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Li M, Yang X, Zhu K, Shen L, Xie C. Effects of perioperative intravenous lidocaine and esketamine on the quality of recovery and emotional state of patients after thyroidectomy: A randomised, double-blind, controlled trial. Indian J Anaesth 2024; 68:340-347. [PMID: 38586266 PMCID: PMC10993934 DOI: 10.4103/ija.ija_1010_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 04/09/2024] Open
Abstract
Background and Aims Perioperative intravenous (IV) infusions of lidocaine and esketamine reduce postoperative pain, but there are few studies on the quality of recovery and patients' emotional states postoperatively. We aimed to explore the effects of perioperative IV lidocaine and esketamine on the quality of recovery and emotional state after thyroidectomy. Methods In this randomised trial, 137 patients undergoing thyroidectomy were randomly assigned to three groups: a lidocaine group (Group L), an esketamine group (Group E) and a normal saline placebo group (Group C). The primary outcome was the Quality of Recovery 40 (QoR-40) on postoperative days (PODs) 1 and 2. The secondary outcomes included Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores on days 1 and 2 after surgery, pain scores, opioid consumption and incidence of postoperative nausea and vomiting (PONV). Statistical analysis was performed using the one-way analysis of variance (ANOVA), the Kruskal-Wallis and Chi-square tests. Results The global QoR-40 scores in groups L and E on POD 1 and POD 2 were significantly higher than in group C (P < 0.001). The SAS and SDS scores on POD 1 and POD 2 in groups L and E were significantly lower than in group C (P < 0.05). There were statistically significant differences in Numerical Rating Scale (NRS) scores among the three groups at 1 h, 2 h, 6 h and 12 h (P < 0.05). Conclusion Perioperative IV lidocaine and esketamine improve the quality of postoperative recovery and the emotional state of patients undergoing thyroidectomy.
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Affiliation(s)
- Mengci Li
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Xiaoqian Yang
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Kairun Zhu
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Lulu Shen
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Chenglan Xie
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, Jiangsu, China
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Yang X, Yang H, Li M, Zhu K, Shen L, Xie C. Effect of ultrasound-guided bilateral superficial cervical plexus block versus perioperative intravenous lidocaine infusion on postoperative quality of recovery in patients undergoing thyroidectomy: A randomised double-blind comparative trial. Indian J Anaesth 2024; 68:238-245. [PMID: 38476543 PMCID: PMC10926339 DOI: 10.4103/ija.ija_852_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 03/14/2024] Open
Abstract
Background and Aims Recent studies have found that ultrasound-guided (USG) bilateral superficial cervical plexus block (BSCPB) and intravenous infusion of lidocaine (IVL) have the potential to improve the quality of postoperative recovery. This study aimed to investigate and compare their effects on postoperative quality of recovery in patients undergoing thyroidectomy. Methods A total of 135 patients were randomised to Group N: BSCPB with 10 mL 0.75% ropivacaine on each side, Group L: intravenous lidocaine (1.5 mg/kg for 10 min, followed by 1.5 mg/kg/h) and Group C: intravenous saline combined with BSCPB saline. The primary objective was quality of recovery-40 (QoR-40). Other parameters compared were numeric rating pain scale (NRS) score, haemodynamic data, opioid dosage and incidence of adverse effects. Statistical analysis was performed using the one-way analysis of variance (ANOVA), the Kruskal-Wallis test and the Chi-square test. Results Compared to Group C, both groups N and L had higher QoR-40 total scores as well as scores indicating physical comfort, emotional state and pain dimensions on postoperative day (POD) 1 and POD2 (P < 0.001). The QoR-40 total and pain dimension scores in Group N were higher on POD1 and POD2 (P < 0.05). The NRS scores and the change in haemodynamics were lower in Group N compared to groups L and C (P < 0.05). The results of other parameters were lower in groups N and L than in Group C (P < 0.05). Conclusion USG BSCPB and IVL are comparable in improving the quality of postoperative recovery in patients undergoing thyroidectomy.
