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Kabanovski A, Popovic MM, Kalaichandran S, Arzola C, Rai A, Ramwani J, Minotti SC, Ma J, Chandrakumar M, El-Defrawy S, Schlenker MB. Validation of a novel patient satisfaction questionnaire for preoperative fasting in cataract surgery: a discrimination analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:401-407. [PMID: 35780859 DOI: 10.1016/j.jcjo.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 05/24/2022] [Accepted: 06/07/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Preoperative fasting is routinely performed to prevent anaesthesia-related pulmonary aspiration. To capture patients' experiences with preoperative fasting, a 13-item questionnaire was developed and validated using Rasch analysis and shortened to 6 items. This extension study aims to assess this questionnaire's ability to discriminate between participants with a short versus long duration of fasting and early versus late day surgery. DESIGN Single-centred cross-sectional study. PARTICIPANTS Subjects were recruited via consecutive sampling of cataract patients on surgery day at Kensington Eye Institute in Toronto from February to December 2019. METHODS A validated preoperative fasting questionnaire was administered. Discriminative ability was assessed by comparing responses in patients scheduled for surgery in the morning (8:00 am-12:00 pm) versus afternoon (12:00 pm-3:30 pm) and fasting for short (≤8 hours) versus long (>8 hours) duration. Diagnostic ability of the 6-item questionnaire relative to the 13-item questionnaire was assessed with receiver operating characteristics curve analysis. RESULTS A total of 164 patients (mean age 70.8 ± 10.0 years; 57% female) were included. Total scores of patients having surgery in the morning were greater (i.e., less fasting-related burden) than in the afternoon (p = 0.04). There was no significant difference in scores between patients fasting for a short versus long duration (p > 0.05). Receiver operating characteristics curve analysis showed excellent diagnostic ability of the 6-item questionnaire relative to the 13-item version (area under the curve = 0.964). CONCLUSION The 6-item questionnaire for fasting-related burden has excellent discriminative ability between early versus late surgery patients. The time fasting while awake may be a more relevant predictor of fasting-related burden relative to the total duration of fasting.
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Affiliation(s)
- Anna Kabanovski
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | | | - Cristian Arzola
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ont
| | - Amandeep Rai
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Jaya Ramwani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Simona C Minotti
- Institute for Better Health, Trillium Health Partners, Mississauga, Ont.; Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Julia Ma
- Institute for Better Health, Trillium Health Partners, Mississauga, Ont
| | | | - Sherif El-Defrawy
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Matthew B Schlenker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Institute for Better Health, Trillium Health Partners, Mississauga, Ont..
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Fujino E, Cobb KW, Schoenherr J, Gouker L, Lund E. Anesthesia Considerations for a Patient on Semaglutide and Delayed Gastric Emptying. Cureus 2023; 15:e42153. [PMID: 37602101 PMCID: PMC10438952 DOI: 10.7759/cureus.42153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Semaglutide is a class of long-acting glucagon-like peptide-1 receptor agonists (GLP1-RA) used for the treatment of type 2 diabetes mellitus (T2DM) and obesity. We present a 31-year-old female patient with a past medical history of T2DM without complication and no long-term or current use of insulin, class 3 obesity, hypertension, hyperlipidemia, polycystic ovary syndrome (PCOS), and anxiety, who underwent an esophagogastroduodenoscopy (EGD) in preparation for bariatric surgery while taking semaglutide. Despite appropriately following the preoperative fasting guidelines of the American Society of Anesthesiologists (ASA), endoscopy revealed food residue in the gastric body, necessitating abortion of the procedure to reduce the risk of intraoperative pulmonary aspiration. Given the lack of preoperative fasting guidelines for patients on semaglutide to date, and delayed gastric emptying being a known side effect among patients taking semaglutide, anesthesiologists should be aware of alternative methods to ensure no food is present in the stomach to mitigate the risk of pulmonary aspiration during general anesthesia.
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Affiliation(s)
- Erina Fujino
- Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Kathryn W Cobb
- Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Jay Schoenherr
- Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Lindsey Gouker
- Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Elisa Lund
- Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
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Popovic MM, Kalaichandran S, Kabanovski A, El-Defrawy S, Arzola C, Rai A, Ramwani J, Minotti SC, Ma J, Chandrakumar M, Schlenker M. Development and Validation of a Questionnaire Assessing Patient Distress from Preoperative Fasting in Cataract Surgery. Ophthalmic Epidemiol 2020; 28:337-348. [PMID: 33225790 DOI: 10.1080/09286586.2020.1849742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To develop and psychometrically validate a questionnaire to measure patient distress with preoperative fasting related to cataract surgery.Methods: In this single-centered cross-sectional study, consecutive sampling of cataract patients was undertaken immediately preoperatively from February to December 2019. A questionnaire evaluating patient distress with fasting was designed and administered. Questionnaire development occurred in an iterative process and was conducted with consultation from expert investigators and patients. Validation and psychometric evaluation of the questionnaire were performed with Rasch analysis.Results: A preliminary version of the questionnaire was developed by 10 study investigators. Across five iterations of development, the questionnaire was administered to 186 cataract patients. Psychometric evaluation of the 13-item questionnaire demonstrated ordered thresholds, acceptable item calibration and fit, adequate internal consistency, ability to discriminate between three levels of distress from preoperative fasting and no notable differential item functioning. However, issues with mistargeting, clustering of items on the person-item map and multidimensionality remained. Given these concerns, 13 separate re-analyses were conducted via removal of certain items. A 6-item subset was determined to be well targeted, unidimensional, did not display item clustering and was able to discriminate between patients with high and low distress from preoperative fasting.Conclusion: A 6-item questionnaire is a valid, psychometrically robust and reliable measure for the assessment of patient distress with preoperative fasting in cataract surgery. Items include hunger, thirst, hoarseness, weakness, anxiety and nausea. Future studies should seek to validate this questionnaire across a variety of sociodemographic contexts, languages and specialties.
