Implementing enhanced recovery pathways to improve surgical outcomes

Patil, Shilpadevi; Cornett, Elyse M.; Jesunathadas, June; Belani, Kumar G.; Fox, Charles J.; Kaye, Alan D.; Lambert, Lee A; Urman, Richard D.

doi:10.4103/joacp.joacp_36_18

Cited by 17 publications

(6 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As the concept of enhanced recovery gains prominence, the significance of blood management becomes increasingly evident [ 31 ]. Adequate blood management measures are crucial for achieving early and rapid recovery in patients, particularly among the elderly.…”

Section: Discussionmentioning

confidence: 99%

Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

Zhang

Fan

Zheng

et al. 2023

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Meta-analyses on the use of tranexamic acid (TXA) in intertrochanteric fractures have shown inconsistent results due to variations in inclusion criteria and clinical heterogeneity. To address these limitations, we conducted a rigorous analysis of recent randomized controlled trials (RCTs) with strict inclusion criteria. The aim of this study was to objectively evaluate the effects and safety of intravenous TXA administration in the treatment of geriatric intertrochanteric femoral fractures with intramedullary nailing. Methods PubMed, Embase, and the Cochrane Library were searched for RCTs published from the database inception to August 2022. The date of total blood loss (TBL), intra-operative blood loss (IBL), hidden blood loss (HBL), transfusion rate, transfusion units, thromboembolic events, and mortality were extracted. Review Manager 5.3 was used for the analysis. Results A total of six RCTs involving 689 patients were included. Meta-analyses indicated that TXA can significantly reduce TBL (WMD = -232.82; 95% CI -312.81 to -152.84; p < 0.00001), IBL (WMD = -36.33; 95% CI -51.38 to -21.28; p < 0.00001), HBL (WMD = -189.23; 95% CI -274.92 to -103.54; p < 0.0001), transfusion rate (RR = 0.53; 95% CI 0.33 to 0.85; p = 0.008), and transfusion units (WMD = -0.58; 95% CI -0.75 to -0.41; p < 0.01). No increase in thromboembolic events rate (RR = 0.75; 95% CI 0.38 to 1.50; p = 0.42) and mortality (RR = 1.36; 95% CI 0.61 to 3.04; p = 0.45) was observed. Conclusions Our meta-analysis provides robust evidence supporting the efficacy and safety of intravenous TXA administration in treating geriatric intertrochanteric femoral fractures with intramedullary nailing. TXA significantly reduces blood loss and transfusion requirements without increasing the risk of thromboembolic events or mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

Zhang

Fan

Zheng

et al. 2023

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…The lack of control during this delicate phase leads to increased risks for the patient, not only related to unconsciousness, but also to respiratory depression and lack of protective reflexes (e.g., laryngeal reflex) [ 1 , 2 ]. The economic burden associated with prolonged recovery highlights the need to shorten it without quality loss [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of methylphenidate on anaesthesia recovery: An experimental study in pigs

Mirra,

Micieli,

Arnold

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

Introduction Due to the lack of specific antagonists for general anaesthetics, the pharmacological stimulation of the arousal pathways might contribute to reduce recovery time. We aimed at assessing the effect of methylphenidate on physiological parameters, nociceptive withdrawal reflex thresholds, electroencephalographic variables and time of reappearance of reflexes in pigs undergoing propofol anaesthesia. Materials and methods Two experiments have been performed. Five (experiment 1) and sixteen (experiment 2) healthy juvenile pigs were anaesthetised with propofol. In experiment 1, saline, methylphenidate 10 mg/kg or methylphenidate 20 mg/kg was administered intravenously at the end of propofol administration, using a cross-over design. In experiment 2, saline (n = 8) or methylphenidate 20 mg/kg (n = 8) was administered immediately after extubation. In both experiments, physiological parameters, nociceptive withdrawal reflex thresholds, electroencephalographic variables and time of reappearance of reflexes were assessed. Comparison among groups was performed using either the two-way repeated measures ANOVA followed by Bonferroni-Test or the t-test in case of parametric data, and either the Kruskal-Wallis test or the Mann-Whitney Rank Sum test in case of non-parametric data. A p value < 0.05 was considered statistically significant. Results No clinically relevant changes were observed in both experiments for physiological parameters, nociceptive withdrawal reflex thresholds and electroencephalographic variables. Conclusions Methylphenidate does not shorten or modify anaesthesia recovery in pigs, when the sole propofol is administered.

show abstract

“…Внедрение ERAS в клиническую практику дает возможность [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]:…”

Section: Introductionunclassified

Enhanced recovery after surgery: the current state in spinal neurosurgery

Sayfullin

Bokov

Mordvinov

et al. 2023

Nejrohirurgiâ (Mosk.)

View full text Add to dashboard Cite

The last decade of the XXI century was marked by the active development and introduction into clinical practice of the technology of Enhanced recovery after surgery. It allows you to ensure a quick and high‑quality recovery after surgery, reduce the number of complications, reduce the time of hospitalization and medical costs without increasing repeated hospitalizations, postoperative morbidity and the need for observation in the intensive care unit, minimize differences in the provision of perioperative care in various medical institutions and improve the quality of medical care to the population.Aim. To describe the history of development and current state of Enhanced recovery after surgery (ERAS or fast‑track), to present the ERAS Society protocol for spine surgery in adults and a consolidated protocol in children, and also have determined the results of the implementation of ERAS in various sections of spinal neurosurgery.

show abstract

Implementing enhanced recovery pathways to improve surgical outcomes

Cited by 17 publications

References 25 publications

Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

The effect of methylphenidate on anaesthesia recovery: An experimental study in pigs

Enhanced recovery after surgery: the current state in spinal neurosurgery

Contact Info

Product

Resources

About