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Affiliation(s)
- Xiaoqian Yang
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Hui Yang
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Mengci Li
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Kairun Zhu
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Lulu Shen
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Chenglan Xie
- Department of Anaesthesiology, Affiliated Huaian Hospital of Xuzhou Medical University, Jiangsu, China
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Wu J, Zhang Y, Shen L. Effect of modified endotracheal intubation protocol combined with early oral intake on postoperative recovery quality in thyroid and parathyroid surgery at a tertiary hospital in China: a 2x2 factorial randomised controlled trial protocol. BMJ Open 2024; 14:e075999. [PMID: 38238052 PMCID: PMC10806907 DOI: 10.1136/bmjopen-2023-075999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Early oral intake (EOI) is supposed to be safe and beneficial to patients' recovery. However, the optimal timing of resuming oral intake has not been validated in thyroid and parathyroid surgery. On the other hand, a modified electromyography (EMG) endotracheal intubation protocol with real-time EMG monitoring during video laryngoscope/fibrescope-guided intubation was presented in 2022, which was regarded as an effective way to shorten the intubation time. We aimed to use Quality of Recovery-15 (QoR-15) questionnaire to compare the efficacy and safety of different EMG endotracheal intubation protocols combined with different postoperative oral intake strategy in thyroid and parathyroid surgery. METHODS AND ANALYSIS This prospective, single-centre, 2×2 factorial, randomised controlled trial will be conducted in the Peking Union Medical College Hospital (PUMCH), China. We plan to recruit 200 adult patients who will receive thyroid or parathyroid surgery under intraoperative nerve monitoring. Eligible patients will be randomly divided into two groups, which will receive either the modified intubation protocol (M group) or conventional intubation process (C group). After patients enter postanaesthesia care unit and Steward scores ≥4, they will be randomly divided into two groups again, which will receive early resumption of oral intake (E group) or delayed resumption of oral intake (D group). Patients will be followed up during hospitalisation and the QoR-15 questionnaire will be administered to compare the quality of recovery on the day before surgery (T0), the first day after surgery (T1) and the day of discharge (T2). The primary outcome is the QoR-15 scores at T1. ETHICS AND DISSEMINATION The study protocol has been approved by the Research Ethics Committee of Peking Union Medical College Hospital (IRB K-2501). All participants will give written informed consent before participation. The results from this study will be shared at conferences and disseminated in international journals. TRIAL REGISTRATION NUMBER NCT05624463.
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Affiliation(s)
- Juelun Wu
- Anesthesiology, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Le Shen
- Anesthesiology, Peking Union Medical College Hospital, Beijing, People's Republic of China
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Anika NN, Mohammed M, Shehryar A, Rehman A, Oliveira Souza Lima SR, Hamid YH, Mimms CS, Abdallah S, Kumar YS, Ibrahim M. Transforming Bariatric Surgery Outcomes: The Pivotal Role of Enhanced Recovery After Surgery (ERAS) Protocols in Patient-Centered Care. Cureus 2024; 16:e52648. [PMID: 38380206 PMCID: PMC10877221 DOI: 10.7759/cureus.52648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/22/2024] Open
Abstract
Bariatric surgery is a critical strategy in managing morbid obesity. Enhanced recovery after surgery (ERAS) protocols have revolutionized perioperative care in this field. This systematic review aims to synthesize current evidence on the impact of ERAS protocols on patient-centered outcomes in bariatric surgery. A comprehensive search across multiple databases was conducted, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies involving adult patients undergoing bariatric surgery and focusing on the implementation and outcomes of ERAS protocols were included. Data extraction and analysis emphasized patient recovery, well-being, and satisfaction. Eleven studies met the inclusion criteria. The review revealed that ERAS protocols are associated with reduced postoperative recovery times, decreased hospital stays, and enhanced patient satisfaction. Notably, ERAS protocols effectively reduced complications and optimized resource utilization in bariatric surgery. Comparative insights from non-bariatric surgeries highlighted the versatility and adaptability of ERAS protocols across different surgical disciplines. ERAS protocols significantly improve patient-centered outcomes in bariatric surgery. Their adoption facilitates a patient-focused approach, accelerating recovery and enhancing overall patient well-being. The findings advocate for the broader implementation of ERAS protocols in surgical care, emphasizing the need for continuous refinement to meet evolving healthcare demands. This review supports the paradigm shift toward integrating ERAS protocols in bariatric surgery and potentially other surgical fields.
