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Anesthesiology Feb 2023These practice guidelines are a modular update of the "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary...
2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative...
These practice guidelines are a modular update of the "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures." The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.
Topics: Humans; Child; Chewing Gum; Anesthesiologists; Preoperative Care; Fasting; Elective Surgical Procedures
PubMed: 36629465
DOI: 10.1097/ALN.0000000000004381 -
Mayo Clinic Proceedings Apr 2020The medical complexity of surgical patients is increasing and medical specialties are frequently asked to assist with the perioperative management surgical patients.... (Review)
Review
The medical complexity of surgical patients is increasing and medical specialties are frequently asked to assist with the perioperative management surgical patients. Effective pre-anesthetic medical evaluations are a valuable tool in providing high-value, patient-centered surgical care and should systematically address risk assessment and identify areas for risk modification. This review outlines a structured approach to the pre-anesthetic medical evaluation, focusing on the asymptomatic patient. It discusses the evidence supporting the use of perioperative risk calculation tools and focused preoperative testing. We also introduce important key topics that will be explored in greater detail in upcoming reviews in this series.
Topics: Anesthesia; Humans; Preoperative Care; Risk Assessment; Surgical Procedures, Operative
PubMed: 31753535
DOI: 10.1016/j.mayocp.2019.04.029 -
Mayo Clinic Proceedings Dec 2020Evaluation of endocrine issues is a sometimes overlooked yet important component of the preoperative medical evaluation. Patients with diabetes, thyroid disease, and... (Review)
Review
Evaluation of endocrine issues is a sometimes overlooked yet important component of the preoperative medical evaluation. Patients with diabetes, thyroid disease, and hypothalamic-pituitary-adrenal axis suppression are commonly encountered in the surgical setting and require unique consideration to optimize perioperative risk. For patients with diabetes, perioperative glycemic control has the strongest association with postsurgical outcomes. The preoperative evaluation should include recommendations for adjustment of insulin and noninsulin diabetic medications before surgery. Recommendations differ based on the type of diabetes, the type of insulin, and the patient's predisposition to hyperglycemia or hypoglycemia. Generally, patients with thyroid dysfunction can safely undergo operations unless they have untreated hyperthyroidism or severe hypothyroidism. Patients with known primary or secondary adrenal insufficiency require supplemental glucocorticoids to prevent adrenal crisis in the perioperative setting. Evidence supporting the use of high-dose supplemental corticosteroids for patients undergoing long-term glucocorticoid therapy is sparse. We discuss an approach to these patients based on the dose and duration of ongoing or recent corticosteroid therapy. As with other components of the preoperative medical evaluation, the primary objective is identification and assessment of the severity of endocrine issues before surgery so that the surgeons, anesthesiologists, and internal medicine professionals can optimize management accordingly.
Topics: Diagnostic Techniques, Endocrine; Endocrine System Diseases; Humans; Preoperative Care; Risk Adjustment; Surgical Procedures, Operative
PubMed: 33168157
DOI: 10.1016/j.mayocp.2020.05.004 -
Complementary Therapies in Clinical... Feb 2020Preoperative anxiety and postoperative pain are common problems in patients undergoing surgery. The aim of this study is to analyse the effect of using guided imagery... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Preoperative anxiety and postoperative pain are common problems in patients undergoing surgery. The aim of this study is to analyse the effect of using guided imagery prior to surgery in adults and children to reduce preoperative anxiety and acute postoperative pain, compared with conventional preoperative nursing care.
METHODS
A systematic review and meta-analysis were conducted. We searched randomised clinical trials in databases and search engines.
RESULTS
A total of 1101 records were identified, of which 21 were included in the qualitative synthesis. Two random model meta-analysis were performed with eight trials. Guided imagery preoperatively was shown to be effective in relieving preoperative state anxiety in children (d = -3.71), preoperative trait anxiety in adults (d = -0.64) and postoperative pain in adults (d = -0.24). Postoperative pain in children and preoperative state anxiety in adults was reduced but without significant difference.
CONCLUSION
Guided imagery preoperatively is an effective, easy and low-cost intervention.
Topics: Adult; Anxiety; Child; Humans; Imagery, Psychotherapy; Pain, Postoperative; Preoperative Care; Randomized Controlled Trials as Topic
PubMed: 32056813
DOI: 10.1016/j.ctcp.2019.101077 -
Mayo Clinic Proceedings Jun 2021Perioperative medical management is challenging due to the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is... (Review)
Review
Perioperative medical management is challenging due to the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources utilize the recommendations derived from individual studies and do not include a multidisciplinary focus or formal consensus. The Society for Perioperative Assessment and Quality Improvement (SPAQI) identified a lack of authoritative clinical guidance as an opportunity to utilize its multidisciplinary membership to improve evidence-based perioperative care. SPAQI seeks to provide guidance on perioperative medication management that synthesizes available literature with expert consensus. The aim of this Consensus Statement is to provide practical guidance on the preoperative management of endocrine, hormonal, and urologic medications. A panel of experts with anesthesiology, perioperative medicine, hospital medicine, general internal medicine, and medical specialty experience was drawn together and identified the common medications in each of these categories. The authors then utilized a modified Delphi approach to critically review the literature and generate consensus recommendations.
