This document summarizes traditional perioperative care practices and proposes evidence-based alternatives as part of an enhanced recovery after surgery (ERAS) protocol. It discusses replacing traditional practices like preoperative starvation, high stress levels during surgery, and excessive intravenous fluid administration with a multi-modal intervention approach including carbohydrate loading before surgery, limiting or avoiding premedication, effective pain relief through regional anesthesia, early mobilization, and goal-directed fluid therapy to improve outcomes.
Fast-track surgery - the role of the anaesthesiologist in ERASscanFOAM
A presentation by Narinder Rawal at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Using Enhanced Recovery After Surgery (ERAS) to Enhance Postoperative OutcomesWellbe
Speaker: Francesco Carli, MD, MPhil, senior staff anesthesiologist at the McGill University Health Centre
Cost: Complimentary, sponsored by Wellbe
There is strong evidence that many of aspects of surgical care have little evidence, and therefore the Enhanced Recovery After Surgery (ERAS) program has been set up to accelerate the recovery process and decrease the rate of postoperative complications. There is an opportunity to improve outcomes by using team approach and revision of the standard procedures.
Learn about:
– The elements of ERAS protocols
– How to structure the Team approach
– The role of the patient in ERAS
– How to perform an audit of your program
About the Speaker:
Francesco Carli, MD, MPhil, is Professor of Anesthesia at McGill University and Associate Professor in the School of Dietetics and Human Nutrition at McGill University and a senior staff anesthesiologist at the McGill University Health Centre. He is currently an Elected Member of the American Academy of Anesthesia and a Board Member of the Enhanced Recovery After Surgery (ERAS) Society. Dr. Carli completed his medical training and anesthesia training in Turin, Italy, Paris, France, and London, England. He completed a Master’s Degree in surgical metabolism at the University of London, England.
His research interests are: metabolic changes associated with surgery and the impact of perioperative interventions (regional analgesia, nutrition, hormones, exercise) on postoperative recovery; evaluation of functional outcome measures during the surgical recovery process; prehabilitation of surgical patients. He is the author of over 250 peer-review scientific articles and has been a recipient of over 50 peer and non peer-review grants.
Fast-track surgery - the role of the anaesthesiologist in ERASscanFOAM
A presentation by Narinder Rawal at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Using Enhanced Recovery After Surgery (ERAS) to Enhance Postoperative OutcomesWellbe
Speaker: Francesco Carli, MD, MPhil, senior staff anesthesiologist at the McGill University Health Centre
Cost: Complimentary, sponsored by Wellbe
There is strong evidence that many of aspects of surgical care have little evidence, and therefore the Enhanced Recovery After Surgery (ERAS) program has been set up to accelerate the recovery process and decrease the rate of postoperative complications. There is an opportunity to improve outcomes by using team approach and revision of the standard procedures.
Learn about:
– The elements of ERAS protocols
– How to structure the Team approach
– The role of the patient in ERAS
– How to perform an audit of your program
About the Speaker:
Francesco Carli, MD, MPhil, is Professor of Anesthesia at McGill University and Associate Professor in the School of Dietetics and Human Nutrition at McGill University and a senior staff anesthesiologist at the McGill University Health Centre. He is currently an Elected Member of the American Academy of Anesthesia and a Board Member of the Enhanced Recovery After Surgery (ERAS) Society. Dr. Carli completed his medical training and anesthesia training in Turin, Italy, Paris, France, and London, England. He completed a Master’s Degree in surgical metabolism at the University of London, England.
His research interests are: metabolic changes associated with surgery and the impact of perioperative interventions (regional analgesia, nutrition, hormones, exercise) on postoperative recovery; evaluation of functional outcome measures during the surgical recovery process; prehabilitation of surgical patients. He is the author of over 250 peer-review scientific articles and has been a recipient of over 50 peer and non peer-review grants.
Multicenter prospective study in several Spaniard hospital
Anemia and iron deficit in preoperative study
Presented at NATA meeting at Dublin, April 2016
This presentation explains change physiological changes occurs in obesity. Which pre op investigation should be done of those patient before scheduling them for surgery. What in the end anaesthesia consideration of obesity with post op care.
Lokarri akordioaren eta kontsultaren aldeko herritarren Sareak hausnarketa ariketa bat abiatu du datorren urteetarako bere lehentasunak eta planak zehazteko. Bukaera datorren urtarrilaren 31n Ohiz kanpoko Batzar Nagusi batean izango duen eztabaida honek oinarrizko txosten bat du abiapuntu, zeinak aldaketak izango dituen batzar prozesu honen baitan. Hauek dira txostenak biltzen dituen ideia nagusiak.