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Affiliation(s)
- Nabila N Anika
- Medicine and Surgery, Holy Family Red Crescent Medical College and Hospital, Dhaka, BGD
| | | | | | | | | | - Yusra H Hamid
- Community Medicine, University of Khartoum, Khartoum, SDN
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Machado N, Mortlock R, Maduka R, Souza Cunha AE, Dyer E, Long A, Canner JK, Tanella A, Gibson C, Hyman J, Ogilvie J. Early observations with an ERAS pathway for thyroid and parathyroid surgery: Moving the goalposts forward. Surgery 2024; 175:114-120. [PMID: 37973430 PMCID: PMC10838521 DOI: 10.1016/j.surg.2023.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/31/2023] [Accepted: 06/18/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Enhanced recovery after surgery pathways have become the standard of care in various surgical specialties. In this study, we discuss our initial experience with a staged enhanced recovery after surgery pathway in endocrine surgery and assess the impact of this pathway on select perioperative outcomes and unanticipated admissions. METHODS We collected information regarding all thyroid/parathyroid surgeries performed by endocrine surgeons at our institution before and after the implementation of the multi-intervention enhanced recovery after surgery pathway. We compared relevant outcomes for all cases 1 year before (n = 479) and 1 year after (n = 166) implementation of the pathway. We also compared outcomes between enhanced recovery after surgery patient groups with varying levels of enhanced recovery after surgery compliance. RESULTS Enhanced recovery after surgery was associated with a significant decrease in total length of stay (9.2 vs 7.5 hours, P < .0001). Whereas there was no significant decrease in all-cause unanticipated postoperative admissions, there was a decrease in patient-initiated admissions in the Enhanced recovery after surgery group. There was also a significant decrease in mean postoperative morphine milligram equivalents (14.4 vs 16.2 vs 24.8, P = .0015), average daily morphine milligram equivalents (25.6 vs 45.6 vs 53, P < .0001), and average daily pain scores (1.89 vs 2.38 vs 2.74, P = .0045) in the Enhanced recovery after surgery group (particularly with increasing Enhanced recovery after surgery compliance). There were no significant differences in the requirement for postoperative antiemetics or in the post-anesthesia care unit length of stay. CONCLUSION This study demonstrates a significant benefit from Enhanced recovery after surgery pathways for thyroidectomies and parathyroidectomies, even with initial data and a staggered roll-out plan. Further directions include a follow-up study once we reach a higher level of institutional compliance with all components of the Enhanced Recovery After Surgery pathway and a prospective trial to identify the relative significance of different portions of the Enhanced Recovery after Surgery pathway, particularly the superficial cervical plexus block.
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Affiliation(s)
- Nikita Machado
- Section of Endocrine Surgery, Yale New Haven Hospital, New Haven, CT. https://twitter.com/NikitaMachado
| | - Ryland Mortlock
- Medical Scientist Training Program, Yale University School of Medicine, New Haven, CT
| | - Richard Maduka
- Department of Surgery, Yale New Haven Hospital, New Haven, CT. https://twitter.com/RylandMortlock
| | | | - Ethan Dyer
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Anne Long
- Yale New Haven Hospital, New Haven, CT
| | - Joseph K Canner
- Department of Surgery, Yale New Haven Hospital, New Haven, CT
| | - Anthony Tanella
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Courtney Gibson
- Section of Endocrine Surgery, Yale New Haven Hospital, New Haven, CT
| | - Jaime Hyman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT. https://twitter.com/JaimeHyman
| | - Jennifer Ogilvie
- Section of Endocrine Surgery, Yale New Haven Hospital, New Haven, CT.
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Xue B, Xue FS, Li XY. Letter to the Editor: A Neural Integrity Monitor Electromyography Endotracheal Tube Causes More Severe Postoperative Sore Throat than a Standard Endotracheal Tube in Adults: A Prospective Cohort Study. World J Surg 2023; 47:3453-3454. [PMID: 37777672 DOI: 10.1007/s00268-023-07188-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Bai Xue
- Department of Anesthesiology, Sengkang General Hospital, Singapore, Singapore
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
| | - Xin-Yue Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
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Gau TP, Wu SH, Huang JM, Lu WL, Huang TY, Lu IC, Wu CW. Multimodal Analgesia with Local Wound Infiltration and Intravenous Parecoxib for Thyroidectomy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050855. [PMID: 37241087 DOI: 10.3390/medicina59050855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Background and objective: Adequate postoperative pain control is an important component to enhance recovery. Multimodal analgesia with various pain control techniques has been widely used to alleviate postoperative pain. The use of either wound infiltration or a superficial cervical plexus block has been reported to be effective for pain management after thyroid surgery. The present study evaluated the effect of multimodal analgesia using lidocaine wound infiltration combined with intravenous parecoxib for patients monitored after thyroidectomy. Materials and Methods: A total of 101 patients with a multimodal analgesia protocol being monitored after thyroidectomy were enrolled. After the induction of anesthesia, multimodal analgesia was performed through wound infiltration of 1% lidocaine and epinephrine at a ratio of 1:200,000 (5 μg/mL) combined 40 mg intravenous parecoxib before skin excision. Patients were divided into two groups for this retrospective analysis based on the injection dose of lidocaine they received. Patients in Group I (the control, n = 52) received a 5 mL injection solution, while those in Group II (the study, n = 49) received a 10 mL dosage in a time-sequential manner, in accordance with a previous clinical trial. The primary outcome was measuring postoperative pain intensity at rest, as well as during motion and coughing, which was measured at the postoperative anesthetic care unit (PACU) and on the first day after the operation (POD 1) in the ward. Pain intensity was assessed using a numerical rating scale (NRS). The secondary outcomes were postoperative adverse events including anesthetic-related side effects, as well as airway and pulmonary complications. Results: Most of the patients reported no pain or mild pain during the observation period. The patients in Group II had a lower pain intensity during motion than Group I (NRS 1.47 ± 0.89 vs. 1.85 ± 0.96, p = 0.043) when measured at the postoperative anesthetic care unit. Pain intensity during coughing was also significantly lower in the study group than in the control group (NRS 1.61 ± 0.95 vs. 1.96 ± 0.79, p = 0.049) when measured at the postoperative anesthetic care unit. There were no severe adverse events in either of the groups. Only one patient (1.9%) in Group I experienced temporary vocal palsy. Conclusions: The use of lidocaine with an equal volume of intravenous parecoxib provided comparable analgesia with minimal adverse events when monitoring thyroidectomy.
