Preoperative Anxiety Among Latinos
While preoperative anxiety is common and studies have shown that culture and religion can influence these feelings, data are lacking on self-reported changes in anxiety among Latino patients in the preoperative waiting area. For a study, researchers evaluated the baseline and situational anxiety levels of patients scheduled to undergo anesthesia for elective surgery. Patients were grouped into those who were English-speaking Caucasians, English-speaking Latinos, and Spanish-speaking Latinos. No significant differences in baseline anxiety were observed between patient groups. However, Spanish-speaking patients were significantly more likely to experience higher situational anxiety than the English-Speaking Caucasian group. Spanish-speaking patients also had higher anxiety levels than English-speaking Latinos.
Increasing Patient Compliance With Preoperative Medications
Day-of-surgery hospital admission for elective surgery can reduce bed occupancy, but this practice relies on patients to ensure that they are appropriately prepared based upon advice from their pre-assessment visits at clinics. Medication errors made by patients in these situations can cause harm or discomfort or may lead to a cancellation of their operation. Participants in a study who were undergoing elective orthopedic surgery were randomized to receive verbal instructions or a newly implemented, simple medication instruction sheet in a pre-assessment clinic. Patients were evaluated based on the error rate at which they were taking their regular medications before surgery. The researchers observed the following:
|Instruction sheet||Verbal instructions|
|Proper continuation or omission of medications||74%||54%|
|Incorrect omission of medications||25%||42%|
|Incorrect continuation of medication||2%||6%|
Improving Outcomes With PSHs
The perioperative surgical home (PSH) is a patient-centered, team-based model of care designed to guide patients through the complete surgical experience. For a study, researchers compared cases of patients who underwent total knee, hip, or shoulder joint replacement before and after implementation of a PSH model. The model was designed to decrease intraoperative fluid use, reduce continuous femoro-sciatic nerve or brachial plexus blocks, and eliminate use of Foley catheters. It also aimed to ensure timely pain consult responses and to discharge patients as soon as the necessary criteria were met. Following implementation of the PSH model, preoperative imaging use dropped by 9% per case and the average number of tests per case was decreased by 22%. The average units of red blood cell use per case was reduced by 87% and the average length of stay decreased by 0.6 days. With the PSH model, patient satisfaction continually improved in the domains of pain management and doctor communication.
Combining Pediatric Dental & Medical Surgeries
Combining dental and non-dental medical operations may address various financial, parental-time, and safety issues, including unnecessary exposure to general anesthesia. However, few studies have assessed the safety of combining restorative dental procedures and other surgeries under general anesthesia in a pediatric population. For a retrospective review, 55 patients (median age, 59 months) underwent a median of three procedures under a single anesthetic. Seven patients had perioperative complications, including vomiting, pain, fever, and pneumonia. Only four patients were admitted due to perioperative concerns, whereas eight were admitted for unrelated reasons.
The Value of “Prehabilitation”
Efforts to streamline the recovery of surgical patients often neglect patient education and empowerment. For a study, investigators administered a 10-question patient survey on postoperative Day 2 to determine the effects of a “prehabilitation” course among patients enrolled in a colorectal enhanced recovery program (ERAS) and a matched cohort. ERAS included teaching patients about nutrition, physical conditioning, and mental health. It also provided information on expectations for length of stay, the recovery regimen, pain control, and potential postoperative complications. Researchers found that patients who were enrolled in ERAS subjectively reported statistically higher levels of satisfaction, empowerment, and preparedness.
NEWS FROM ANESTHESIOLOGY 2016
MORE FROM ANESTHESIOLOGY 2016