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Yunus RA, Saeed S, Levy N, Di Fenza R, Sharkey A, Pobywajlo S, Liang P, Schermerhorn M, Mahmood F, Matyal R, Neves S. A Multidisciplinary Protocolized Approach for Ruptured Abdominal Aortic Aneurysm Management: A Retrospective Before-After Study. J Cardiothorac Vasc Anesth 2024; 38:755-770. [PMID: 38220517 DOI: 10.1053/j.jvca.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES To investigate whether implementation of a multidisciplinary protocol for ruptured abdominal aortic aneurysm (rAAA) management reduces rates of adverse complications. DESIGN A retrospective before-after study. SETTING A tertiary-care academic hospital. PARTICIPANTS Adult patients who underwent open or endovascular rAAA repair; data were stratified into before-protocol implementation (group 1: 2015-2018) and after-protocol implementation (group 2: 2019-2022) groups. INTERVENTION The protocol details the workflow for vascular surgery, anesthesia, emergency department, and operating room staff for a rAAA case; training was accomplished through yearly workshops. MEASUREMENTS AND MAIN RESULTS The primary outcome was in-hospital mortality. Secondary outcomes included all-cause morbidity and other major complications. Differences in postoperative complication rates between groups were assessed using Pearson's χ2 test. Of the 77 patients included undergoing rAAA repair, 41 (53.2%) patients were in group 1, and 36 (46.8%) patients were in group 2. Patients in group 2 had a significantly shorter median time to incision (1.0 v 0.7 hours, p = 0.022) and total procedure time (180.0 v 160.5 minutes, p = 0.039) for both endovascular and open repair. After protocol implementation, patients undergoing endovascular repair exhibited significantly lower rates of mortality (46.2% v 20.0%, p = 0.048), all-cause morbidity (65.4% v 44.0%, p = 0.050), and renal complications (15.4% v 0.0%, p = 0.036); patients undergoing open repair for a rAAA exhibited significantly lower rates of mortality (53.3% v 27.3%, p = 0.018) and bowel ischemia (26.7% v 0.0%, p = 0.035). CONCLUSIONS Implementation of a multidisciplinary protocol for the management of a rAAA may reduce rates of adverse complications and improve the quality of care.
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Affiliation(s)
- Rayaan A Yunus
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Shirin Saeed
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Nadav Levy
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Raffaele Di Fenza
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Aidan Sharkey
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Susan Pobywajlo
- The CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - Patric Liang
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Marc Schermerhorn
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Sara Neves
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
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Liu S, Patanwala AE, Naylor JM, Levy N, Knaggs R, Stevens JA, Bugeja B, Begley D, Khor KE, Lau E, Allen R, Adie S, Penm J. Impact of modified-release opioid use on clinical outcomes following total hip and knee arthroplasty: a propensity score-matched cohort study. Anaesthesia 2023; 78:1237-1248. [PMID: 37365700 PMCID: PMC10952779 DOI: 10.1111/anae.16070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/28/2023]
Abstract
Modified-release opioids are often prescribed for the management of moderate to severe acute pain following total hip and knee arthroplasty, despite recommendations against their use due to increasing concerns regarding harm. The primary objective of this multicentre study was to examine the impact of modified-release opioid use on the incidence of opioid-related adverse events compared with immediate-release opioid use, among adult inpatients following total hip or knee arthroplasty. Data for total hip and knee arthroplasty inpatients receiving an opioid analgesic for postoperative analgesia during hospitalisation were collected from electronic medical records of three tertiary metropolitan hospitals in Australia. The primary outcome was the incidence of opioid-related adverse events during hospital admission. Patients who received modified with or without immediate-release opioids were matched to those receiving immediate-release opioids only (1:1) using nearest neighbour propensity score matching with patient and clinical characteristics as covariates. This included total opioid dose received. In the matched cohorts, patients given modified-release opioids (n = 347) experienced a higher incidence of opioid-related adverse events overall, compared with those given immediate-release opioids only (20.5%, 71/347 vs. 12.7%, 44/347; difference in proportions 7.8% [95%CI 2.3-13.3%]). Modified-release opioid use was associated with an increased risk of harm when used for acute pain during hospitalisation after total hip or knee arthroplasty.
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Affiliation(s)
- S. Liu
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
- Department of PharmacyPrince of Wales HospitalRandwickNWSAustralia
| | - A. E. Patanwala
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
- Pharmacy DepartmentRoyal Prince Alfred HospitalCamperdownNSWAustralia
| | - J. M. Naylor
- Orthopaedic Department, Whitlam Orthopaedic Research CentreLiverpool HospitalLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - N. Levy
- Department of Anaesthesia and Peri‐operative MedicineWest Suffolk HospitalBury St. EdmundsUK
| | - R. Knaggs
- School of PharmacyUniversity of Nottingham and Primary Integrated Community ServicesNottinghamUK
| | - J. A. Stevens
- School of Clinical Medicine, St Vincent's Clinical CampusUniversity of New South WalesSydneyNSWAustralia
- School of MedicineUniversity of Notre DameSydneyNSWAustralia
| | - B. Bugeja
- Department of Pain ManagementPrince of Wales HospitalSydneyNSWAustralia
| | - D. Begley
- Department of Pain ManagementPrince of Wales HospitalSydneyNSWAustralia
| | - K. E. Khor
- Department of Pain ManagementPrince of Wales HospitalSydneyNSWAustralia
- Prince of Wales Clinical SchoolUniversity of New South Wales Medicine and HealthSydneyNSWAustralia
| | - E. Lau
- Department of PharmacySt George HospitalKogarahNSWAustralia
| | - R. Allen
- Pain Management UnitSt George HospitalKogarahNSWAustralia
| | - S. Adie
- St George and Sutherland Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - J. Penm
- Department of PharmacyPrince of Wales HospitalRandwickNWSAustralia
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
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Liu S, Athar A, Quach D, Patanwala AE, Naylor JM, Stevens JA, Levy N, Knaggs RD, Lobo DN, Penm J. Risks and benefits of oral modified-release compared with oral immediate-release opioid use after surgery: a systematic review and meta-analysis. Anaesthesia 2023; 78:1225-1236. [PMID: 37415284 PMCID: PMC10952256 DOI: 10.1111/anae.16085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
Prescription of modified-release opioids for acute postoperative pain is widespread despite evidence to show their use may be associated with an increased risk of adverse effects. This systematic review and meta-analysis aimed to examine the available evidence on the safety and efficacy of modified-release, compared with immediate-release, oral opioids for postoperative pain in adults. We searched five electronic databases from 1 January 2003 to 1 January 2023. Published randomised clinical trials and observational studies on adults who underwent surgery which compared those who received oral modified-release opioids postoperatively with those receiving oral immediate-release opioids were included. Two reviewers independently extracted data on the primary outcomes of safety (incidence of adverse events) and efficacy (pain intensity, analgesic and opioid use, and physical function) and secondary outcomes (length of hospital stay, hospital readmission, psychological function, costs, and quality of life) up to 12 months postoperatively. Of the eight articles included, five were randomised clinical trials and three were observational studies. The overall quality of evidence was low. Modified-release opioid use was associated with a higher incidence of adverse events (n = 645, odds ratio (95%CI) 2.76 (1.52-5.04)) and worse pain (n = 550, standardised mean difference (95%CI) 0.2 (0.04-0.37)) compared with immediate-release opioid use following surgery. Our narrative synthesis concluded that modified-release opioids showed no superiority over immediate-release opioids for analgesic consumption, length of hospital stay, hospital readmissions or physical function after surgery. One study showed that modified-release opioid use is associated with higher rates of persistent postoperative opioid use compared with immediate-release opioid use. None of the included studies reported on psychological function, costs or quality of life.