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Affiliation(s)
- Tz-Ping Gau
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Information Management, National Sun Yat-sen University, Kaohsiung 804, Taiwan
| | - Sheng-Hua Wu
- Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jui-Mei Huang
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wen-Ling Lu
- Department of Anesthesiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Tzu-Yen Huang
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - I-Cheng Lu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Anesthesiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Che-Wei Wu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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8
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Tsai CH, Kuo CY, Leu YS, Lee JJ, Cheng SP. Impact of completion thyroidectomy on postoperative recovery in patients with differentiated thyroid cancer. Updates Surg 2023; 75:209-216. [PMID: 36201137 DOI: 10.1007/s13304-022-01394-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/29/2022] [Indexed: 01/14/2023]
Abstract
While an increasing number of patients now undergo lobectomy for low-risk differentiated thyroid cancer, a subset of patients require completion thyroidectomy to facilitate radioactive iodine therapy. Completion thyroidectomy is generally as safe as the initial operation, but a previous study showed that a longer hospitalization is required for completion thyroidectomy. In this study, we reviewed 61 consecutive patients who had been treated with an initial lobectomy and subsequent completion thyroidectomy at our institution from 2012 to 2021. We detected a changepoint in 2016 for the proportion of patients who were treated with a thyroid lobectomy (Pettitt's test P = 0.049). The rate of completion thyroidectomy remained stable throughout the study period. There was no difference in operating time, intraoperative blood loss, perioperative drop in calcium levels, and postoperative hospital stay between surgeries. The patients reported higher pain scores on the day of operation (P = 0.007) and the postoperative day 1 (P = 0.022). Occult papillary microcarcinomas were identified in the contralateral thyroid lobe in 13 (21%) patients. Multifocality was the only predictor for residual malignancy in multivariate regression. In conclusion, patients with differentiated thyroid cancer experienced more pain in the immediate postoperative period following completion thyroidectomy. Hospital stays do not change with appropriate opioid-free pain control.
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Affiliation(s)
- Chung-Hsin Tsai
- Department of Surgery, MacKay Memorial Hospital, 92, Chung-Shan North Road, Section 2, Taipei, 104215, Taiwan
- Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chi-Yu Kuo
- Department of Surgery, MacKay Memorial Hospital, 92, Chung-Shan North Road, Section 2, Taipei, 104215, Taiwan
- Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yi-Shing Leu
- Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jie-Jen Lee
- Department of Surgery, MacKay Memorial Hospital, 92, Chung-Shan North Road, Section 2, Taipei, 104215, Taiwan
- Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Shih-Ping Cheng
- Department of Surgery, MacKay Memorial Hospital, 92, Chung-Shan North Road, Section 2, Taipei, 104215, Taiwan.
- Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, Taiwan.
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan.
- Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Ambulatory anesthesia and discharge: an update around guidelines and trends. Curr Opin Anaesthesiol 2022; 35:691-697. [PMID: 36194149 DOI: 10.1097/aco.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Provide an oversight of recent changes in same-day discharge (SDD) of patient following surgery/anesthesia. RECENT FINDINGS Enhanced recovery after surgery pathways in combination with less invasive surgical techniques have dramatically changed perioperative care. Preparing and optimizing patients preoperatively, minimizing surgical trauma, using fast-acting anesthetics as well as multimodal opioid-sparing analgesia regime and liberal prophylaxis against postoperative nausea and vomiting are basic cornerstones. The scope being to maintain physiology and minimize the impact on homeostasis and subsequently hasten and improve recovery. SUMMARY The increasing adoption of enhanced protocols, including the entire perioperative care bundle, in combination with increased use of minimally invasive surgical techniques have shortened hospital stay. More intermediate procedures are today transferred to ambulatory pathways; SDD or overnight stay only. The traditional scores for assessing discharge eligibility are however still valid. Stable vital signs, awake and oriented, able to ambulate with acceptable pain, and postoperative nausea and vomiting are always needed. Drinking and voiding must be acknowledged but mandatory. Escort and someone at home the first night following surgery are strongly recommended. Explicit information around postoperative care and how to contact healthcare in case of need, as well as a follow-up call day after surgery, are likewise of importance. Mobile apps and remote monitoring are techniques increasingly used to improve postoperative follow-up.