Topics: Hormone Replacement Therapy; Humans; Hypoglycemic Agents; Insulin; Medication Therapy Management; Preoperative Care; Quality Improvement; Surgical Procedures, Operative
PubMed: 33714600
DOI: 10.1016/j.mayocp.2020.10.002 -
Der Anaesthesist Mar 2020Music is one of the most commonly used non-pharmacological interventions to reduce anxiety. It helps patients overcome emotional and physical alienation, provides... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Music is one of the most commonly used non-pharmacological interventions to reduce anxiety. It helps patients overcome emotional and physical alienation, provides comfort and familiarity in an improved environment and offers a pleasant distraction from pain and anxiety. This study aimed to evaluate the effects of listening to preoperative favorite music on postoperative anxiety and pain.
MATERIAL AND METHODS
This prospective, randomized, single-blinded, controlled trial included the American Society of Anesthesiologists (ASA) I-III patients, aged 18-70 years, undergoing elective inguinal hernia surgery. Demographic data and anxiety status were recorded. Anxiety status was measured using the Spielberger state-trait anxiety inventory form 1 (STAI-1) and state-trait anxiety inventory form 2 (STAI-2). After recording baseline heart rate, blood pressure and STAI levels, patients were randomly allocated to the music group (Group M) or control group (Group C). Patients in Group M listened to their favorite music using headphones and patients in the control group received standard care. The STAI‑1 was repeated after surgery and the numeric rating scale (NRS) and patient satisfaction were measured.
RESULTS
A total of 117 patients were included. Demographic data, educational status, and previous surgical history were similar between the groups. Mean preoperative STAI‑1 and STAI‑2 scores were similar between the groups (p > 0.05). Mean postoperative STAI‑1 score was significantly lower in Group M than in Group C (39 [range 35-43] vs. 41 [range 37-43], p < 0.05). Moreover, the change in the STAI score was significantly higher in Group M compared with Group C (p < 0.05). The difference of hemodynamic measurements pre-music to post-music was significant between Group M and Group C (p = 0.001). The NRS scores remained similar between the groups. Patient satisfaction score was significantly higher in Group M (p = 0.017).
CONCLUSION
Listening to patient-preferred favorite music preoperatively reduced anxiety, regulated hemodynamic parameters, and improved postoperative patient satisfaction. Reduced anxiety was not associated with reduced pain.
Topics: Adult; Aged; Anxiety; Blood Pressure; Elective Surgical Procedures; Female; Heart Rate; Hernia, Inguinal; Humans; Male; Middle Aged; Music; Pain; Pain, Postoperative; Patient Satisfaction; Preoperative Care; Prospective Studies; Random Allocation; Single-Blind Method; Young Adult
PubMed: 32047952
DOI: 10.1007/s00101-020-00731-8 -
Jornal de Pediatria 2019To verify the effect of psychological preparation on the relief of preoperative anxiety in children and to correlate parents' and children's levels of anxiety. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To verify the effect of psychological preparation on the relief of preoperative anxiety in children and to correlate parents' and children's levels of anxiety.
METHOD
After the approval of the institutional Research Ethics Committee and written consent of the children's parents or guardians, 118 children of both genders were prospectively selected, aged between 2 and 8 years, physical condition classification ASA I, who were treated in the pre-anesthetic evaluation ambulatory of the University Hospital and who underwent ambulatory surgeries at the same hospital. Two controlled groups of 59 children were randomized: control group basic preparation and psychological preparation group. On the day of surgery, all selected children were evaluated regarding their level of anxiety using the modified Yale Preoperative Anxiety Scale and their parents were evaluated regarding their level of anxiety through the Visual Analog Scale. The evaluator was blinded to which study group the child and family member belonged to.
RESULTS
Nine children and their family members were excluded per group when the results were analyzed. Children from the prepared group showed significant reductions in their level of anxiety in relation to the control group (p=0.04). There was no correlation between the level of anxiety of children and their parents' levels (p=0.78).
CONCLUSION
The psychological preparation was effective in reducing the level of anxiety of children. However, there was no relation between the level of anxiety of children and their parents' level.
Topics: Anxiety; Child; Child, Preschool; Double-Blind Method; Female; Humans; Male; Parents; Preoperative Care; Preoperative Period; Prospective Studies; Statistics, Nonparametric; Treatment Outcome; Visual Analog Scale
PubMed: 31340899
DOI: 10.1016/j.jped.2018.05.009 -
Journal of Perianesthesia Nursing :... Feb 2023Preoperative education is an important part of surgical preparation. Nursing visits offer nurses the opportunity to provide personalized care. The aim of this study was... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Preoperative education is an important part of surgical preparation. Nursing visits offer nurses the opportunity to provide personalized care. The aim of this study was to determine the effect of nursing visits before laparoscopic surgery on the anxiety and pain levels of patients in the postoperative period.