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Affiliation(s)
- S. Liu
- Faculty of Medicine and HealthSchool of Pharmacy, University of SydneySydneyNSWAustralia
- Department of PharmacyPrince of Wales Hospital, RandwickSydneyNSWAustralia
| | - A. Athar
- Faculty of Medicine and Health, School of MedicineUniversity of Notre DameSydneyNSWAustralia
| | - D. Quach
- Faculty of Medical and Health Sciences, School of PharmacyUniversity of AucklandAucklandNew Zealand
| | - A. E. Patanwala
- Faculty of Medicine and Health, School of PharmacyUniversity of SydneySydneyNSWAustralia
- Department of PharmacyRoyal Prince Alfred HospitalCamperdownNSWAustralia
| | - J. M. Naylor
- Whitlam Orthopaedic Research Centre, Orthopaedic Department, Liverpool HospitalLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - J. A. Stevens
- School of Clinical Medicine, St VincentTable s Clinical CampusUniversity of New South WalesSydneyNSWAustralia
- University of Notre DameSydneyNSWAustralia
| | - N. Levy
- Department of Anaesthesia and Perioperative MedicineWest Suffolk HospitalBury St. EdmundsUK
| | - R. D. Knaggs
- School of PharmacyUniversity of Nottingham, and Primary Integrated Community ServicesNottinghamUK
| | - D. N. Lobo
- Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research CentreNottingham University Hospitals and University of Nottingham, Queen's Medical CentreNottinghamUK
- David Greenfield Metabolic Physiology Unit, MRC Versus Arthritis Centre for Musculoskeletal Ageing ResearchSchool of Life SciencesUniversity of Nottingham, Queen's Medical CentreNottinghamUK
| | - J. Penm
- Department of PharmacyPrince of Wales Hospital, RandwickSydneyNSWAustralia
- Faculty of Medicine and Health, School of PharmacyUniversity of SydneySydneyNSWAustralia
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Simpson A, Levy N, Mariano E. Opioid stewardship. BJA Educ 2023; 23:389-397. [PMID: 37720559 PMCID: PMC10501885 DOI: 10.1016/j.bjae.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- A.K. Simpson
- University Hospitals Bristol and Weston, Bristol, UK
| | - N. Levy
- West Suffolk Hospital, Bury St. Edmunds, UK
| | - E.R. Mariano
- Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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5
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Simpson A, Keane E, Levy N. The prescribed opioid crisis as an impetus to improve postoperative pain management. Anaesthesia 2023. [PMID: 37313994 DOI: 10.1111/anae.16054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/15/2023]
Affiliation(s)
- A Simpson
- Department of Anaesthesia, Bristol Royal Infirmary, University Hospitals Bristol and Weston, Bristol, UK
| | - E Keane
- Department of Anaesthesia and Critical Care Medicine, Children's Hospital Ireland at Temple Street, Dublin, Ireland
| | - N Levy
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK
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6
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Zucco L, Chen MJ, Levy N, Obeidat SS, Needham MJ, Hyatt A, Keane JR, Pollard RJ, Mitchell JD, Ramachandran SK. Just-in-Time In Situ Simulation Training as a Preparedness Measure for the Perioperative Care of COVID-19 Patients. Simul Healthc 2023; 18:90-99. [PMID: 35148284 PMCID: PMC10081926 DOI: 10.1097/sih.0000000000000635] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Routine workflows were redesigned during the first surge of the COVID-19 pandemic to standardize perioperative management of patients and minimize the risk of viral exposure and transmission to staff members. Just-in-time (JIT), in situ simulation training was adopted to implement urgent change, the value of which in a public health crisis has not previously been explored. METHODS Implementation of workflow changes in the setting of the COVID-19 pandemic was accomplished through JIT, in situ simulation training, delivered over a period of 3 weeks to participants from anesthesia, nursing, and surgery, within our healthcare network. The perceived value of this training method was assessed using a postsimulation training survey, composed of Likert scale assessments and free-text responses. The impact on change in practice was assessed by measuring compliance with new COVID-19 workflows for cases of confirmed or suspected COVID-19 managed in the operating room, between March and August 2020. RESULTS Postsimulation survey responses collected from 110 of 428 participants (25.7%) demonstrated significant positive shifts along the Likert scale on perceived knowledge of new workflow processes, comfort in adopting them in practice and probability that training would have an impact on future practice (all P s < 0.001). Free-text responses reflected appreciation for the training being timely, hands-on, and interprofessional. Compliance with new COVID workflows protocols in practice was 95% (121 of 127 cases) and was associated with lower than expected healthcare worker test positive rates (<1%) within the network during this same period. CONCLUSIONS These findings support JIT, in situ simulation training as a preparedness measure for the perioperative care of COVID-19 patients and demonstrate the value of this approach during public health crises.
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Aulanier A, Levy N, Denis D, David T. Severe diffuse lamellar keratitis after femtosecond laser-assisted in situ keratomileusis: Case report. J Fr Ophtalmol 2023; 46:e95-e96. [PMID: 36577630 DOI: 10.1016/j.jfo.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 12/27/2022]
Affiliation(s)
- A Aulanier
- Service d'ophtalmologie, hôpital universitaire de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - N Levy
- Service d'ophtalmologie, hôpital universitaire de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - D Denis
- Service d'ophtalmologie, hôpital universitaire de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - T David
- Service d'ophtalmologie, hôpital universitaire de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
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8
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Pearcey S, Knaggs RD, Levy N. Routine use of modified-release opioids on hospital discharge can no longer be justified. Anaesthesia 2023; 78:657-658. [PMID: 36716330 DOI: 10.1111/anae.15972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 02/01/2023]
Affiliation(s)
- S Pearcey
- West Suffolk Hospital NHS Foundation Trust, Bury St. Edmunds, UK
| | | | - N Levy
- West Suffolk Hospital NHS Foundation Trust, Bury St. Edmunds, UK
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Attia R, Stolowy N, Levy N, Dambricourt L, David T. [Transient posterior subcapsular cataract in a type 1 diabetic girl]. J Fr Ophtalmol 2023; 46:97-98. [PMID: 36494266 DOI: 10.1016/j.jfo.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 12/12/2022]
Affiliation(s)
- R Attia
- Service d'ophtalmologie, hôpital universitaire de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - N Stolowy
- Service d'ophtalmologie, hôpital universitaire de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - N Levy
- Service d'ophtalmologie, hôpital universitaire de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - L Dambricourt
- Service d'ophtalmologie, hôpital universitaire de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - T David
- Service d'ophtalmologie, hôpital universitaire de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
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Faruki AA, Nguyen TB, Gasangwa DV, Levy N, Proeschel S, Yu J, Ip V, McGourty M, Korsunsky G, Novack V, Mueller AL, Banner-Goodspeed V, Rozental TD, O’Gara BP. Virtual reality immersion compared to monitored anesthesia care for hand surgery: A randomized controlled trial. PLoS One 2022; 17:e0272030. [PMID: 36129891 PMCID: PMC9491608 DOI: 10.1371/journal.pone.0272030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/09/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Common anesthesia practice for hand surgery combines a preoperative regional anesthetic and intraoperative monitored anesthesia care (MAC). Despite adequate regional anesthesia, patients may receive doses of intraoperative sedatives which can result in oversedation and potentially avoidable complications. VR could prove to be a valuable tool for patients and providers by distracting the mind from processing noxious stimuli resulting in minimized sedative use and reduced risk of oversedation without negatively impacting patient satisfaction. Our hypothesis was that intraoperative VR use reduces sedative dosing during elective hand surgery without detracting from patient satisfaction as compared to a usual care control. Methods Forty adults undergoing hand surgery were randomized to receive either intraoperative VR in addition to MAC, or usual MAC. Patients in both groups received preoperative regional anesthesia at provider discretion. Intraoperatively, the VR group viewed programming of their choice via a head-mounted display. The primary outcome was intraoperative propofol dose per hour (mg · hr-1). Secondary outcomes included patient reported pain and anxiety, overall satisfaction, functional outcome, and post anesthesia care unit (PACU) length of stay (LOS). Results Of the 40 enrolled patients, 34 completed the perioperative portion of the trial. VR group patients received significantly less propofol per hour than the control group (Mean (±SD): 125.3 (±296.0) vs 750.6 (±334.6) mg · hr-1, p<0.001). There were no significant differences between groups in patient reported overall satisfaction, (0–100 scale, Median (IQR) 92 (77–100) vs 100 (100–100), VR vs control, p = 0.087). There were no significant differences between groups in PACU pain scores, perioperative opioid analgesic dose, or in postoperative functional outcome. PACU LOS was significantly decreased in the VR group (53.0 (43.0–72.0) vs 75.0 (57.5–89.0) min, p = 0.018). Conclusion VR immersion during hand surgery led to significant reductions in intraoperative propofol dose and PACU LOS without negatively impacting key patient reported outcomes.