Multicenter prospective study in several Spaniard hospital
Anemia and iron deficit in preoperative study
Presented at NATA meeting at Dublin, April 2016
This presentation explains change physiological changes occurs in obesity. Which pre op investigation should be done of those patient before scheduling them for surgery. What in the end anaesthesia consideration of obesity with post op care.
Lokarri akordioaren eta kontsultaren aldeko herritarren Sareak hausnarketa ariketa bat abiatu du datorren urteetarako bere lehentasunak eta planak zehazteko. Bukaera datorren urtarrilaren 31n Ohiz kanpoko Batzar Nagusi batean izango duen eztabaida honek oinarrizko txosten bat du abiapuntu, zeinak aldaketak izango dituen batzar prozesu honen baitan. Hauek dira txostenak biltzen dituen ideia nagusiak.
Enhanced recovery care pathways: a better journey for patients seven days a week and a better deal for the NHS - presentation from the Health and Care Innovation Expo 2014 - Sue Cottle, Amy Kerr and Neil Betteridge
Anaesthesia challenges in neonatal emergencies-1.pptxsouravdash24
Neonatal emergencies present unique challenges in anesthesia, requiring specialized knowledge and skills to ensure safe and effective care for these vulnerable patients. This presentation delves into the intricacies of providing anesthesia to neonates in emergency situations, discussing physiological differences, equipment considerations, medication dosages, and monitoring techniques tailored to this population. Explore essential strategies and best practices for managing airway, ventilation, and hemodynamic stability in neonatal emergencies, aiming to optimize outcomes and mitigate risks. Whether you're a seasoned anesthesiologist or a healthcare professional seeking insight into neonatal anesthesia, this presentation offers valuable insights into navigating the complexities of neonatal emergencies with confidence and expertise.
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LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
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International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
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- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
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Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
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Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
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Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
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Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
9. Mendelson's syndrome
2006 saw the 60th anniversary of the publication of New York obstetrician Curtis
Lester Mendelson's classic paper, ‘The aspiration of stomach contents into the lungs
during obstetric anesthesia’.
Mendelson went on to show that acid was responsible for this asthma-like
syndrome. He instilled into the respiratory tracts of rabbits a variety of substances
including 0.1N hydrochloric acid and vomitus (both untreated and neutralized) from
pregnant women.
He concluded that gastric retention of solid and liquid material is prolonged during
labour, and that aspiration of vomitus into the lungs can occur while laryngeal
reflexes are abolished.
‘Respiratory failure secondary to aspiration pneumonitis during anaesthesia’ became
synonymous with Mendelson's syndrome, and its prevention a cornerstone of
anaesthetic practice.
10.
11. Key points
Residual gastric volume (RGV) and pH (two surrogate end-points of aspiration risk)
are determined by oral intake, gastric secretion and gastric emptying. A 2 h fasting
interval (vs. midnight) for fluids neither increases RGV nor decreases pH.
Gastric emptying of liquids is an exponential process. The half-time for water is
about 10 min. It is wrong to regard the stomach as either ‘empty’ or ‘full’, and
induction of anaesthesia ‘safe’ or ‘unsafe’.
Current accepted fasting intervals for elective cases are 2 h for water and clear fluids,
4 h for breast milk, and 6 h for food (including milky drinks). ‘Nil by mouth from
midnight’ has no place in modern perioperative practice.
Gastric emptying is impaired by trauma, labour and opioid analgesia. Fasting
intervals assume limited importance compared with other aspects of the
anaesthesia regimen (e.g. choice of airway management) in the prevention of
aspiration.
The ‘top 3’ risk factors for aspiration are emergency surgery, light
anaesthesia/unexpected response to stimulation and upper/lower gastrointestinal
pathology.
12. CHO LOADING
What is it?
• 100G ;12.5% ;CHO
PREVIOUS DAY NIGHT
• 50G ;12.5% ;CHO 2 HOURS
BEFORE SURGERY
• CHO MUST BE COMPLEX
MALTODEXTRINS AND NOT
THE PLAIN GLUCOSE!!!
• NEED A COMMERSIAL FEED
FOR THIS PURPOSE!
Advantages
• Gives satisfaction
• Decreases stress
• Decrease insulin resistance
• No increase in GRV
• No increase in aspiration
13. • CAN HAVE NORMAL ORAL DIET 2 HOURS
AFTER REGIONAL AND 4 HOURS AFTER
GENERAL ANAESTHESIA
• DON’T EVER RESIST THE NATURAL APPETITE!