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Chorath K, Hobday S, Suresh NV, Go B, Moreira A, Rajasekaran K. Enhanced recovery after surgery protocols for outpatient operations in otolaryngology: Review of literature. World J Otorhinolaryngol Head Neck Surg 2022; 8:96-106. [PMID: 35782396 PMCID: PMC9242417 DOI: 10.1002/wjo2.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/07/2021] [Indexed: 11/12/2022] Open
Abstract
Objective Enhanced recovery after surgery (ERAS) protocols are patient‐centered, evidence‐based pathways designed to reduce complications, promote recovery, and improve outcomes following surgery. These protocols have been successfully applied for the management of head and neck cancer, but relatively few studies have investigated the applicability of these pathways for other outpatient procedures in otolaryngology. Our goal was to perform a systematic review of available evidence reporting the utility of ERAS protocols for the management of patients undergoing outpatient otolaryngology operations. Methods A systematic literature review was conducted using MEDLINE, EMBASE, SCOPUS, and gray literature. We identified studies that evaluated ERAS protocols among patients undergoing otologic, laryngeal, nasal/sinus, pediatric, and general otolaryngology operations. We assessed the outcomes and ERAS components across protocols as well as the study design and limitations. Results A total of eight studies fulfilled the inclusion criteria and were included in the analysis. Types of procedures evaluated with ERAS protocols included tonsillectomy and adenoidectomy, functional endoscopic sinus surgery, tympanoplasty and mastoidectomy, and septoplasty. A reduction in postoperative length of stay and hospital costs was reported in two and three studies, respectively. Comparative studies between ERAS and control groups showed persistent improvement in pre‐ and postoperative anxiety and pain levels, without an increase in postoperative complications and readmission rates. Conclusions A limited number of studies discuss implementation of ERAS protocols for outpatient operations in otolaryngology. These clinical pathways appear promising for these procedures as they may reduce length of stay, decrease costs, and improve pain and anxiety postoperatively. Enhanced recovery after surgery (ERAS) protocols in outpatient otolaryngology operations are effective in significantly decreasing hospital length of stay, hospital costs, and postoperative pain/anxiety. The most common components among ERAS protocols were postoperative analgesia regimen, postoperative nutrition, fluid management, and preoperative education/counseling.
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Affiliation(s)
- Kevin Chorath
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Sara Hobday
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Neeraj V. Suresh
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Beatrice Go
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Alvaro Moreira
- Department of Pediatrics University of Texas Health‐San Antonio San Antonio Texas USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
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11
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Zheng L, Zhang S. Application and Evaluation of a Care Plan for Enhanced Recovery After Thyroidectomy. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221090404. [PMID: 35418270 PMCID: PMC9016575 DOI: 10.1177/00469580221090404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose: To develop and evaluate a nursing care plan based on the
ERAS (Enhanced Recovery After Surgery) approach for thyroid surgery patients.
Methods: A nursing care plan has been developed after the
literature review and focus group discussion. The content was validated using
the Delphi method. Then, a quasi-experimental study was designed. A total of 120
cases with thyroid surgery at Ruijin Hospital from March to June 2018 were
divided equally into an ERAS group and a conventional group
Results: The nursing care plan consisted of 13 first-level and
32 second-level indicators. (P < .001). Strikingly the
outcomes, such as pain scores, length of hospital stay, and hospitalization
costs, were significantly less in the ERAS group than those in the conventional
group (P<.001), while no difference was detected in the postoperative
complications rate. Conclusion: A scientific and reliable nursing
care plan has been used for thyroidectomy patients to enhance recovery.
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Affiliation(s)
- Lei Zheng
- Department of Thyroid Vascular Surgery, Shanghai Jiao Tong University School of Medicine affiliated Ruijin Hospital, Shanghai, China
| | - Shiyu Zhang
- Department of Thyroid Vascular Surgery, Shanghai Jiao Tong University School of Medicine affiliated Ruijin Hospital, Shanghai, China
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