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Affiliation(s)
- Adeel A. Faruki
- Department of Anesthesiology, University of Colorado Hospital, Aurora, CO, United States of America
- * E-mail:
| | - Thy B. Nguyen
- University of Colorado Medical School, Aurora, CO, United States of America
| | | | - Nadav Levy
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Sam Proeschel
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Jessica Yu
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Victoria Ip
- Nova Southeastern School of Osteopathic Medicine, Fort Lauderdale, FL, United States of America
| | - Marie McGourty
- University of Massachusetts, Boston, MA, United States of America
| | - Galina Korsunsky
- Department of Anesthesiology, Spectrum Healthcare Partners, Portland, ME, United States of America
| | - Victor Novack
- Research Authority and Clinical Research, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ariel L. Mueller
- Anesthesia Research Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Valerie Banner-Goodspeed
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Tamara D. Rozental
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Brian P. O’Gara
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, United States of America
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Levy N, McNally SA, Lobo DN. The need to improve opioid prescribing and data collection in patients undergoing orthopaedic surgery. Anaesthesia 2022; 77:854-857. [PMID: 35762197 DOI: 10.1111/anae.15784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- N Levy
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK
| | - S A McNally
- Department of Trauma and Orthopaedics, East Sussex Healthcare NHS Trust, Eastbourne, Sussex, UK
- Honorary Clinical Professor, Brighton and Sussex Medical School, Brighton, UK
| | - D N Lobo
- Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Nottingham, UK
- David Greenfield Metabolic Physiology Unit, MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Taube HS, Matot I, Levy N, Goren O, Marom R, Weiniger CF. Indications and diagnosis-specific features of maternal and neonatal peripartum intensive care unit admissions: A retrospective study. Acta Anaesthesiol Scand 2022; 66:256-264. [PMID: 34811732 DOI: 10.1111/aas.14006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 08/29/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although peripartum intensive care unit admission indications are well-reported, clinical and laboratory details rarely are. We described admission indications and categorised laboratory values and vital signs according to admission diagnosis. METHODS Retrospective Institutional Review Board approved study. We identified intensive care unit admission diagnosis, laboratory values and vital signs from patient charts. Groups were compared according to admission diagnoses. Data were analysed using descriptive statistics. RESULTS We included 91 general intensive care unit admissions among 56,865 deliveries (2011-2015) with complete data. The most common admission diagnosis was postpartum haemorrhage followed by hypertensive diseases of pregnancy and respiratory complications. Women with postpartum haemorrhage had lower mean (standard deviation) platelet counts (120.2 (45.8) vs. 181.2 (109.9), p = .003) and temperatures (35.7 (1.1) vs. 36.5 (1.2), p = .002). Women with hypertensive diseases of pregnancy had higher mean (standard deviation) blood pressures (systolic 150.4 (29.1) vs. 127.4 (21.0), p = .013, diastolic 100.3 (18.7) vs. 76.1 (16.1), p = .001), creatinine (1.1 (0.6) vs. 0.8 (0.3), p = .003), urea (14.6 (7.7) vs. 10.5 (4.7), p = .005) and liver enzymes, including aspartate transaminase (258.4 (297.0) vs. 41.4 (42.9), p = .000), alanine transaminase (184.4 (199.2) vs. 35.1 (75.9), p = .000), and alkaline phosphatase (166.6 (112.6) vs. 96.0 (60.0), p = .006). Women with respiratory complications had lower mean (standard deviation) oxygen saturations (93.7 (6.1) vs. 98.0 (2.6), p = .000), and higher mean (standard deviation) temperatures (37.1 (0.8) vs. 36.0 (1.2), p = .001). CONCLUSIONS We report differences in laboratory values and vital signs, according to intensive care unit admission diagnosis. Recognising these differences might help individualise patient assessment and care.
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Affiliation(s)
- Hamutal S. Taube
- Division of Anesthesia, Pain and Critical Care Tel‐Aviv Sourasky Medical Center Tel Aviv‐Yafo Israel
| | - Idit Matot
- Division of Anesthesia, Pain and Critical Care Tel‐Aviv Sourasky Medical Center Tel Aviv‐Yafo Israel
| | - Nadav Levy
- Division of Anesthesia, Pain and Critical Care Tel‐Aviv Sourasky Medical Center Tel Aviv‐Yafo Israel
| | - Or Goren
- Division of Anesthesia, Pain and Critical Care Tel‐Aviv Sourasky Medical Center Tel Aviv‐Yafo Israel
| | - Ronella Marom
- Division of Anesthesia, Pain and Critical Care Tel‐Aviv Sourasky Medical Center Tel Aviv‐Yafo Israel
| | - Carolyn F. Weiniger
- Division of Anesthesia, Pain and Critical Care Tel‐Aviv Sourasky Medical Center Tel Aviv‐Yafo Israel
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13
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Minot M, Levy N, Proust H, Denis D. [Multimodal imaging of lattice corneal dystrophy]. J Fr Ophtalmol 2022; 45:249-250. [PMID: 35034855 DOI: 10.1016/j.jfo.2021.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/18/2021] [Accepted: 06/21/2021] [Indexed: 11/19/2022]
Affiliation(s)
- M Minot
- Service d'ophtalmologie, CHU Timone, 264, Rue Saint-Pierre, 13005 Marseille, France.