DESIGN
Randomized controlled clinical trial.
METHODS
Data were collected from 135 patients who underwent laparoscopic surgery between March and October 2019 in Istanbul. During the nursing visits, the experimental group (n = 72) was educated by the operating room nurse, while the control group (n = 63) was educated by the service nurse. Data were collected using the State-Trait Anxiety Inventory and the Visual Analog Scale. The CONSORT checklist was followed.
FINDINGS
The pre-education state anxiety scores of the control and experimental groups were similar and at a moderate level (P > .05). The state anxiety score of the experimental group visited by operating room nurses decreased more than that of the control group after education (P < .001). The postoperative state anxiety and pain scores of the control and experimental groups were found to be similar (P > .05).
CONCLUSIONS
Visits by operating room nurses before laparoscopic surgery can be an effective method to reduce the anxiety level of patients. Obtaining the opinions of operating room nurses on care integration and organization of in-service education programs may be necessary.
Topics: Humans; Anxiety; Anxiety Disorders; Preoperative Care; Pain
PubMed: 35970660
DOI: 10.1016/j.jopan.2022.05.086 -
Journal of Cardiothoracic and Vascular... Aug 2019The care of patients undergoing cardiac surgery is becoming more complex, in part owing to the increasing burden of comorbid disease, frailty, and psychosocial issues.... (Review)
Review
The care of patients undergoing cardiac surgery is becoming more complex, in part owing to the increasing burden of comorbid disease, frailty, and psychosocial issues. Many risk factors for postoperative morbidity and mortality are potentially modifiable if identified and treated in a timely fashion before surgery. Cardiac prehabilitation, draws from strategies currently undertaken in cardiac rehabilitation but implements them proactively rather than reactively. There is substantial evidence that in multiple domains, including aerobic conditioning, respiratory muscle training, lifestyle modification, diabetic control, sleep, and psychoeducation, selected interventions before cardiac surgery may improve outcomes. However, the optimal preoperative program remains unclear and there is an unmet need for a comprehensive evaluation of the range of interventions specifically targeted at modifiable perioperative risk factors that may reduce adverse outcomes after cardiac surgery.
Topics: Breathing Exercises; Cardiac Surgical Procedures; Humans; Postoperative Complications; Preoperative Care; Risk Reduction Behavior
PubMed: 30765210
DOI: 10.1053/j.jvca.2019.01.023 -
Current Gastroenterology Reports May 2020Colorectal cancer is the third most common cancer in the USA. Colonoscopy is considered the gold standard for colorectal cancer screening and can offer both diagnosis... (Review)
Review
PURPOSE OF THIS REVIEW
Colorectal cancer is the third most common cancer in the USA. Colonoscopy is considered the gold standard for colorectal cancer screening and can offer both diagnosis and therapy. The bowel preparation remains a significant barrier for patients who need to undergo colonoscopy and is often cited as the most dreaded aspect of the colonoscopy process. Inadequate bowel preparations still occur in 10-25% of colonoscopies, and this in turn can lead to increased procedural times, lower cecal intubation rates, and shorter interval between colonoscopies. From a quality standpoint, it is imperative that we do what we can to decrease the rate of inadequate bowel preparations. This review will focus on recent data regarding bowel preparation and offers a glimpse into what may be coming in the future.
RECENT FINDINGS
Recent advances in the field have been made to improve tolerability of bowel preparations and allow for more adequate colonoscopies. Newer, lower volume, flavored preparations, the use of adjuncts, and using split-dose preparations all can help with tolerability, compliance, and, in turn, preparation quality. Edible bowel preparations may become available in the near future. Early data on the use of artificial intelligence for assessment of preparation quality has been promising. Additionally, utilization of smartphone technology for education prior to the bowel preparation has also been shown to improve the adequacy of bowel preparations.
CONCLUSIONS
Ongoing efforts to improve the tolerability and palatability of colonoscopy bowel preparations are important from a quality improvement standpoint to ensure the adequacy of colonoscopy. Incorporating patient-specific factors and comorbidities is also an essential aspect of improving the quality of bowel preparation. Leveraging technology to better communicate with and educate patients on the bowel preparation process is likely to play a larger role in the coming years.
Topics: Artificial Intelligence; Cathartics; Colonoscopy; Colorectal Neoplasms; Diet; Early Detection of Cancer; Humans; Patient Compliance; Patient Education as Topic; Preoperative Care; Quality Improvement; Smartphone
PubMed: 32377915
DOI: 10.1007/s11894-020-00764-4