Articles: operative.
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Introduction: Risk scoring systems exist to predict perioperative blood transfusion risk in cardiac surgery, but none have been validated in the Australian or New Zealand population. The ACTA-PORT score was developed in the United Kingdom for this purpose. In this study, we validate and recalibrate the ACTA-PORT score in a large national database. ⋯ Conclusions: The AntiPORT is the first red cell transfusion risk scoring system for cardiac surgery patients to be validated using Australian data. It is accurate and simple to calculate. The demonstrated accuracy of AntiPORT may help facilitate benchmarking and future research in patient blood management, as well as providing a useful tool to help clinicians target these resource-saving strategies.
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Objective: Vital signs abnormalities in the post-anaesthesia care unit (PACU) may identify patients at risk of severe postoperative complications in the general ward, but are sparsely investigated by continuous monitoring. We aimed to assess if the severity of vital signs abnormalities in the PACU was correlated to the duration of severe vital signs abnormalities and serious adverse events (SAEs) in the general ward. Design: Prospective cohort study. ⋯ Seventeen patients (18%) experienced SAEs, without significant association to the PACU stay (area under the receiver operating characteristic [AUROC], 0.59; 95% CI, 0.46-0.73). Conclusion: Vital signs abnormalities in the PACU did not show a tendency towards predicting overall severe vital signs abnormalities or SAEs during the first days in the general ward. Circulatory abnormalities in the PACU showed a tendency towards predicting circulatory complications in the ward.
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Also in ambulatory surgery, there will usually be a need for analgesic medication to deal with postoperative pain. Even so, a significant proportion of ambulatory surgery patients have unacceptable postoperative pain, and there is a need for better education in how to provide proper prophylaxis and treatment. ⋯ Multimodal analgesia should start pre or per-operatively and include paracetamol, nonsteroidal anti-inflammatory drug (NSAID), dexamethasone (or alternative glucocorticoid) and local anaesthetic wound infiltration, unless contraindicated in the individual case. Paracetamol and NSAID should be continued postoperatively, supplemented with opioid on top as needed. Extra analgesia may be considered when appropriate and needed. First-line options include nerve blocks or interfascial plane blocks and i.v. lidocaine infusion. In addition, gabapentinnoids, dexmedetomidine, ketamine infusion and clonidine may be used, but adverse effects of sedation, dizziness and hypotension must be carefully considered in the ambulatory setting.