| | - N Levy
- Service d'ophtalmologie, CHU Timone, 264, Rue Saint-Pierre, 13005 Marseille, France
| | - H Proust
- Service d'ophtalmologie, CHU Timone, 264, Rue Saint-Pierre, 13005 Marseille, France
| | - D Denis
- Service d'ophtalmologie, CHU Timone, 264, Rue Saint-Pierre, 13005 Marseille, France
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14
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Dambricourt L, Gonzalvez M, Levy N, Denis D, David T. Une anomalie de Peters de type 1 de découverte tardive. J Fr Ophtalmol 2022; 45:360-362. [DOI: 10.1016/j.jfo.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/08/2021] [Indexed: 10/19/2022]
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15
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Affiliation(s)
- N Levy
- Department of Anaesthesia, West Suffolk Hospital, Bury St. Edmunds, UK
| | - K Raghunathan
- Department of Anesthesiology and Population Health, Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - D N Lobo
- Department of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
- David Greenfield Metabolic Physiology Unit, MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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16
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Daliya P, Adiamah A, Roslan F, Theophilidou E, Knaggs RD, Levy N, Lobo DN. Opioid prescription at postoperative discharge: a retrospective observational cohort study. Anaesthesia 2021; 76:1367-1376. [PMID: 33768532 DOI: 10.1111/anae.15460] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/31/2022]
Abstract
Opioid misuse is now considered a major public health epidemic in North America, with substantial social and financial consequences. As well as socio-economic and commercial drivers, modifiable risk-factors that have resulted in this crisis have been identified. The purpose of this study was to identify whether, within England, modifiable drivers for persistent postoperative opioid use were present. This was a retrospective cohort study of practice at 14 National Health Service hospitals across England. Data were collected retrospectively and validated for adult patients undergoing elective intermediate and major or complex major general surgical procedures between 1 and 31 March 2019. Of the 509 patients enrolled from 14 centres, 499 were included in the data analysis. In total, 31.5% (157/499) patients were in the intermediate surgery cohort and 68.5% (342/499) were in the major or complex major surgery cohort, with 21.0% (33/157) and 21.6% (74/342) discharged with opioid medicines to be taken at regular intervals, respectively. There were similar median oral morphine equivalent doses prescribed at discharge. Of patients prescribed regular opioid medicines, 76.6% (82/107) had a specified duration at discharge. However, 72.9% (78/107) had no written deprescribing advice on discharge. Similarly, of patients prescribed 'when required' opioids, 59.6% (93/156) had a specified duration of their prescription and 33.3% (52/156) were given written deprescribing advice. This study has identified a pattern of poor prescribing practices, a lack of guidance and formal training at individual institutions and highlights opportunities for improvement in opioid-prescribing practices within England.
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Affiliation(s)
- P Daliya
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, UK
- Gastro-intestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - A Adiamah
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, UK
- Gastro-intestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - F Roslan
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, UK
- Gastro-intestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - E Theophilidou
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, UK
- Gastro-intestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - R D Knaggs
- School of Pharmacy, Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - N Levy
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk Hospital, Bury St. Edmunds, UK
| | - D N Lobo
- East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, UK
- Gastro-intestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
- David Greenfield Metabolic Physiology Unit, MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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17
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Zucco L, Levy N, Li Y, Golen T, Shainker SA, Hess PE, Ramachandran SK. Correction to: Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery. BMC Health Serv Res 2021; 21:833. [PMID: 34407816 PMCID: PMC8371297 DOI: 10.1186/s12913-021-06868-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Liana Zucco
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Nadav Levy
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Yunping Li
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Toni Golen
- Department of Obstetrics, Gynecology and Reproductive Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Scott A Shainker
- Department of Obstetrics, Gynecology and Reproductive Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Philip E Hess
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Satya Krishna Ramachandran
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
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18
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Zucco L, Levy N, Li Y, Golen T, Shainker SA, Hess PE, Ramachandran SK. Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery. BMC Health Serv Res 2021; 21:775. [PMID: 34362350 PMCID: PMC8342983 DOI: 10.1186/s12913-021-06787-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/13/2021] [Indexed: 02/01/2023] Open
Abstract
Background Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe factors which influenced rapid cycle implementation of a novel comprehensive checklist for the perioperative care of the COVID-19 parturient. Methods Within our labour and delivery unit, implementation of a novel checklist for the COVID-19 parturient requiring perioperative care was accomplished through rapid cycling, debriefing and on-site walkthroughs. Post-implementation, consistent use of the checklist was reported for all obstetric COVID-19 perioperative cases (100% workflow checklist utilization). Retrospective analysis of the factors influencing implementation was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results Analysis of factors influencing implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting, and characteristic of individuals (external pressures, baseline culture, and personal attributes) were perceived to act as early barriers. Constructs such as communication culture and learning climate, shifted in influence over time. Conclusion We describe the influential factors of implementing a novel comprehensive obstetric workflow for care of the COVID-19 perioperative parturient during the first surge of the pandemic using the CFIR framework. Early workflow adoption was facilitated primarily by two domains, namely thoughtful innovation design and careful implementation planning in the setting of a long-standing culture of improvement. Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into facilitators once a perceived benefit was experienced by healthcare teams. These results provide important information for the implementation of rapid change during a time of crisis. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06787-5.
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Affiliation(s)
- Liana Zucco
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Nadav Levy
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Yunping Li
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Toni Golen
- Department of Obstetrics, Gynecology and Reproductive Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Scott A Shainker
- Department of Obstetrics, Gynecology and Reproductive Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Philip E Hess
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Satya Krishna Ramachandran
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
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19
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Mairot K, Sahakian N, Salgues B, Levy N, Gascon P, Denis D. Somatostatin receptor PET/CT scan as a helpful diagnostic tool for optic nerve sheath meningioma. J Fr Ophtalmol 2021; 44:e619-e621. [PMID: 34229893 DOI: 10.1016/j.jfo.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/24/2022]
Affiliation(s)
- K Mairot
- Service d'ophtalmologie, centre hospitalier universitaire de l'hôpital Nord, Chemin des Bourrely, 13015 Marseille, France.
| | - N Sahakian
- Médecine nucléaire, centre hospitalier universitaire de l'hôpital Nord, Chemin des Bourrely, 13015 Marseille, France
| | - B Salgues
- Médecine nucléaire, groupe hospitalier Pitié-Salpêtrière-Charles Foix, Sorbonne université, Paris, France
| | - N Levy
- Service d'ophtalmologie, centre hospitalier universitaire de l'hôpital Nord, Chemin des Bourrely, 13015 Marseille, France
| | - P Gascon
- Service d'ophtalmologie, centre hospitalier universitaire de l'hôpital Nord, Chemin des Bourrely, 13015 Marseille, France
| | - D Denis
- Service d'ophtalmologie, centre hospitalier universitaire de l'hôpital Nord, Chemin des Bourrely, 13015 Marseille, France
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20
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Levy N, Santer P, Zucco L, Nabel S, Korsunsky G, Ramachandran SK. Evaluation of early postoperative intravenous opioid rescue as a novel quality measure in patients who receive thoracic epidural analgesia: a retrospective cohort analysis and prospective performance improvement intervention. BMC Anesthesiol 2021; 21:120. [PMID: 33874890 PMCID: PMC8054410 DOI: 10.1186/s12871-021-01332-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In this study, we explored the utility of intravenous opioid rescue analgesia in the post anesthesia care unit (PACU-OpResc) as a single marker of thoracic epidural analgesia (TEA) failure and evaluated the resource implications and quality improvement applications of this measure. METHODS We performed a retrospective analysis of all TEA placements over a three-year period at a single academic medical center in Boston, Massachusetts. The study exposure was PACU-OpResc. Primary outcome was PACU length of stay (LOS). Secondary outcomes included reasons for delayed PACU discharge and intraoperative hypotension. The analyses were adjusted for confounding variables including patient comorbidities, surgical complexity, intraoperative intravenous opioids, chronic opioid use and local anesthetic bolus through TEA catheter. Post analysis chart review was conducted to determine the positive predictive value (PPV) of PACU-OpResc for inadequate TEA. As a first Plan-Do-Study-Act cycle, we then introduced a checkbox for documentation of a sensory level check after TEA placement. Post implementation data was collected for 7 months. RESULTS PACU-OpResc was required by 211 (22.1%) patients who received preoperative TEA, was associated with longer PACU LOS (incidence rate ratio 1.20, 95% CI:1.07-1.34, p = 0.001) and delayed discharge due to inadequate pain control (odds ratio 5.15, 95% CI 3.51-7.57, p < 0.001). PACU-OpResc had a PPV of 76.3 and 60.4% for re-evaluation and manipulation of the TEA catheter in PACU, respectively. Following implementation of a checkbox, average monthly compliance with documented sensory level check after TEA placement was noted to be 39.7%. During this time, a reduction of 8.2% in the rate of PACU-OpResc was observed. CONCLUSIONS This study demonstrates that PACU-OpResc can be used as a quality assurance measure or surrogate for TEA efficacy, to track performance and monitor innovation efforts aimed at improving analgesia, such as our intervention to facilitate sensory level checks and reduced PACU-OpResc. TRIAL REGISTRATION not applicable.
