Journal of anaesthesiology, clinical pharmacology
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J Anaesthesiol Clin Pharmacol · Apr 2019
ReviewPerioperative surgical home models and enhanced recovery after surgery.
In recent years, numerous initiatives have been introduced to address changes in health-care costs, delivery methods, reimbursements, and the health-care needs of our aging population. The American Society of Anesthesiologists (ASA) defines the Perioperative Surgical Home (PSH) as a patient-centric, team-based model of care to help meet the demands of a rapidly approaching health-care paradigm emphasizing value, patient satisfaction, and a reduction in costs. Enhanced recovery pathways were initially established by a group of surgeons from Europe who formed a research group with the aim to explore the ultimate care pathway for patients undergoing colonic resections. ⋯ A PubMed and World Wide Web search was performed with the following key words: "ERAS®," "enhanced recovery after surgery," "PSH," "perioperative surgical home," "protocols," "outcomes." Articles found were published over a 20-year time range (1997-2017). In the present investigation, the most common elements of enhanced recovery protocols are reviewed. Review of how existence of a PSH model facilitates the creation of an enhanced recovery protocol and improves cost-efficiency, patient satisfaction, and clinical outcomes observed in enhanced recovery studies that are applicable to health-care systems universally is described.
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J Anaesthesiol Clin Pharmacol · Apr 2019
ReviewMultimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings.
Enhanced recovery after surgery protocols are multimodal perioperative care pathways designed to achieve early recovery in patients after surgical procedures by defining and maintaining preoperative organ function and minimizing the profound stress response following surgery. Enhanced recovery protocols have primarily been studied for major abdominal surgeries, however, the knowledge acquired from studying these protocols has facilitated treating patients in ambulatory settings. ⋯ A PubMed search was performed with the following key words: multimodal analgesia, enhanced recovery, ambulatory care, pain management, and opioids. We discuss the use of enhanced recovery protocols and multimodal pain care plans in the ambulatory setting.
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J Anaesthesiol Clin Pharmacol · Apr 2019
Current transfusion practices of anesthesiologists in a major city in South India.
Allogenic blood transfusion is a double edged sword with a delicate balance between benefits and risks. There is heavy use of blood products in the perioperative setting mostly initiated by anesthesiologists. Limited research has been done in evaluating the transfusion practices of anesthesiologists especially in Indian setting. We conducted a survey among the anesthesiologists in our city to assess their blood transfusion practices, to evaluate the level of adherence to principles of Patient Blood Management and to look for innovative strategies to improve the perioperative transfusions. ⋯ The restrictive strategy of our practitioners was an encouraging finding. There is lack of uniformity in patient blood management services. Regular educational interventions are needed to update the clinicians. Formulation and implementation of institutional protocols for perioperative blood transfusion is mandatory.
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J Anaesthesiol Clin Pharmacol · Jan 2019
Comparative evaluation of Ambu Aura-i and Fastrach™ intubating laryngeal mask airway for tracheal intubation: A randomized controlled trial.
Ambu Aura-i was compared with Fastrach™ (FT)-laryngeal mask airway (LMA) as a conduit for tracheal intubation. ⋯ FT-LMA had a higher success rate in facilitating blind tracheal intubation compared with Ambu Aura-i.
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J Anaesthesiol Clin Pharmacol · Jan 2019
Comparative evaluation of Truview evo2 and Macintosh laryngoscope for ease of orotracheal intubation in children - A prospective randomized controlled trial.
Truview evo2 has been found to improve the glottic view when compared with the Miller blade in pediatric population. However, there is limited literature comparing it with Macintosh laryngoscope in children. We thus aimed to assess and compare Truview evo2 with the Macintosh laryngoscope for orotracheal intubation in children with regards to time to intubate, laryngoscopic view, ease of intubation, and associated hemodynamic changes. ⋯ Truview evo2 provides better laryngeal view and has a lesser IDS, but takes longer for intubation, when compared to the Macintosh laryngoscope in children.