14. SAY NO TO PREMEDICATION
• ADMISSION ON THE DAY OF
SURGERY
• NO NEED TO PREMEDICATE
• SEDATIVES DELAYS RECOVERY
• NO ROLE FOR PROPHYLACTIC
ANTIEMETICS
• GASTRIC ACID SUPPRESSION
DELAYS APPETITE
• GLYCO TAKES OUT THE TASTE
/DYSPHAGIA
PREMED
• SEDATIVE
DIAZEPAM
• H2 BLOCKER/PROTON
INHIBITORS
RANITIDINE/OMEPERAZOLE
• ANTISIALOGOUGE
ATROPINE/GLYCOPYRROLATE
15. PONV-PREVENTION
• PREOP RISK FACTORS
MILD/MODERATE/SEVERE
YOUNGER/FEMALE/OBESE/ANXIETY/MOTION
SICKNESS/PREVIOUS PONV
• TIVA INSTEAD OF GA IN HIGH RISK
• AVOID NARCOTICS/VOLATILES/N2O/REVERSAL
• LIBERAL ANTIEMETICS
MULTIMODAL
STEROIDS/5HT
ANTAGONIST/METACLOPROMIDE/DOMPERIDONE
16.
17. PAIN RELIEF!
• REGIONAL ANALGESIA
MIDTHORASIC-T8/T9; EPIDURAL
LUMBAR EPIDURAL
TAB-TRANSVERSUS ABDOMINIS BLOCK
• ONLY LA ; HIGH VOLUME/LOW CONCENTRATION
• NO NARCOTICS ;PREFERABLY SHORT ACTING FENTANYL;
NAUSEA/ILEUS/IMMOBILITY
• BUT CLONIDINE/DEXMED IN RA
• GENEROUS USE OF NSAIDS
PARENTERAL PARACETAMOL
NSAID SUPPOSITORIES
19. EPIDURAL MANAGEMENT
• IT ATTENEUATES THE STRESS RESPONSE (TETRAD OF
ANAESTHESIA) OF SURGERY/DECREASES CATACHOLAMINES
• EPIDURAL ANALGESIA IN LAPAROSCOPIC SURGERIES????
• MANAGE HYPOTENTION WITH VASOPRESSORS
• DON’T INFUSE MORE VASOPRESSORS
• USE LESS FLUID CHALLENGES
• AVOID LIMB PARESIS
• BALANCE ANALGESIA AND HYPOTENTION
20. INTRA-OP HYPOTHERMIA
HYPOTHERMIA PREVENTION
• TEMPERATURE
MONITORING
• HYPOTHERMIA MORE
COMMON WITH REGIONAL
ANAESTHESIA
• O.T ROOM TEMPERATURE
• EXTERNAL WARMER
• FLUID WARMER
ILL EFFECTS OF HYPOTHERMIA
• INFECTION
• POST OP SHIVERING/STRESS
• BLEEDING
• MI
• ARRYTHMIA
21.
22. EARLY MOBILIZATION
• WALKING EPIDURAL
• SEGMENTAL EPIDURAL WITH PRESERVED
BLADDER SENSATION
• NO SEDATIVES
• NO NARCOTICS
23. HIGH INSPIRED OXYGEN
80%-BAG&MASK
• OXYGEN IS REQUIRED BY IMMUNE CELLS TO
PRODUCE FREE RADICALS-A DEFENCE AGAIST
PATHOGENS
• NEED FOR COLLAGEN SYNTHESIS /
ANGIOGENESIS
• IMPROVES ANASTAMOTIC HEALING
• DECREASE SURGICAL SITE INFECTIONS
• REDUCE PONV
25. GOAL DIRECTED INTRAOP FLUID
THERAPY
• EXCESS FLUIDS DELAYS GUT FUNCTION/CARDIAC
MORBIDITY
• LiDCO/PICCO DEVICES/OESOPHAGEAL ECHO
• CO/SV/TLW ARE THE GOAL PARAMETERS
• MINIMAL GOALS-UO/MAP/CVP
• POST OP FLUIDS NOT MORE THAN 2.5 L/DAY
29. The ability of the patient to get rid of the accumulated sodium is
greatly curtailed in the postop period!
9g Sodium Chloride =
36 Bags of Chips,
or 1L Bag of Saline
30. THE VERDICT ON SALINE
Compared with balanced crystalloids, saline use is
associated with:
• Increased mortality1
• Hyperchloremic acidosis1,2,3,4
• Adverse effects on the kidney1,2
• Increased morbidity1
• Increased resource consumption1
• DELAYED GUT FUNCTION-PARALYTIC ILEUS
The future of IV Fluid Management: Balanced Crystalloids
1. Shaw AD, et al., Ann Surg. 2012 May; 255(5):821-9 2. Chowdhury AH et al. Ann Surgery 2012 ;256(1):18-24 3: McFarlane C. & Lee A . Anaesthesia 1994;49:779-
81.4: Hadimioglu N. et al. Anesth Analg. 2008;107:264-9
31. HOW DO I LIMIT IV
FLUIDS/SODIUM?
TAKE THE DRIP
DOWN ON THE
FIRST POST-OP DAY
32. LET US SEE WHEATHER THIS FIRE
WORKS!
T
THANK YOU!!