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Affiliation(s)
- Nadav Levy
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Peter Santer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Liana Zucco
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Sarah Nabel
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Galina Korsunsky
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Satya Krishna Ramachandran
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
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21
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Levy N, Quinlan J, El-Boghdadly K, Fawcett WJ, Agarwal V, Bastable RB, Cox FJ, de Boer HD, Dowdy SC, Hattingh K, Knaggs RD, Mariano ER, Pelosi P, Scott MJ, Lobo DN, Macintyre PE. An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients. Anaesthesia 2021; 76:520-536. [PMID: 33027841 DOI: 10.1111/anae.15262] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2020] [Indexed: 01/01/2023]
Abstract
This international multidisciplinary consensus statement was developed to provide balanced guidance on the safe peri-operative use of opioids in adults. An international panel of healthcare professionals evaluated the literature relating to postoperative opioid-related harm, including persistent postoperative opioid use; opioid-induced ventilatory impairment; non-medical opioid use; opioid diversion and dependence; and driving under the influence of prescription opioids. Recommended strategies to reduce harm include pre-operative assessment of the risk of persistent postoperative opioid use; use of an assessment of patient function rather than unidimensional pain scores alone to guide adequacy of analgesia; avoidance of long-acting (modified-release and transdermal patches) opioid formulations and combination analgesics; limiting the number of tablets prescribed at discharge; providing deprescribing advice; avoidance of automatic prescription refills; safe disposal of unused medicines; reducing the risk of opioid diversion; and better education of healthcare professionals, patients and carers. This consensus statement provides a framework for better prescribing practices that could help reduce the risk of postoperative opioid-related harm in adults.
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Affiliation(s)
- N Levy
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk Hospital, Bury St. Edmunds, UK
| | - J Quinlan
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - W J Fawcett
- Department of Anaesthesia and Pain Medicine, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - V Agarwal
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - F J Cox
- Pain Management Service, Critical Care and Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - H D de Boer
- Department of Anaesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Groningen, The Netherlands
| | - S C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA
| | - K Hattingh
- Bendigo Health, Bendigo, Victoria, Australia
| | - R D Knaggs
- School of Pharmacy, Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - E R Mariano
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Anesthesiology and Peri-operative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - P Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy
| | - M J Scott
- Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
- David Greenfield Metabolic Physiology Unit, MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - P E Macintyre
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
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22
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Abstract
Diabetes is the most common metabolic condition worldwide and about 20% of surgical patients will have this condition. It is a major risk-factor for worse outcomes after surgery including mortality; infective and non-infective complications; and increased length of stay. However, diabetes is a modifiable risk-factor, and programs to improve medical management have the potential to reduce peri-operative complications and the risk of harm. Regional anaesthesia has well-documented benefits in promoting the restoration of function but there are legitimate concerns that the incidence of complications of regional anaesthesia in patients with diabetes is higher. The aim of this review is to explore in detail the various potential advantages and disadvantages of regional anaesthesia in patients with diabetes. This, in turn, will allow practitioners to undertake more informed shared decision-making and potentially modify their anaesthetic technique for patients with diabetes.
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Affiliation(s)
- N Levy
- Department of Anaesthesia, West Suffolk Hospital, Bury St. Edmunds, Suffolk, UK
| | - P Lirk
- Department of Anesthesiology, Peri-operative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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23
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Bertrand E, Levy N, Sauvan L, Beylerian M, Denis D. [Macular cherry red spot: A case of Tay-Sachs disease]. J Fr Ophtalmol 2021; 44:602-603. [PMID: 33422345 DOI: 10.1016/j.jfo.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/01/2020] [Accepted: 06/21/2020] [Indexed: 10/22/2022]
Affiliation(s)
- E Bertrand
- Service d'ophtalmologie, hôpital la Timone, université d'Aix-Marseille, 64, rue Saint-Pierre, 13385 Marseille cedex 5, France.
| | - N Levy
- Service d'ophtalmologie, hôpital la Timone, université d'Aix-Marseille, 64, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - L Sauvan
- Service d'ophtalmologie, hôpital Nord, université d'Aix-Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - M Beylerian
- Service d'ophtalmologie, hôpital Nord, université d'Aix-Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - D Denis
- Service d'ophtalmologie, hôpital Nord, université d'Aix-Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France
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24
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Levy N, Carbonnel E, Bertrand E, Mairot K, Gonzalvez M, Denis D. [Clinical variant of herpetic keratitis: Archipelago keratitis]. J Fr Ophtalmol 2020; 44:609-610. [PMID: 33339614 DOI: 10.1016/j.jfo.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- N Levy
- Service d'ophtalmologie, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Université Aix-Marseille, Marseille, France.
