Fast Track (Acerto) in Elderly Patients for Hip Orthopedic Surgeries. Ten Years of Experience

Imbelloni, Luiz Eduardo; Araujo, André Augusto de; Sakamoto, Jaime Weslei; Viana, Eduardo Piccinini; Filho, Wagner Ferreira; Mori, Marcos Kayu; Filho, Geraldo Borges de Morais

doi:10.47363/jsar/2020(1)103

Cited by 4 publications

(3 citation statements)

References 32 publications

(64 reference statements)

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“…Blockade of the lumbar and sacral plexuses improved postoperative analgesia in elderly patients with hip and femur fractures, reducing the side effects of opioids, and thus facilitating the rapid recovery process. 1,7,21,22 The average duration of analgesia was 22 hours, similar to other studies with the same type of surgery.…”

Section: Discussionsupporting

confidence: 76%

“…This study was based on the recently published 1,226 patients. 1 Due to the fact that the study was retrospective, the Free and Informed Consent Term was released. The patients also were informed about risk of spinal anesthesia.…”

Section: Methodsmentioning

confidence: 99%

“…We recently published an experience with an acceleration of postoperative recovery (Projeto ACERTO) in 1,226 patients over 60 years old with hip and femur fractures, in 10 years of project implementation. 1 The implementation of the project was chosen for elderly patients in a Brazilian Public Health System (SUS) hospital with the objectives of reducing the length of hospital stay, surgical complications, and increasing patient satisfaction after surgery. Goals achieved in these 10 years of implementing the ACERTO project.…”

Section: Introductionmentioning

confidence: 99%

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Importance of fasting abbreviation and analgesia in the satisfaction and recovery of elderly patients with hip and femur fractures. retrospective study with 1,001 patients

Imbelloni¹,

Ventura²,

Brasileiro³

et al. 2023

JACCOA

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Background and objectives: There are several ways to assess patient satisfaction, as it is a standard indicator of the quality of care provided. The aim of this study was to evaluate whether the abbreviation of fasting with 200 ml CHO, the intake of the same beverage in the PACU, the return to oral feeding in the ward, and postoperative analgesia can improve comfort and satisfaction with anesthesia in elderly patients. with hip and femur fracture. Methods: A retrospective trial carried out in a Brazilian public health hospital (SUS), with 1,001 patients physical status ASA I-III submitted to hip and femur fracture surgery. The following items were evaluated: preoperative fasting time, evaluation of thirst and hunger upon arrival in the operating room, time of CHO administration in the PACU, time of reintroduction of oral feeding in the ward, and at this moment, the degree of satisfaction with the anesthetic conduct, abbreviation of fasting and early feeding. A satisfaction assessment was performed with YES and NO answers regarding the pre-anesthetic visit, the fasting abbreviation, the use of CHO in PACU, refeeding in the ward, and postoperative analgesia. Family members were also asked to return immediately to the ward, without intravenous hydration and without going through the ICU. Results: All patients had the fasting abbreviation between 1:20 h and 4:00 h. None of the 1,001 patients reported being thirsty when they arrived in the operating room, against only 26 patients reporting being hungry. The time of administration of dextrinomaltose in PACU ranged from 20 minutes to 5:45 h, and the reintroduction of oral feeding in the ward ranged from 4 h to 8:15 h. Analgesia with lumbar plexus block with a neurostimulator and levobupivacaine before or after providing mean analgesia of 22±4 h, with a minimum time of 13 h and a maximum of 34 h. All patients were able to be discharged from the hospital on the second postoperative day. Conclusion: This study with 1,001 patients clearly shows that in hospitalized elderly, the liberal use of CHO before surgery and immediately in PACU, and better quality analgesia is an easy and practical way to increase patient comfort and satisfaction with anesthesia care and with better outcomes.

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Section: Discussionsupporting

confidence: 76%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Importance of fasting abbreviation and analgesia in the satisfaction and recovery of elderly patients with hip and femur fractures. retrospective study with 1,001 patients

Imbelloni¹,

Ventura²,

Brasileiro³

et al. 2023

JACCOA

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Segmental thoracic anesthesia for transabdominal colectomy with spontaneous ventilation through combined spinal-epidural block. Case report with video

Imbelloni, MD, PhD,

Fornasari, MD,

Sant’Anna, MD

et al. 2024

JACCOA

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Introduction: The combined spinal-epidural (CSE) technique offers advantages over the epidural or single injection spinal anesthesia alone. Assessing the distance between the dura mater and the spinal cord in the thoracic region with magnetic resonance imaging showed that there is a large space that allows the needle to enter without reaching the spinal cord. Segmental thoracic spinal anesthesia is being used in several types of surgery. Case report: A woman aged 73 years, 64 kg, 163 cm, physical status ASA II, type II diabetic, with systemic arterial hypertension, was scheduled for resection of a tumor in the right colon. The CSE was placed at the T9-T10 interspace and 10mg 0.5% hyperbaric bupivacaine was injected into the subarachnoid space. The epidural catheter (20G) was then inserted four centimeters. Sedation was obtained with 1mg of midazolam as needed (total 5mg). Two hours after 0.5% bupivacaine had to be administered in a bolus of 25 mg through the catheter. There was no necessity for the use of vasopressor drugs or atropine. Conclusion: This case has provided evidence that segmental spinal anesthesia can be an effective anesthetic technique for gastrointestinal surgery with spontaneous ventilation, and the infusion of 0.1% bupivacaine with an elastomeric pump provided 40 hours of analgesia.

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ACERTO Project - 15 years changing perioperative care in Brazil

De-Aguilar-Nascimento

Salomão

Caporossi

et al. 2021

Rev. Col. Bras. Cir.

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The ACERTO project is a multimodal perioperative care protocol. Implemented in 2005, the project in the last 15 years has disseminated the idea of a modern perioperative care protocol, based on evidence and with interdisciplinary team work. Dozens of published studies, using the protocol, have shown benefits such as reduced hospital stay, postoperative complications and hospital costs. Disseminated in Brazil, the project is supported by the Brazilian College of Surgeons and the Brazilian Society of Parenteral and Enteral Nutrition, among others. This article compiles publications by the authors who belong to the CNPq research group “Acerto em Nutrição e Cirurgia”, refers to the experience of other national authors in various surgical specialties, and finally outlines the evolution of the ACERTO project in the timeline.

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Fast Track (Acerto) in Elderly Patients for Hip Orthopedic Surgeries. Ten Years of Experience

Cited by 4 publications

References 32 publications

Importance of fasting abbreviation and analgesia in the satisfaction and recovery of elderly patients with hip and femur fractures. retrospective study with 1,001 patients

Importance of fasting abbreviation and analgesia in the satisfaction and recovery of elderly patients with hip and femur fractures. retrospective study with 1,001 patients

Segmental thoracic anesthesia for transabdominal colectomy with spontaneous ventilation through combined spinal-epidural block. Case report with video

ACERTO Project - 15 years changing perioperative care in Brazil

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