In Pursuit of an Opioid-Free Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative

Franz, Amber; Martin, Lynn D.; Liston, David E.; Latham, Gregory J.; Richards, Michael J.; Low, Daniel

doi:10.1213/ane.0000000000004774

Cited by 47 publications

(47 citation statements)

References 28 publications

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“…Thus, a multimodal approach to analgesia with the co-administration of nonopioid adjuvant analgesic agents and regional anesthesia is recommended. The intraoperative use of these technics have reduced the need of intraoperative opioids from 84 to 8% and in terms of postoperative morphine consumption from 11 to 6% [63]. As previously stated, this multimodal approach has significantly reduced the risk of respiratory depression [64][65][66] and unexpected hospital admissions [67,68].…”

Section: Intraoperative Managementmentioning

confidence: 88%

Perioperative respiratory adverse events during ambulatory anesthesia in obese children

et al. 2021

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Obesity is one of the most common clinical conditions in the pediatric population with an increasing prevalence ranging from 20 to 30% worldwide. It is well known that during ambulatory anesthesia, obese children are more prone to develop perioperative respiratory adverse events (PRAEs) associated with obesity. To avoid or at least minimize these adverse effects, a thorough preoperative assessment should be undertaken as well as consideration of specific anesthetic approaches such as preoxygenation before induction of anesthesia and optimizing drug dosing. The use of short-acting opioid and nonopioid analgesics and the frequent implementation of regional anesthesia should also be included. Noninvasive airway management, protective mechanical ventilation, and complete reversion of neuromuscular blockade and awake extubation also proved to be beneficial in preventing PRAEs. During the postoperative period, continuous monitoring of oxygenation and ventilation is mandatory in obese children. In the current review, we sought to provide recommendations that might help to reduce the severity of perioperative respiratory adverse events in obese children, which could be of particular importance for reducing the rate of unplanned hospitalizations and ultimately improving the overall postoperative recovery.

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Section: Intraoperative Managementmentioning

confidence: 88%

Perioperative respiratory adverse events during ambulatory anesthesia in obese children

et al. 2021

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“…While opioids are the most effective antinociceptive agents, they have undesirable side effects, including respiratory depression, nausea, vomiting, urinary retention, constipation, ileus, and pruritus. Another problem is opioid addiction, a 4.8%-6.5% incidence of persistent opioid use after surgery in older children and adults in the United States [14]. With this mind, opioid-free anesthesia (OFA) was introduced to avoid current crisis.…”

Section: Discussionmentioning

confidence: 99%

Application of magnesium sulphate as a " multimodal general anesthesia" protocol in patients undergoing hysteroscopy: a randomized controlled study

Gao

Lin

Wang

et al. 2020

Preprint

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Background: The purpose of the study was to applicate magnesium sulphate as a " multimodal general anesthesia" protocol to reduce perioperative opioids requirements in patients undergoing hysteroscopy.Methods: 70 patients scheduled for hysteroscopy were randomly divided into 2 groups. Patients in Group M received intravenous magnesium sulfate 50 mg/kg in 100 ml of isotonic saline over 15 min before fentanyl injection and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group received an equal volume of normal saline as placebo. All patients were anesthetized under a BIS guided monitored anesthesia care with propofol and fentanyl. Intraoperative hemodynamic variables were recorded and postoperative pain scores were assessed with verbal numerical rating scale (VNRS) 1 min, 15 min, 30 min, 1 hour, and 4 hours after recovery of consciousness. The primary outcome of our study was total amount of intraoperative and postoperative analgesics administered.Results: Postoperative serum magnesium concentrations in Group C were significantly decreased than preoperative levels (0.86 ± 0.06 to 0.80 ± 0.08 mmol/L, P=0.001) while there was no statistical change in Group M (0.86 ± 0.07 to 0.89 ± 0.07 mmol/L, P=0.129). Bradycardia did not occur in either group and the incidence of hypotension was comparable between the two groups. Total dose of fentanyl given to patients in Group M was less than the one administered to Group C [100 (75-150) vs 145 (75-175) μg, median (range); P < 0.001]. Fewer patients in Group M required additional analgesics postoperatively. In addition, patients receiving magnesium displayed lower VNRS scores at 15 min, 30 min, 1 hour, and 4 hours postoperatively. Conclusions: Intravenous infusion of magnesium sulphate significantly reduces postoperative pain and perioperative opioid requirements without increasing the risk of cardiovascular side effects. Meanwhile, it was beneficial to maintain a stable serum magnesium concentration after the procedure.Trial registration: www.chictr.org.cn ChiCTR1900024596 date of registration: July 18th 2019.

