Journal of clinical anesthesia
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In the United States, alcohol use disorder adversely affects 5.6% of all adults. Excessive alcohol consumption adversely affects organ functions critical for adaptation to stress induced by surgery. Colorectal resection is one of the most common major surgeries in patients at risk for alcohol use disorder. The objective of this study was to assess the impact of alcohol use disorder on hospital outcomes after colectomy using a population-based discharge database. ⋯ Alcohol use disorder is associated with an increased risk of in-hospital mortality in patients undergoing colectomy, one of the most common major surgeries. Future research should examine if enhanced efforts to identify patients with alcohol use disorder could enable anesthesiologists to provide worthwhile perioperative interventions for this high-risk population.
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The optimal methods of preoperative assessment and prehabilitation specific to patients with obesity undergoing non-bariatric surgery have not been described. We investigated two questions: 1) which methods of preoperative assessment in patients with obesity are associated with improved patient management, and 2) which methods of prehabilitation in patients with obesity are associated with improved patient outcomes? ⋯ There is a limited body of work addressing preoperative assessment and prehabilitation specific to surgical patients with obesity, especially when undergoing non-bariatric surgery. Preoperative polysomnography was shown to improve both the diagnosis of obstructive sleep apnoea and the prediction of postoperative complications. Half of the prehabilitation studies showed evidence of benefit. From this review, we were unable to make strong recommendations as to best practice in patients with obesity presenting for non-bariatric surgery.
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Review Meta Analysis
Perioperative ketamine for postoperative pain management in patients with preoperative opioid intake: A systematic review and meta-analysis.
Postoperative pain management in opioid users remains challenging. The perioperative administration of ketamine might lead to favourable pain outcomes in these patients. ⋯ Prospero CRD42020185497.
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The concept of patient blood management (PBM) was introduced by the World Health Organization in 2011 and is defined as a "patient-focused, evidence-based and systematic approach for optimizing the management of patients and transfusion of blood products to ensure high quality and effective patient care". Patient blood management is a multimodal approach based on three pillars: optimization of blood mass, minimization of blood loss and optimization of patient tolerance to anaemia. Antifibrinolytics play a major role in cardiac surgery, where the risk of perioperative bleeding is high and affects a majority of patients, by effectively reducing bleeding, transfusions, re-operations, as well as their associated morbidity and mortality. ⋯ Thus, the implementation of PBM programs in Europe is still challenging. In 2021, the WHO published a new document highlighting the urgent need to close the gap in PBM awareness and implementation and announced their upcoming initiative to develop specific PBM implementation guidelines. This review aims first, to summarize the role played by fibrinolysis in haemostatic disorders; second, to give an overview of the current available guidelines in Europe detailing PBM implementation in cardiac surgery; and third, to analyse the place and use of antifibrinolytics in these guidelines.