Enhanced recovery after cardiac surgery protocol reduces perioperative opioid use

Loria, Chelsea M.; Zborek, Kirsten; Millward, James B.; Anderson, Matthew P.; Richardson, Cynthia M.; Namburi, Niharika; Faiza, Zainab; Timsina, Lava; Lee, Lawrence S.

doi:10.1016/j.xjon.2022.08.008

Cited by 6 publications

(2 citation statements)

References 19 publications

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“…The line between allowing a non-opioid approach and adequate pain control could be very fine, and optimizing pain control after cardiac surgery hastens return to a “normalization” of quality of life and functionality in these patients. [ 40 ]…”

Section: Post-operative Interventionsmentioning

confidence: 99%

Enhanced recovery after cardiac surgery: A literature review

Navas-Blanco,

Kantola,

Whitton

et al. 2024

Saudi Journal of Anaesthesia

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Enhanced recovery after cardiac surgery (ERACS) represents a constellation of evidence-based peri-operative methods aimed to reduce the physiological and psychological stress patients experience after cardiac surgery, with the primary objective of providing an expedited recovery to pre-operative functional status. The method involves pre-operative, intra-operative, and post-operative interventions as well as direct patient engagement to be successful. Numerous publications in regard to the benefits of enhanced recovery have been presented, including decreased post-operative complications, shortened length of stay, decreased overall healthcare costs, and higher patient satisfaction. Implementing an ERACS program undeniably requires a culture change, a methodical shift in the approach of these patients that ultimately allows the team to achieve the aforementioned goals; therefore, team-building, planning, and anticipation of obstacles should be expected.

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Section: Post-operative Interventionsmentioning

confidence: 99%

Enhanced recovery after cardiac surgery: A literature review

Navas-Blanco,

Kantola,

Whitton

et al. 2024

Saudi Journal of Anaesthesia

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show abstract

“…This activation in turn prevents the opening of the mitochondrial permeability transition pore (mPTP) and results in antiapoptotic effects. The protective effects of anesthetics and opioids, however, are limited because the dosage used should be the minimum necessary based on the fast-track strategy and enhanced recovery after surgery (ERAS) program to minimize excessive arti cial ventilation time and opioid side effects [11,12].…”

Section: Introductionmentioning

confidence: 99%

Cardioprotective effects of S-equol and role of the PI3K/Akt pathway in the isolated ischemic rat heart

Yamada,

Nakadate,

Omiya

et al. 2023

Preprint

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Purpose This study aimed to assess the cardioprotective effects of S-equol on stunned myocardium in an isolated rat heart model. Additionally, we examined the role of the PI3K/Akt signaling pathway.l Methods Rat hearts were perfused using the Langendorff system and assigned to receive 1) modified Krebs–Henseleit (KH) buffer containing 1 µmol/L S-equol (EQ), 2) KH buffer (Cont), 3) KH buffer supplemented with 1 µmol/L S-equol and 100 nmol/L wortmannin (a specific PI3K inhibitor) (EQW), or 4) KH buffer containing wortmannin (ContW). After stabilization, each group was perfused for 20 min prior to no-flow ischemia for 7.5 min, followed by reperfusion for 20 min. The primary outcome was the maximum left ventricular derivative of pressure development (LV dP/dt max) after 20 min of reperfusion. Myocardial Akt and glycogen synthase kinase-3 beta (GSK-3β) were assayed using western blotting. Results The LV dP/dt max in the EQ group was greater than that in the Cont group after 15 and 20 min of reperfusion; however, this effect was attenuated in the presence of PI3K inhibitors. S-equol treatment increased Akt and suppressed GSK-3β in the EQ group compared to the Cont group. However, these effects were not observed in the presence of wortmannin. Conclusion S-equol exerted a protective effect against myocardial ischemia-reperfusion injury, possibly by activating PI3K/Akt signaling.

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Perioperative multimodal analgesia: a review of efficacy and safety of the treatment options

Kianian,

Bansal,

Lee

et al. 2024

APS

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Pain in the postoperative period is a common patient experience that can subsequently lead to other postoperative complications if not managed appropriately. While opioids are a common pharmacologic tool for managing pain, there are risks associated with liberal opioid use. Multimodal analgesic strategies, however, can adequately manage postoperative pain and minimize the risks associated with opioids. In this review, common pharmacological treatments for multimodal analgesia will be reviewed for efficacy, risks, and benefits, including gabapentinoids, opioids, alpha-2 agonists, ketamine, Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. While this may not be a comprehensive list of medication options, it represents some of the most commonly used pharmacologic techniques for managing pain in the perioperative period. In addition, newer regional anesthetic techniques will be discussed to review their efficacy, risks, and benefits as well. The goal of this review is to summarize the various options for a multimodal analgesic protocol that we encourage providers to utilize when managing postoperative pain to facilitate conservative opioid usage and improve patient outcomes overall. Graphical Abstract

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Enhanced recovery after cardiac surgery protocol reduces perioperative opioid use

Cited by 6 publications

References 19 publications

Enhanced recovery after cardiac surgery: A literature review

Enhanced recovery after cardiac surgery: A literature review

Cardioprotective effects of S-equol and role of the PI3K/Akt pathway in the isolated ischemic rat heart

Perioperative multimodal analgesia: a review of efficacy and safety of the treatment options

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