| | - E Carbonnel
- Service de chirurgie orale et maxillo-faciale, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
| | - E Bertrand
- Service d'ophtalmologie, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Université Aix-Marseille, Marseille, France
| | - K Mairot
- Service d'ophtalmologie, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Université Aix-Marseille, Marseille, France
| | - M Gonzalvez
- Service d'ophtalmologie, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Université Aix-Marseille, Marseille, France
| | - D Denis
- Service d'ophtalmologie, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Université Aix-Marseille, Marseille, France
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25
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Carbonnel E, Levy N, Guyot L, Haen P, Foletti JM. Spontaneous bony orbital decompression in Graves' orbitopathy: Case report and discussion of the pathophysiology. J Fr Ophtalmol 2020; 44:e87-e89. [PMID: 33317853 DOI: 10.1016/j.jfo.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/01/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022]
Affiliation(s)
- E Carbonnel
- Service de chirurgie orale et maxillofaciale, AP-HM, hôpital La Conception, 147, boulevard Baille, 13005 Marseille, France; Service de chirurgie orale et maxillofaciale, AP--HM, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
| | - N Levy
- Service de chirurgie orale et maxillofaciale, AP-HM, hôpital La Conception, 147, boulevard Baille, 13005 Marseille, France; Service de chirurgie orale et maxillofaciale, AP--HM, hôpital Nord, chemin des Bourrely, 13015 Marseille, France; Service d'ophtalmologie, AP-HM, hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - L Guyot
- Service de chirurgie orale et maxillofaciale, AP-HM, hôpital La Conception, 147, boulevard Baille, 13005 Marseille, France; Service de chirurgie orale et maxillofaciale, AP--HM, hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - P Haen
- Service de chirurgie orale et maxillofaciale, hôpital d'instruction des Armées Laveran, 4, boulevard Lavéran, 13013 Marseille, France
| | - J-M Foletti
- Service de chirurgie orale et maxillofaciale, AP-HM, hôpital La Conception, 147, boulevard Baille, 13005 Marseille, France; Service de chirurgie orale et maxillofaciale, AP--HM, hôpital Nord, chemin des Bourrely, 13015 Marseille, France
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26
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Bowen J, Levy N, Macintyre P. Opioid-induced ventilatory impairment: current 'track and trigger' tools need to be updated. Anaesthesia 2020; 75:1574-1578. [PMID: 32249425 DOI: 10.1111/anae.15030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- J Bowen
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk NHS Foundation Trust, Suffolk, UK
| | - N Levy
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk NHS Foundation Trust, Suffolk, UK
| | - P Macintyre
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.,Discipline of Acute Care Medicine, University of Adelaide, SA, Australia
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27
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Bertrand E, Stolowy N, Levy N, Comet A, Denis D. [Recurrence of capsular pseudoexfoliation after cataract surgery]. J Fr Ophtalmol 2020; 44:273-274. [PMID: 33187739 DOI: 10.1016/j.jfo.2020.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 10/23/2022]
Affiliation(s)
- E Bertrand
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
| | - N Stolowy
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - N Levy
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - A Comet
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - D Denis
- Service d'ophtalmologie, université d'Aix-Marseille, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
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Levy N, Zucco L, Ehrlichman RJ, Hirschberg RE, Hutton Johnson S, Yaffe MB, Ramachandran SK, Bose S, Leibowitz A. Development of Rapid Response Capabilities in a Large COVID-19 Alternate Care Site Using Failure Modes and Effect Analysis with In Situ Simulation. Anesthesiology 2020; 133:985-996. [PMID: 32773686 PMCID: PMC7434018 DOI: 10.1097/aln.0000000000003521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022]
Abstract
Preparedness measures for the anticipated surge of coronavirus disease 2019 (COVID-19) cases within eastern Massachusetts included the establishment of alternate care sites (field hospitals). Boston Hope hospital was set up within the Boston Convention and Exhibition Center to provide low-acuity care for COVID-19 patients and to support local healthcare systems. However, early recognition of the need to provide higher levels of care, or critical care for the potential deterioration of patients recovering from COVID-19, prompted the development of a hybrid acute care-intensive care unit. We describe our experience of implementing rapid response capabilities of this innovative ad hoc unit. Combining quality improvement tools for hazards detection and testing through in situ simulation successfully identified several operational hurdles. Through rapid continuous analysis and iterative change, we implemented appropriate mitigation strategies and established rapid response and rescue capabilities. This study provides a framework for future planning of high-acuity services within a unique field hospital setting.
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Li Y, Ciampa EJ, Zucco L, Levy N, Colella M, Golen T, Shainker SA, Lunderberg JM, Ramachandran SK, Hess PE. Adaptation of an Obstetric Anesthesia Service for the Severe Acute Respiratory Syndrome Coronavirus-2 Pandemic: Description of Checklists, Workflows, and Development Tools. Anesth Analg 2020; 132:31-37. [PMID: 33315601 PMCID: PMC7571613 DOI: 10.1213/ane.0000000000005256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Supplemental Digital Content is available in the text. Care of the pregnant patient during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic presents many challenges, including creating parallel workflows for infected and noninfected patients, minimizing waste of materials, and ensuring that clinicians can seamlessly transition between types of anesthesia. The exponential community spread of disease limited the time for development and training.
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Affiliation(s)
- Yunping Li
- From the Departments of Anesthesia, Critical Care and Pain Medicine
| | - Erin J Ciampa
- From the Departments of Anesthesia, Critical Care and Pain Medicine
| | - Liana Zucco
- From the Departments of Anesthesia, Critical Care and Pain Medicine
| | - Nadav Levy
- From the Departments of Anesthesia, Critical Care and Pain Medicine
| | - Meredith Colella
- From the Departments of Anesthesia, Critical Care and Pain Medicine
| | - Toni Golen
- Gynecology and Reproductive Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Scott A Shainker
- Gynecology and Reproductive Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Philip E Hess
- From the Departments of Anesthesia, Critical Care and Pain Medicine
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Benquey T, Fockens E, Kouton L, Delmont E, Martini N, Levy N, Attarian S, Bonello-Palot N. A New Point Mutation in the PMP22 Gene in a Family Suffering From Atypical HNPP. J Neuromuscul Dis 2020; 7:505-510. [DOI: 10.3233/jnd-190460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant inherited disorder commonly presenting with acute-onset, non-painful focal sensory and motor mono neuropathy. In 80% of cases, the genetic defect is a 1.5 Mb deletion on chromosome 17p11.2, including PMP22. Only few cases of partial deletion and point mutations in PMP22 are involved in HNPP. We investigated a 62-years-old man with lower limb plexopathy first considered as Garland’s syndrome. A month later, his 29 years old son also consulted for paresthesia on the peroneal nerve. Targeted sequencing of the PMP22 gene identified a c.370delT (p.Trp124Glyfs*31) in both affected patients. We report a new PMP22 point mutation associated with an atypical clinical phenotype of HNPP, a painful plexopathy of the lower limb worsenen by diabetes and a mere paresthesia, but a typical ENMG. This study illustrates the large spectrum of the disease, and emphasizes the importance of a complete ENMG and family history.
