Enhanced Recovery After Cardiac Surgery

Charlesworth, M.; Klein, Andrew

doi:10.1016/j.anclin.2021.11.007

Cited by 7 publications

(7 citation statements)

References 46 publications

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“…Evidently, this does not meet the requirements of current ERACS protocols. 2 Furthermore, incidences of rescue analgesia and chronic pain at 3 months postoperatively were 57.4% and 50.0% in the control group, respectively; and 31.5% and 42.6% in the multimodal group. Based on these results, we argue that the multimodal analgesic regimen designed by this study is not ideal for pain control after cardiac surgery.…”

Section: Dear Editormentioning

confidence: 86%

“…In a single-center, prospective, randomized, controlled clinical trial of 108 patients who underwent cardiac surgery, Jin et al 1 showed that a multimodal regimen including paracetamol, gabapentin, ketamine, lidocaine, dexmedetomidine and sufentanil was not superior to the traditional opioid-based regimen in terms of analgesia effects but it reduced perioperative opioid consumption and rescue analgesia use. Given that use of a multimodal opioid-sparing regimen is increasingly emphasized in current practice of enhanced recovery after cardiac surgery (ERACS), 2 this study has potentially clinical implications. However, we had several questions about the design and results of this study and wished to get the authors’ responses.…”

Section: Dear Editormentioning

confidence: 99%

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Evaluation of the Effect of New Multimodal Analgesia Regimen for Cardiac Surgery: A Prospective, Randomized Controlled, Single-Center Clinical Study [Letter]

Chen¹,

Xue²,

Li³

2023

DDDT

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Section: Dear Editormentioning

confidence: 86%

Section: Dear Editormentioning

confidence: 99%

Evaluation of the Effect of New Multimodal Analgesia Regimen for Cardiac Surgery: A Prospective, Randomized Controlled, Single-Center Clinical Study [Letter]

Chen¹,

Xue²,

Li³

2023

DDDT

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“…Satisfactory postoperative pain control is essential to patient recovery after cardiothoracic surgery because inadequate analgesia may contribute to prolonged immobilization as well as impaired lung expansion and respiratory function, especially in those undergoing median sternotomy ( 4 , 42 – 44 ). Our results demonstrated an association of low-to-medium dose ITM with a lower pain score and intravenous morphine consumption compared to the control group up to postoperative 48 h without increasing the risks of PONV and respiratory depression.…”

Section: Discussionmentioning

confidence: 99%

Analgesic efficacy and risk of low-to-medium dose intrathecal morphine in patients undergoing cardiac surgery: An updated meta-analysis

Chen

Sun

et al. 2022

Front. Med.

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BackgroundTo evaluate the analgesic efficacy and risk of low-to-medium dose intrathecal morphine (ITM) (i.e., ≤0.5 mg) following cardiac surgery.MethodsMedline, Cochrane Library, Google scholar and EMBASE databases were searched from inception to February 2022. The primary outcome was pain intensity at postoperative 24 h, while the secondary outcomes included intravenous morphine consumption (IMC), extubation time, hospital/intensive care unit (ICU) length of stay (LOS), and ITM-associated side effects (e.g., respiratory depression). Subgroup analysis was performed on ITM dosage (low: <0.3 mg vs. medium: 0.3–0.5 mg).ResultsFifteen RCTs involving 683 patients published from 1988 to 2021 were included. Pooled results showed significantly lower postoperative 24-h pain scores [mean difference (MD) = −1.61, 95% confidence interval: −1.98 to −1.24, p < 0.00001; trial sequential analysis: sufficient evidence; certainty of evidence: moderate] in the ITM group compared to the controls. Similar positive findings were noted at 12 (MD = −2.1) and 48 h (MD = −1.88). Use of ITM was also associated with lower IMC at 24 and 48 h (MD: −13.69 and −14.57 mg, respectively; all p < 0.05) and early tracheal extubation (i.e., 48.08 min). No difference was noted in hospital/ICU LOS, and nausea/vomiting in both groups, but patients receiving ITM had higher risk of pruritus (relative risk = 2.88, p = 0.008). There was no subgroup difference in IMC except a lower pain score with 0.3–0.5 mg than <0.3 mg at postoperative 24 h. Respiratory depression events were not noted in the ITM group.ConclusionOur results validated the analgesic efficacy of low-to-medium dose ITM for patients receiving cardiac surgery without increasing the risk of respiratory depression.

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“…Likewise, there is little or no evidence on the best approach to more complex procedures such as heart/lung transplantation or aortic dissection repair. Modifiable risk factor mitigation is essential and the principles underlying this are well‐known [57]. Surgery must be timely following patient listing, as decompensation, heart failure, inactivity and sarcopenia due to long waits are disastrous for patients and health services.…”

Section: Cardiac Anaesthesiamentioning

confidence: 99%

Anaesthetic subspecialties and sustainable healthcare: a narrative review

Oliver,

Charlesworth,

Pratt

et al. 2024

Anaesthesia

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SummaryThe principles of environmentally sustainable healthcare as applied to anaesthesia and peri‐operative care are well documented. Associated recommendations focus on generic principles that can be applied to all areas of practice. These include reducing the use of inhalational anaesthetic agents and carbon dioxide equivalent emissions of modern peri‐operative care. However, four areas of practice have specific patient, surgical and anaesthetic factors that present barriers to the implementation of some of these principles, namely: neuroanaesthesia; obstetric; paediatric; and cardiac anaesthesia. This narrative review describes these factors and synthesises the available evidence to highlight areas of sustainable practice clinicians can address today, as well as posing several unanswered questions for the future. In neuroanaesthesia, improvements can be made by undertaking awake surgery, moving towards more reusables and embracing telemedicine in quaternary services. Obstetric anaesthesia continues to present questions regarding how services can move away from nitrous oxide use or limit its release to the environment. The focus for paediatric anaesthesia is addressing the barriers to total intravenous and regional anaesthesia. For cardiac anaesthesia, a significant emphasis is determining how to focus the substantial resources required on those who will benefit from cardiac interventions, rather than universal implementation. Whilst the landscape of evidence‐based sustainable practice is evolving, there remains an urgent need for further original evidence in healthcare sustainability targeting these four clinical areas.

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Enhanced Recovery After Cardiac Surgery

Cited by 7 publications

References 46 publications

Evaluation of the Effect of New Multimodal Analgesia Regimen for Cardiac Surgery: A Prospective, Randomized Controlled, Single-Center Clinical Study [Letter]

Evaluation of the Effect of New Multimodal Analgesia Regimen for Cardiac Surgery: A Prospective, Randomized Controlled, Single-Center Clinical Study [Letter]

Analgesic efficacy and risk of low-to-medium dose intrathecal morphine in patients undergoing cardiac surgery: An updated meta-analysis

Anaesthetic subspecialties and sustainable healthcare: a narrative review

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