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Affiliation(s)
- Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Anna Kabanovski
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sherif El-Defrawy
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Christian Arzola
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Amandeep Rai
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Jaya Ramwani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Simona C Minotti
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milano, Italy
| | - Julia Ma
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | | | - Matthew Schlenker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
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St. Pierre M, Krischke F, Luetcke B, Schmidt J. The influence of different patient positions during rapid induction with severe regurgitation on the volume of aspirate and time to intubation: a prospective randomised manikin simulation study. BMC Anesthesiol 2019; 19:16. [PMID: 30678655 PMCID: PMC6346548 DOI: 10.1186/s12871-019-0686-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/15/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Aspiration is a main contributor to morbidity and mortality in anaesthesia. The ideal patient positioning for rapid sequence induction remains controversial. A head-down tilt and full cervical spine extension (Sellick) might prevent aspiration but at the same time compromise airway management. We aimed to determine the influence of three different positions during induction of general anaesthesia on the volume of aspirate and on participants' airway management. METHODS Eighty-four anaesthetic trainees and consultants participated in a prospective randomised simulation study. Anaesthesia was induced in reverse Trendelenburg position (+ 15°) in a manikin capable of dynamic fluid regurgitation. Participants were randomised to change to Trendelenburg position (- 15°) a) as soon as regurgitation was noticed, b) as soon as 'patient' had been anaesthetised, and c) as soon as 'patient' had been anaesthetised and with full cervical spine extension (Sellick). Primary endpoints were the aspirated volume and the time to intubation. Secondary endpoints were ratings of the laryngoscopic view and the intubation situation (0-100 mm). RESULTS Combining head-down tilt with Sellick position significantly reduced aspiration (p < 0.005). Median time to intubate was longer in Sellick position (15 s [8-30]) as compared with the head in sniffing position (10 s [8-12.5]; p < 0.05). Participants found laryngoscopy more difficult in Sellick position (39.3 ± 27.9 mm) as compared with the sniffing position (23.1 ± 22.1 mm; p < 0.05). Both head-down tilt intubation situations were considered equally difficult: 34.8 ± 24.6 mm (Sniffing) vs. 44.2 ± 23.1 mm (Sellick; p = n.s). CONCLUSIONS In a simulated setting, using a manikin-based simulator capable of fluid regurgitation, a - 15° head-down tilt with Sellick position reduced the amount of aspirated fluid but increased the difficulty in visualising the vocal cords and prolonged the time taken to intubate. Assessing the airway management in the identical position in healthy patients without risk of aspiration might be a promising next step to take.
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Affiliation(s)
- Michael St. Pierre
- Anästhesiologische Klinik, Universitätsklinikum Erlangen, Krankenhaustrasse 12, 91054 Erlangen, Germany
| | - Frederick Krischke
- Anästhesiologische Klinik, Universitätsklinikum Erlangen, Krankenhaustrasse 12, 91054 Erlangen, Germany
| | - Bjoern Luetcke
- Anästhesiologische Klinik, Universitätsklinikum Erlangen, Krankenhaustrasse 12, 91054 Erlangen, Germany
| | - Joachim Schmidt
- Anästhesiologische Klinik, Universitätsklinikum Erlangen, Krankenhaustrasse 12, 91054 Erlangen, Germany
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Popovic M, Schlenker MB, Goldshtein D, Rai A, El-Defrawy S. Preoperative fasting for ambulatory cataract surgery: asystematic review. Can J Ophthalmol 2018; 54:145-149. [PMID: 30975334 DOI: 10.1016/j.jcjo.2018.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/14/2018] [Indexed: 11/26/2022]
Abstract
Given the lack of policy standardization in Canada, this systematic review investigates the optimal duration of preoperative fasting in cataract surgery. A literature search was conducted on Ovid MEDLINE, with potential articles screened by 2 independent authors. The primary endpoint was the incidence of aspiration. Overall, 231 articles were screened, of which 6 were eligible. Two studies found no cases of aspiration in over 35 000 patients who underwent cataract surgery without preoperative fasting, some with intravenous sedation (50% in 1 series, less than 1% in the second). A survey of the British Ophthalmic Anaesthesia Society found that over 50% of centres did not require fasting before cataract surgery. Only 1 included report discussed a case of aspiration pneumonitis following cataract surgery with general anaesthesia and 14hours of preoperative fasting. In closing, further evidence is needed to delineate the risk of pulmonary aspiration based on fasting time in cataract surgery.