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“…While opioids are the most effective antinociceptive agents, they have undesirable side effects, including respiratory depression, nausea, vomiting, urinary retention, constipation, ileus, and pruritus. Another problem is opioid addiction, a 4.8%-6.5% incidence of persistent opioid use after surgery in older children and adults in the United States [15]. With this in mind, opioid-free anesthesia (OFA) was introduced to avoid current crisis.…”

Section: Discussionmentioning

confidence: 99%

Antinociceptive effects of magnesium sulfate for monitored anesthesia care during hysteroscopy: a randomized controlled study

Gao

Lin

Wang

et al. 2020

Preprint

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Background: Opioids are the most effective antinociceptive agents, they have undesirable side effects such as respiratory depressant and postoperative nausea and vomiting. The purpose of the study was to evaluate the antinociceptive efficacy of adjuvant magnesium sulphate to reduce intraoperative and postoperative opioids requirements and their related side effects during hysteroscopy.Methods: 70 patients scheduled for hysteroscopy were randomly divided into 2 groups. Patients in the magnesium group (Group M) received intravenous magnesium sulfate 50 mg/kg in 100 ml of isotonic saline over 15 min before anesthesia induction and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group (Group C) received an equal volume of isotonic saline as placebo. All patients were anesthetized under a BIS guided monitored anesthesia care with propofol and fentanyl. Intraoperative hemodynamic variables were recorded and postoperative pain scores were assessed with verbal numerical rating scale (VNRS) 1 min, 15 min, 30 min, 1 hour, and 4 hours after recovery of consciousness. The primary outcome of our study was total amount of intraoperative and postoperative analgesics administered.Results: Postoperative serum magnesium concentrations in Group C were significantly decreased than preoperative levels (0.86 ± 0.06 to 0.80 ± 0.08 mmol/L, P=0.001) while there was no statistical change in Group M (0.86 ± 0.07 to 0.89 ± 0.07 mmol/L, P=0.129). Bradycardia did not occur in either group and the incidence of hypotension was comparable between the two groups. Total dose of fentanyl given to patients in Group M was less than the one administered to Group C [100 (75-150) vs 145 (75-175) μg, median (range); P < 0.001]. There was no statistically significant difference for patients who needed rescue analgesic between the two groups [14 vs 6 subjects in Group C and Group M, RR=0.44 (0.19 to 1.01), P=0.052, NNT 4.349]. In addition, patients receiving magnesium displayed lower VNRS scores at 15 min, 30 min, 1 hour, and 4 hours postoperatively. Conclusions: In hysteroscopy, adjuvant magnesium administration is beneficial to reduce intraoperative fentanyl requirement and postoperative pain without cardiovascular side effects. Our study indicates that if surgical patients have risk factors for hypomagnesemia, assessing and correcting magnesium level will be necessary.Trial registration: www.chictr.org.cn ChiCTR1900024596 date of registration: July 18th 2019.

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In Pursuit of an Opioid-Free Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative

Cited by 47 publications

References 28 publications

Perioperative respiratory adverse events during ambulatory anesthesia in obese children

Perioperative respiratory adverse events during ambulatory anesthesia in obese children

Application of magnesium sulphate as a " multimodal general anesthesia" protocol in patients undergoing hysteroscopy: a randomized controlled study

Antinociceptive effects of magnesium sulfate for monitored anesthesia care during hysteroscopy: a randomized controlled study

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