intestinal injury, vascular injury, wound complications, reoperation, venous thromboembolism, pelvic abscess, wound infections, and prolonged hospital and ICU stays. Currently, there are no guidelines clearly defining which patients require admission to the ICU after hysterectomy for accreta and hospital protocols and practices vary. Clear indications include prolonged need of mechanical ventilation, persistent hypotension requiring vasoactive medications, coagulopathy and severe anemia, and any evidence of renal, cardiac, and other end organ dysfunction. If none of these indications exists, transfer to the ICU should remain at the discretion of the surgical and anesthesia teams, and is dependent on institutional practices.
Development of a list of high-risk perioperative medications for the elderly: a Delphi method
Published in Expert Opinion on Drug Safety, 2019
Ke Wang, Jianghua Shen, Dechun Jiang, Xiaoxuan Xing, Siyan Zhan, Suying Yan
Perioperative period mostly refers to the period of time starting from entering the hospital for surgical treatment till discharge [16]. However, there is no clear definition of the specific length of this period. Hence, this list is suitable for drug screening during the entire period of hospitalization. By reducing the use of high-risk drugs and incidence of perioperative adverse events, hospitalization time and related costs can be reduced, and patient satisfaction can be improved. Previous studies have reported potentially inappropriate medications for the elderly population focusing on high-risk medications and improvement in medication safety [17] without specifying any particular time period. This list focuses on the main risk profiles that could affect perioperative outcomes. Its application range is narrower than that of the PIM list, and hence, the feasibility is higher. Moreover, the guidelines for perioperative medication management have pointed out the advantages and disadvantages of continuing use and stopping medications, but they have not specifically considered the risks and treatment recommendations from the perspective of the elderly population. In this study, the contents of the above guidelines were combined with the expert argumentation to form a drug list for the elderly population and a consensus was reached on the circumvention recommendations for clinical reference. The list focuses on providing pharmacy services to elderly patients in the perioperative period to increase help in clinical decision making.
Can Applying a Risk Stratification System, Preoperatively, Reduce Intraoperative Complications during Phacoemulsification?
Published in Current Eye Research, 2021
Pakinee Pooprasert, James Hansell, Tafadzwa Young-Zvandasara, Mohammed Muhtaseb
Amongst the principles of providing healthcare is the need for safe surgery. Guidance from the Royal College of Ophthalmologists states the aims of modern cataract surgery is not only the restoration of vision and to achieve the desired refractive outcome but also improvement in quality of life and ensuring patient safety and satisfaction. 1 Similar guidance is reiterated by other Colleges, Academies and Societies such as the American Academy of Ophthalmology. Achieving these aims is likely to require an uneventful preoperative, intraoperative and postoperative period. Although all are important for a successful recovery, the intraoperative period is crucial, as a turbulent time during surgery could have an immediate effect in the post-operative period – be it the need for further treatment, a delay in recovery or not reaching the full postoperative visual potential. Cataract surgery is thought to be arguably the most cost-effective procedure in medicine and remains the leading surgical procedure in modern Health Services.2 A good outcome is highly desirable and cataract surgeons are reminded of this by various studies.
Comparison of complication and conversion rates between robotic-assisted and laparoscopic rectal resection for rectal cancer: which patients and providers could benefit most from robotic-assisted surgery?
Published in Journal of Medical Economics, 2018
Stacey J. Ackerman, Shoshana Daniel, Rebecca Baik, Emelline Liu, Shilpa Mehendale, Scott Tackett, Minia Hellan
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedures for rectal resections including anterior and low anterior resections (ICD-9-CM codes 48.62, 48.63, or 48.69) and ICD-9-CM diagnoses for rectal cancer (ICD-9-CM codes 154.0, 154.1, 154.2, 154.3, or 154.8) were used to identify rectal resection procedures for rectal cancer. ICD-9-CM codes were also used to identify conversion to OS (V64.41) and complications (Supplementary Material: Appendix A). Complications were assessed during hospitalization and through 30 days post-discharge; specifically for the intra-operative, initial hospitalization, post-operative 30 day, and perioperative periods, where perioperative is defined as the period from the day of rectal resection procedure through 30 days post-discharge. The specific complications and the corresponding ICD-9-CM codes are provided in Supplementary Material: Appendix B. Surgical modality was identified with ICD-9-CM codes, current procedural terminology (CPT) codes, and text strings available in the Premier database, which are described in the Supplementary Material (Appendix C). Patients identified in the RA or LS group were analyzed in their respective groups, even if they were converted to OS (intent-to-treat analysis).
Related Knowledge Centers
- Anesthesia
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