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Affiliation(s)
- Marko Popovic
- Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Matthew B Schlenker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | | | - Amandeep Rai
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Sherif El-Defrawy
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont..
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Lalic-Popovic M, Paunkovic J, Grujic Z, Golocorbin-Kon S, Vasovic V, Al-Salami H, Mikov M. The Effect of Diabetes and Hypertension on the Placental Permeation of the Hydrophilic Drug, Ranitidine. Placenta 2016; 48:144-150. [PMID: 27871467 DOI: 10.1016/j.placenta.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Ranitidine is a hydrophilic weak base and an H2-receptor antagonist which is commonly used for gastroesophageal reflux, including during pregnancy. It has limited placental permeation and can be used as a pre-anesthetic antacid to prevent aspiration of acidic stomach contents. Recent studies suggest that diabetes and hypertension may influence placental permeation of hydrophilic drugs. Thus, this study aimed to investigate the influence of diabetes and hypertension on ranitidine's placental permeation in pregnant women. METHODS Forty one pregnant women all scheduled for elective cesarean section entered the study: healthy control (n = 15), with hypertension (n = 16) and with gestational diabetes (n = 10). All women received 50 mg of ranitidine intravenously. Three samples of maternal plasma (after ranitidine application, at delivery and after delivery), and two umbilical cord samples (arterial and venous blood) were collected and analyzed for ranitidine concentrations. Maternal pharmacokinetic parameter were calculated as well as feto:maternal and umbilical cord arterial to venous concentration ratios. RESULTS Ranitidine maternal and umbilical cord (arterial and venous) concentrations were similar in all three groups and there were no difference between feto:maternal ratios nor volume of distribution, clearance and half life between the groups. DISCUSSION Fetal concentrations are dependent on maternal concentrations in healthy and hypertensive women but not in diabetic women. Hypertension and diabetes did not affect fetal handling of ranitidine. Though hypertension and diabetes did not influence ranitidine placental permeation, it appears they altered time needed to achieve unity between maternal and fetal plasma.
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Affiliation(s)
| | - Jovana Paunkovic
- Health Department in Novi Sad for Women Health Protection, Serbia
| | - Zorica Grujic
- University of Novi Sad, Faculty of Medicine, Department of Gynecology and Obstetistric, Serbia
| | | | - Velibor Vasovic
- University Novi Sad, Faculty of Medicine, Department of Pharmacology, Toxicology and Clinical Pharmacology, Serbia
| | - Hani Al-Salami
- Biotechnology and Drug Development Research Lab, School of Pharmacy, Curtin Health Innovation Research Institute, Curtin University, Perth WA, Australia
| | - Momir Mikov
- University Novi Sad, Faculty of Medicine, Department of Pharmacology, Toxicology and Clinical Pharmacology, Serbia
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Abstract
Acute intraoperative aspiration is a potentially fatal complication with significant associated morbidity. Patients undergoing thoracic surgery are at increased risk for anesthesia-related aspiration, largely due to the predisposing conditions associated with this complication. Awareness of the risk factors, predisposing conditions, maneuvers to decrease risk, and immediate management options by the thoracic surgeon and the anesthesia team is imperative to reducing risk and optimizing patient outcomes associated with acute intraoperative pulmonary aspiration. Based on the root-cause analyses that many of the aspiration events can be traced back to provider factors, having an experienced anesthesiologist present for high-risk cases is also critical.
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Affiliation(s)
- Katie S Nason
- Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, 5200 Centre Avenue, Suite 715, Shadyside Medical Building, Pittsburgh, PA 15232, USA.
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Grade M, Quintel M, Ghadimi BM. Standard perioperative management in gastrointestinal surgery. Langenbecks Arch Surg 2011; 396:591-606. [PMID: 21448724 PMCID: PMC3101361 DOI: 10.1007/s00423-011-0782-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 03/08/2011] [Indexed: 01/08/2023]
Abstract
Introduction The outcome of patients who are scheduled for gastrointestinal surgery is influenced by various factors, the most important being the age and comorbidities of the patient, the complexity of the surgical procedure and the management of postoperative recovery. To improve patient outcome, close cooperation between surgeons and anaesthesiologists (joint risk assessment) is critical. This cooperation has become increasingly important because more and more patients are being referred to surgery at an advanced age and with multiple comorbidities and because surgical procedures and multimodal treatment modalities are becoming more and more complex. Objective The aim of this review is to provide clinicians with practical recommendations for day-to-day decision-making from a joint surgical and anaesthesiological point of view. The discussion centres on gastrointestinal surgery specifically.
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Affiliation(s)
- Marian Grade
- Department of General and Visceral Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
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