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Affiliation(s)
- T. Benquey
- Service de Biochimie et Biologie moléculaire Grand Est, Unité Médicale Pathologies neurologiques et cardiologiques, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
| | - E. Fockens
- Referral Centre for ALS and Neuromuscular Diseases, Hospital La Timone 264 rue Saint Pierre, 13005, Marseille, France
| | - L. Kouton
- Referral Centre for ALS and Neuromuscular Diseases, Hospital La Timone 264 rue Saint Pierre, 13005, Marseille, France
| | - E. Delmont
- Referral Centre for ALS and Neuromuscular Diseases, Hospital La Timone 264 rue Saint Pierre, 13005, Marseille, France
| | - N. Martini
- Referral Centre for ALS and Neuromuscular Diseases, Hospital La Timone 264 rue Saint Pierre, 13005, Marseille, France
| | - N. Levy
- Aix Marseille University, INSERM, GMGF, Marseille, France
- Medical Genetics Department, La Timone Teaching hospital, 264, rue Saint-Pierre, 13385 Marseille, France
| | - S. Attarian
- Referral Centre for ALS and Neuromuscular Diseases, Hospital La Timone 264 rue Saint Pierre, 13005, Marseille, France
- Aix Marseille University, INSERM, GMGF, Marseille, France
| | - N. Bonello-Palot
- Aix Marseille University, INSERM, GMGF, Marseille, France
- Medical Genetics Department, La Timone Teaching hospital, 264, rue Saint-Pierre, 13385 Marseille, France
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Zucco L, Santer P, Levy N, Hammer M, Grabitz SD, Nabel S, Ramachandran SK. A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single-centre cohort study. Anaesthesia 2020; 76:36-44. [PMID: 32743803 DOI: 10.1111/anae.15203] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2020] [Indexed: 11/28/2022]
Abstract
Sevoflurane and desflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia. In this study, we aimed to evaluate the relationship between choice of volatile anaesthetic and early postoperative respiratory complications, and to address a critical knowledge gap in safety outcomes between these two commonly used agents. We performed a retrospective analysis of adult (non-cardiac surgery) patients who received sevoflurane or desflurane for the maintenance of general anaesthesia at our institution between 2005 and 2018. We evaluated the association between desflurane exposure (when compared with sevoflurane) and the primary outcome of postoperative respiratory complications, defined by early post-extubation desaturation (Sp O2 < 90%) or re-intubation within 7 days postoperatively. Multivariable regression analyses were performed and adjusted for confounding factors, including patient, anaesthetic and surgical factors. Propensity matched, interaction and sub-group analyses were performed to assess outcomes in high-risk groups: morbidly obese (BMI > 35 kg.m-2 ); elderly (age > 65 years); and high risk of respiratory complications as well as the primary outcome at 24 h. Desflurane was used for 23,830 patients and sevoflurane for 84,608 patients. Patients exposed to desflurane did not demonstrate a reduced risk of postoperative respiratory complications when compared with sevoflurane (adjusted odds ratio 0.99, 95%CI 0.94-1.04, p = 0.598). These findings were consistent across all sub-groups of high-risk patients and in the propensity score matched cohort. In summary, desflurane use was not associated with reduced postoperative respiratory complications when compared with sevoflurane. In the context of environmental and cost concerns with volatile anaesthetic agents, our study provides important data to support organisational decisions regarding the use of desflurane.
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Affiliation(s)
- L Zucco
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - P Santer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - N Levy
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - M Hammer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S D Grabitz
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S Nabel
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S K Ramachandran
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Affiliation(s)
- N Levy
- Department of Anaesthesia and Perioperative Medicine, West Suffolk Hospital, Bury St Edmunds, UK
| | - G M Hall
- Department of Anaesthesia, St George's Hospital Medical School, London, UK
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Affiliation(s)
- Joseph D Feuerstein
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nadav Levy
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Liana Zucco
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lior A Levy
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mandeep Sawhney
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Satya Krishna Ramachandran
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Levy N, Modi A, Hall GM. Pseudoaxioms in the intrapartum management of diabetes. Diabet Med 2020; 37:897-898. [PMID: 31833582 DOI: 10.1111/dme.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- N Levy
- Consultant Anaesthesia, Department of Anaesthesia and Peri-operative Medicine, West Suffolk NHS Foundation Trust, Hardwick Lane, Bury St Edmunds, UK
| | - A Modi
- Consultant Anaesthesia, Department of Anaesthesia and Peri-operative Medicine, West Suffolk NHS Foundation Trust, Hardwick Lane, Bury St Edmunds, UK
| | - G M Hall
- Emeritus Professor of Anaesthesia, Department of Anaesthesia and Intensive Care Medicine, St George's Hospital Medical School, London, UK
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35
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Affiliation(s)
| | - N Levy
- West Suffolk Hospital, Bury St Edmunds, UK
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Yap Y, Modi A, Levy N. Utilising the multidisciplinary concepts of peri-operative medicine to improve the outcome of the parturient with diabetes. Anaesthesia 2020; 75:557-558. [PMID: 32128799 DOI: 10.1111/anae.14962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Y Yap
- West Suffolk Hospital, Bury St Edmunds, UK
| | - A Modi
- West Suffolk Hospital, Bury St Edmunds, UK
| | - N Levy
- West Suffolk Hospital, Bury St Edmunds, UK
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37
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Levy N, Benzaquen M, Le Roux MK, Arnaud M, Graillon N, Foletti JM. Self‐injection of a solution intended for topical use containing hyaluronic acid and vitamin B5. Clin Exp Dermatol 2020; 45:600. [DOI: 10.1111/ced.14168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- N. Levy
- Department of Maxillofacial Surgery Aix Marseille University APHM Hôpital de la Conception Marseille France
- Departments of Department of Ophthalmology Aix Marseille University APHM Hôpital Nord Marseille France
| | - M. Benzaquen
- Department of Dermatology Aix Marseille University APHM Hôpital Nord Marseille France
| | - M. K. Le Roux
- Department of Maxillofacial Surgery Aix Marseille University APHM Hôpital de la Conception Marseille France
| | - M. Arnaud
- Department of Maxillofacial Surgery Aix Marseille University APHM Hôpital de la Conception Marseille France
| | - N. Graillon
- Department of Maxillofacial Surgery Aix Marseille University APHM Hôpital de la Conception Marseille France
| | - J. M. Foletti
- Department of Maxillofacial Surgery Aix Marseille University APHM Hôpital de la Conception Marseille France
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Affiliation(s)
- J Quinlan
- Department of Anaesthesia and Pain Management, Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
- David Greenfield Human Physiology Unit, MRCVersus Arthritis Centre for Musculoskeletal Ageing, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - N Levy
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK
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39
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Affiliation(s)
- N Levy
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK
| | - M P W Grocott
- Anaesthesia and Critical Care Medicine, Southampton National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust / University of Southampton, Southampton, UK
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
- David Greenfield Human Physiology Unit,MRCVersus Arthritis Centre for Musculoskeletal Ageing, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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40
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Faruki A, Nguyen T, Proeschel S, Levy N, Yu J, Ip V, Mueller A, Banner-Goodspeed V, O'Gara B. Virtual reality as an adjunct to anesthesia in the operating room. Trials 2019; 20:782. [PMID: 31882015 PMCID: PMC6935058 DOI: 10.1186/s13063-019-3922-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/20/2019] [Indexed: 11/21/2022] Open
Abstract
Background Advancements in virtual reality (VR) technology have resulted in its expansion into health care. Preliminary studies have found VR to be effective as an adjunct to anesthesia to reduce pain and anxiety for patients during upper gastrointestinal endoscopies, dental procedures and joint arthroplasties. Current standard care practice for upper extremity surgery includes a combination of regional anesthesia and intraoperative propofol sedation. Commonly, patients receive deep propofol sedation during these cases, leading to potentially avoidable risks of over-sedation, hypotension, upper airway obstruction, and apnea. The objective of this study is to evaluate the effectiveness of VR technology to promote relaxation for patients undergoing upper extremity surgery, thereby reducing intraoperative anesthetic requirements and improving the perioperative patient experience. Methods In this single-center, randomized controlled trial, 40 adult patients undergoing upper extremity orthopedic surgery will be randomly allocated to either intraoperative VR immersion or usual care. VR immersion is designed to provide patients with a relaxing virtual environment to alleviate intraoperative anxiety. All patients receive a peripheral nerve block prior to surgery. Patients in the intervention group will select videos or immersive environments which will be played in the VR headset during surgery. An anesthesia provider will perform their usual clinical responsibilities intraoperatively and can administer anesthetic medications if and when clinically necessary. Patients in the control arm will undergo perioperative anesthesia according to standard care practice. The primary outcome is the difference in intraoperative propofol dose between the groups. Secondary outcomes include postoperative analgesia requirements and pain scores, length of stay in the postanesthesia care unit, overall patient satisfaction and postoperative functional outcomes. Discussion It is unknown whether the use of VR during upper extremity surgery can reduce intraoperative anesthetic requirements, reduce perioperative complications, or improve the postoperative patient experience. A positive result from this clinical trial would add to the growing body of evidence that demonstrates the effectiveness of VR as an adjunct to anesthesia in reducing intraoperative pain and anxiety for multiple types of procedure. This could lead to a change in practice, with the introduction of a nonpharmacologic intervention potentially reducing the burden of over-sedation while still providing a satisfactory perioperative experience. Trial registration ClinicalTrials.gov, NCT03614325. Registered on 9 July 2018.
