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  • 1.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Perioperative Medicine, Karolinska University Hospital, Stockholm, Sweden.
    “Let the patient decide” – person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: secondary analysis of a randomized controlled trial2019In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, p. 33-37Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients undergoing day surgery are expected to manage their recovery on their own. Follow-up routines differ, but many patients have expressed a need for more professional support during recovery. The aim of this study was to describe how many follow-up contacts were initiated, and when and why, via a digital solution. Also, we wanted to compare postoperative recovery and characteristics between patients requesting, and patients not requesting, contact.

    MATERIALS AND METHODS: This was a secondary analysis of a multicenter, two-group, parallel randomized controlled trial. Participants used a digital solution called "Recovery Assessment by Phone Points (RAPP)" for initiating follow-up contacts after day surgery. The quality of postoperative recovery was measured with the Swedish web-version of Quality of Recovery.

    RESULTS: Of 494 patients, 84 (17%) initiated contact via RAPP. The most common reasons for initiating contact were related to the surgical wound and pain. Contacts were initiated across the 14-day assessment period, with 62% (62/100) in the first postoperative week. The RAPP contact group had significantly poorer postoperative recovery on days 1-14 compared to those not requesting contact via RAPP (p < 0.001). There was a significantly higher proportion of patients who had undergone general anesthesia in the RAPP contact group (85% [71/84]) compared to the non-RAPP contact group (71% [291/410]), p = 0.003.

    CONCLUSION: Letting the patient decide him/herself whether, and when, contact and support is needed during the postoperative period, is possible and does not increase the frequency of contacts. This study investigates a digital solution, RAPP, as one example of a person-centered approach that can be implemented in day surgery follow-up.

  • 2.
    Jildenstål, Pether K.
    et al.
    Örebro University Hospital. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Hallén, Jan L.
    Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
    Rawal, Narinder
    Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
    Berggren, Lars
    Örebro University Hospital. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Department of Anaesthesiology and Intensive Care, Institution for Clinical Science, Danderyds University Hospital, The Karolinska Institute, Stockholm, Sweden.
    Jakobsson, Jan G.
    Department of Anaesthesiology and Intensive Care, Institution for Clinical Science, Danderyds University Hospital, The Karolinska Institute, Stockholm, Sweden.
    AAI-guided anaesthesia is associated with lower incidence of 24-h MMSE < 25 and may impact the IL-6 response2014In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, Vol. 12, no 4, p. 290-295Article in journal (Refereed)
    Abstract [en]

    Introduction: Trauma stress and neuro-inflammation caused by surgery/anaesthesia releases cytokines. This study analysed impact of Auditory Evoked Potential Index (AAI) depth-of-anaesthesia titration on the early plasma IL-6 release after eye surgery under general anaesthesia.

    Method: This is a subgroup analysis of a prospective randomized study on the effect of auditory evoked potential guided anaesthesia for eye surgery. Plasma IL-6 levels taken before, 5 and 24 h after end of surgery from 450 patients undergoing elective ophthalmic surgery under desflurane anaesthesia were analysed. Minimal mental state examination (MMSE) was also tested at 24-h.

    Results: IL-6 increased significantly at both 5 and further at 24 h after surgery (3.2, 4.5 and 5.1 base-line, 5 and 24-h respectively), the IL-6 increase showed different patterns between the 2 groups; IL-6 was significantly increased in the control group of patients between preoperative baseline and 24 h after surgery (p = 0.008) also between 5 h and 24 h, (p = 0.006) after surgery while the AAI-group had only minor non-significant changes. The 18 patients that showed a 24-h MMSE score less than 25 had a significant higher 24-h IL-6 compared to the 390 patients with a MMSE score > 24 (p = 0.002).

    Conclusion: The IL-6 increase after surgery was less pronounced in patients where anaesthesia was titrated by AAI compared to anaesthesia adjusted on clinical signs only. IL-6 were also found to be higher in patients with a MMSE < 25 at 24-h. Further studies are warranted evaluating the role of depth of anaesthesia monitoring on the risk for early cognitive impairment and neuro-inflammation.

  • 3.
    Lovely, Jenna K.
    et al.
    Mayo Clin, Rochester MN, USA.
    Hyland, Sara Jordan
    Grant Medical Center, Columbus OH, USA.
    Smith, April N.
    Creighton University School of Pharmacy and Health Professions, Omaha NE, USA.
    Nelson, Gregg
    Departments of Obstetrics & Gynecology and Oncology, Section Chief, Gynecologic Oncology, Secretary, ERAS® Society, Tom Baker Cancer Centre, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. ERAS Society; Department of Surgery.
    Parrish, Richard H., II
    St. Christopher's Hospital for Children, Philadelphia PA, USA; Virginia Commonwealth University School of Pharmacy, Richmond VA, USA.
    Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS (R)) programs2019In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, Vol. 63, p. 58-62Article, review/survey (Refereed)
    Abstract [en]

    One of the most durable approaches to perioperative enhanced recovery programming has culminated in the formation of perioperative organizations devoted to improvements in the quality of the surgical patient experience, such as the Enhanced Recovery After Surgery (ERAS (R)) Society. Members of the American College of Clinical Pharmacy (ACCP) Perioperative Care Practice and Research Network (PRN) and officials from the ERAS (R) Society present an opinion that: (1) identifies therapeutic options within each pharmacotherapy-intensive area of ERAS (R); (2) generates applied research questions that would allow for comparative analyses of pharmacotherapy options within ERAS (R) programs; (3) proposes collaborative practice opportunities between key stakeholders in the surgical journey and clinical pharmacists to manage drug therapy problems and research questions; and (4) highlights examples of pharmacist-led cost savings attributed to ERAS (R) implementation. Clinical pharmacists, working in this manner with the perioperative team across the care continuum, have optimized pharmacotherapy towards measurable outcomes improvements, and stand ready to partner with inter-professional stakeholders and organizations to advance the care of our mutual patients.

  • 4.
    Öbrink, Emma
    et al.
    Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden.
    Jildenstål, Pether
    Örebro University Hospital. Department of Anaesthesiology and Intensive Care.
    Oddby, Eva
    Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden.
    Jakobsson, Jan G.
    Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden.
    Post-operative nausea and vomiting: Update on predicting the probability and ways to minimize its occurrence, with focus on ambulatory surgery2015In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, Vol. 15, p. 100-106Article, review/survey (Refereed)
    Abstract [en]

    Postoperative nausea and vomiting "the little big problem" after surgery/anaesthesia is still a common side-effect compromising quality of care, delaying discharge and resumption of activities of daily living. A huge number of studies have been conducted in order to identify risk factors, preventive and therapeutic strategies. The Apfel risk score and a risk based multi-modal PONV prophylaxis is advocated by evidence based guidelines as standards of care but is not always followed. Tailored anaesthesia and pain management avoiding too liberal dosing of anaesthetics and opioid analgesics is also essential in order to reduce risk. Thus multi-modal opioid sparing analgesia and a risk based PONV prophylaxis should be provided in order to minimise the occurrence. There is however still no way to guarantee an individual patient that he or she should not experience any PONV. Further studies are needed trying to identify risk factors and ways to tailor the individual patient prevention/therapy are warranted.

    The present paper provides a review around prediction, factors influencing the occurrence and the management of PONV with a focus on the ambulatory surgical patient.

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