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Affiliation(s)
- Adeel Faruki
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Thy Nguyen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Samantha Proeschel
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Nadav Levy
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Jessica Yu
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Victoria Ip
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Valerie Banner-Goodspeed
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Brian O'Gara
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
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41
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Levy N, Beylerian M, Dambricourt L, Esposito F, Denis D. Mydriase persistante après injection de toxine botulique dans le cadre d’une ésotropie précoce. J Fr Ophtalmol 2019; 42:e473-e474. [DOI: 10.1016/j.jfo.2019.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022]
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42
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Singleton G, Levy N. Age‐adjusted minimum alveolar concentration and standards of monitoring. Anaesthesia 2019; 74:1615-1616. [PMID: 31681996 DOI: 10.1111/anae.14824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - N. Levy
- West Suffolk NHS Foundation Trust Suffolk UK
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43
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Gargaun E, Wahbi K, Ben Yaou R, Guibaud M, Solé G, Tiffreau V, Laforêt P, Parent M, Husson M, Bassez G, Cuisset J, Urtizberea A, Eymard B, Boland A, Deleuze J, Salgado D, Khran M, Levy N, Blesius A, Leturcq F, Pietri-Rouxel F. P.335Phenotypic and genomic characterization as predictors of DMD 45 to 55 multi-exon skipping therapy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stubbs D, Levy N, Moonesinghe SR. Good intra‐operative anaesthesia is more than an ‘airway, breathing, circulation, drugs with a three, two and a one’. Anaesthesia 2019; 75:309-312. [PMID: 31435942 DOI: 10.1111/anae.14809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 12/26/2022]
Affiliation(s)
- D. Stubbs
- University of Cambridge, Division of Anaesthesia Addenbrooke's Hospital CambridgeUK
| | - N. Levy
- Department of Anaesthesia and Peri‐operative Medicine West Suffolk NHS Foundation Trust Bury St Edmunds, Suffolk UK
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Levy N, Matot I, Weiniger CF. Low-budget In situ multidisciplinary operating room simulation programme: just add a mock patient. BMJ STEL 2019; 6:243-244. [DOI: 10.1136/bmjstel-2019-000495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 01/09/2023]
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46
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Levy N, Mills P. Controlled-release opioids cause harm and should be avoided in management of postoperative pain in opioid naïve patients. Br J Anaesth 2019; 122:e86-e90. [DOI: 10.1016/j.bja.2018.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 12/15/2022] Open
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Dambricourt L, Sampo M, Levy N, Arnould T, Ho Wang Yin G, Denis D. [Leukemic chorioretinal infiltrates with serous retinal detachment in acute pre-B lymphoblastic leukemia]. J Fr Ophtalmol 2019; 42:e247-e249. [PMID: 31079912 DOI: 10.1016/j.jfo.2018.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022]
Affiliation(s)
- L Dambricourt
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - M Sampo
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - N Levy
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - T Arnould
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Ho Wang Yin
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - D Denis
- Service d'ophtalmologie, CHU Timone, 264, rue Saint-Pierre, 13385 Marseille, France; Service d'ophtalmologie, hôpital Nord, CHU, chemin des Bourrely, 13015 Marseille, France
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48
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Levy N, Ballegeer E, Koenigshof A. Clinical and radiographic findings in cats with aspiration pneumonia: retrospective evaluation of 28 cases. J Small Anim Pract 2019; 60:356-360. [PMID: 30843218 DOI: 10.1111/jsap.12990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 12/20/2018] [Accepted: 01/15/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To describe the clinical syndrome of aspiration pneumonia in cats and record potential predisposing factors. MATERIALS AND METHODS A retrospective medical records search for cats with a diagnosis of "aspiration pneumonia" or "bronchopneumonia" was performed. Cases were included if they had a complete medical record and three-view thoracic radiographs with pulmonary changes consistent with aspiration pneumonia and no other radiographic or physical examination findings suggestive of another cause of pulmonary or cardiac disease. RESULTS We identified 28 cases. Potential predisposing conditions included: vomiting (12 of 28; 43%), anaesthesia (five of 28; 18%), enteral nutrition (five of 28; 18%), preexisting oesophageal disease (four of 28; 14%), neurologic disease (two of 28; 7%) and laryngeal disease (one of 28; 3.6%); 15 of 28 (53%) had more than one potentially predisposing condition. The most common lung lobe affected was the right middle (18 of 28; 64%), followed by the left cranial (16 of 28; 57%); multiple lung lobes were affected in 16 of 28 (57%) cases. Most cats (25 of 28; 89%) survived to discharge, with a median hospitalisation of 3 days. CLINICAL SIGNIFICANCE Potential predisposing factors for developing aspiration pneumonia in cats are similar to those recorded in dogs and people. Aspiration pneumonia occurred in cats following vomiting, anaesthesia or after receiving enteral nutrition. Survival rates are high following treatment with antibiotics and supportive care, with 89% of cats in this study surviving to discharge.
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Affiliation(s)
- N Levy
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan 48824, USA
| | - E Ballegeer
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Koenigshof
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan 48824, USA
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49
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Levy N, Dhatariya K. Pre-operative optimisation of the surgical patient with diagnosed and undiagnosed diabetes: a practical review. Anaesthesia 2019; 74 Suppl 1:58-66. [PMID: 30604420 DOI: 10.1111/anae.14510] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2018] [Indexed: 01/08/2023]
Abstract
Peri-operative hyperglycaemia, whether the cause is known diabetes, undiagnosed diabetes or stress hyperglycaemia, is a risk factor for harm, increased length of stay and death. There is increasing evidence that peri-operative hyperglycaemia is a modifiable risk factor, and many of the interventions required to improve the outcome of surgery must be instituted before the actual surgical admission. These interventions depend on communication and collaboration within the multidisciplinary team along each stage of the patient journey to ensure that integration of care occurs across the whole of the patient-centred care pathway.
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Affiliation(s)
- N Levy
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK
| | - K Dhatariya
- Diabetes and Endocrinology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich Medical School, University of East Anglia, Norwich, UK
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Levy N, Grocott MPW, Carli F. Patient optimisation before surgery: a clear and present challenge in peri-operative care. Anaesthesia 2019; 74 Suppl 1:3-6. [DOI: 10.1111/anae.14502] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 12/20/2022]
Affiliation(s)
- N. Levy
- Department of Anaesthesia and Peri-operative Medicine; West Suffolk NHS Foundation Trust; Bury St Edmunds Suffolk
| | - M. P. W. Grocott
- Southampton NIHR Biomedical Research Centre; University Hospitals Southampton/University of Southampton; Southampton UK
| | - F. Carli
- Department of Anesthesia; McGill University Health Centre; Montreal Quebec Canada
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