Pub Date : 2023-09-01DOI: 10.1136/rapm-2023-esra.405
Peter Daum, Griffiths Isabel
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Delays to intravenous (IV) access are an independent predictor of delayed care and prolonged length of stay, leading to worse outcomes and poor patient experience. As populations become more comorbid and with rising levels of obesity this is an increasingly prevalent issue and medical teams are frequently turning to the anaesthetic department for support. Ultrasound-guided (USG) peripheral venous catheter (PVC) insertion has emerged as a safe and effective technique to establish vascular access in difficult patients, but training opportunities are limited, and commercially available phantom models are costly.
Methods
We assessed the impact of difficult IV access requests on the anaesthetic department and identified a need for greater training. We developed a cost-effective, high-fidelity phantom model easily produced from commonly available materials (gelatin, ispaghula husk and modelling balloons) to train doctors and allied health professionals in USG PVC insertion. We subsequently piloted and delivered training sessions to different departments within our hospital.
Results
Our training sessions resulted in increased operator confidence performing USG PVC insertion and out-of-plane needling. Participants agreed that the session also improved related complementary skills including USG arterial blood gas sampling and arterial or central line insertion.
Conclusions
These phantom models provide an effective simulation for teaching USG PVC insertion. Following these results, our difficult vascular access team have requested we use these models to train their members and adapt them to also teach peripherally inserted central catheter (PICC) line insertion. There are potential applications to needling and catheter insertion for regional anaesthesia that we intend to develop further.
{"title":"#36307 A cost-effective, high-fidelity phantom model for teaching ultrasound-guided vascular access and needling skills","authors":"Peter Daum, Griffiths Isabel","doi":"10.1136/rapm-2023-esra.405","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.405","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Delays to intravenous (IV) access are an independent predictor of delayed care and prolonged length of stay, leading to worse outcomes and poor patient experience. As populations become more comorbid and with rising levels of obesity this is an increasingly prevalent issue and medical teams are frequently turning to the anaesthetic department for support. Ultrasound-guided (USG) peripheral venous catheter (PVC) insertion has emerged as a safe and effective technique to establish vascular access in difficult patients, but training opportunities are limited, and commercially available phantom models are costly. <h3>Methods</h3> We assessed the impact of difficult IV access requests on the anaesthetic department and identified a need for greater training. We developed a cost-effective, high-fidelity phantom model easily produced from commonly available materials (gelatin, ispaghula husk and modelling balloons) to train doctors and allied health professionals in USG PVC insertion. We subsequently piloted and delivered training sessions to different departments within our hospital. <h3>Results</h3> Our training sessions resulted in increased operator confidence performing USG PVC insertion and out-of-plane needling. Participants agreed that the session also improved related complementary skills including USG arterial blood gas sampling and arterial or central line insertion. <h3>Conclusions</h3> These phantom models provide an effective simulation for teaching USG PVC insertion. Following these results, our difficult vascular access team have requested we use these models to train their members and adapt them to also teach peripherally inserted central catheter (PICC) line insertion. There are potential applications to needling and catheter insertion for regional anaesthesia that we intend to develop further.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1136/rapm-2023-esra.412
Nicolas Suarez, Thomas Hine, Alexander Tough, Katherine Finlay
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims
Though awake surgery may minimise risk and reduce inpatient stays, uptake of awake surgery remains low. This qualitative study aimed to provide the baseline for future intervention development by identifying and characterising the qualitative barriers and drivers of awake surgery.
Methods
Post-operative semi-structured interviews using a 14-item interview were conducted with 19 people (12 females, seven males) undergoing day case orthopaedic surgery. Mean interview length was 34.8 minutes (SD 11.4 minutes). Interviews were transcribed verbatim and analysed using Thematic Analysis. Triangulation of themes generated high inter-rater agreement (96%).
Results
Two superordinate themes were identified: (1) Generation of anaesthetic preferences; and (2) Optimising pre-operative anaesthetic discussion. Strong preconceptions about the efficacy and appropriateness of general anaesthesia (GA) combined with pre-surgical online research to inform patient decision-making processes, were biased against regional anaesthesia (RA). Optimising the timing and content of pre-surgical anaesthetic consultations was felt to build rapport, elevate locus of control and increase satisfaction with care. Rushed, pressured conversations acted as barriers to RA uptake, risking patient disengagement and jeopardising informed consent. Developing rapport with the anaesthetist in advance of the day of surgery facilitated awake surgery willingness
Conclusions
The anaesthetic decision is highly personal and online research generated preconceptions, advantaging GA above RA. To facilitate informed decision-making, attention-diversion methods and engaged, patient-focused interpersonal clinical interactions acted as facilitators of awake surgery. This research demonstrated a novel area for patient-centred care enhancement: the need to optimise the timing, content and interpersonal dynamics involved in patient-anaesthetist interactions about RA.
{"title":"#35861 A qualitative study of patients’ attitudes to awake orthopaedic surgery under regional anaesthesia","authors":"Nicolas Suarez, Thomas Hine, Alexander Tough, Katherine Finlay","doi":"10.1136/rapm-2023-esra.412","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.412","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I apply as an Anesthesiologist (Aged 35 years old or less) <h3>Background and Aims</h3> Though awake surgery may minimise risk and reduce inpatient stays, uptake of awake surgery remains low. This qualitative study aimed to provide the baseline for future intervention development by identifying and characterising the qualitative barriers and drivers of awake surgery. <h3>Methods</h3> Post-operative semi-structured interviews using a 14-item interview were conducted with 19 people (12 females, seven males) undergoing day case orthopaedic surgery. Mean interview length was 34.8 minutes (SD 11.4 minutes). Interviews were transcribed verbatim and analysed using Thematic Analysis. Triangulation of themes generated high inter-rater agreement (96%). <h3>Results</h3> Two superordinate themes were identified: (1) Generation of anaesthetic preferences; and (2) Optimising pre-operative anaesthetic discussion. Strong preconceptions about the efficacy and appropriateness of general anaesthesia (GA) combined with pre-surgical online research to inform patient decision-making processes, were biased against regional anaesthesia (RA). Optimising the timing and content of pre-surgical anaesthetic consultations was felt to build rapport, elevate locus of control and increase satisfaction with care. Rushed, pressured conversations acted as barriers to RA uptake, risking patient disengagement and jeopardising informed consent. Developing rapport with the anaesthetist in advance of the day of surgery facilitated awake surgery willingness <h3>Conclusions</h3> The anaesthetic decision is highly personal and online research generated preconceptions, advantaging GA above RA. To facilitate informed decision-making, attention-diversion methods and engaged, patient-focused interpersonal clinical interactions acted as facilitators of awake surgery. This research demonstrated a novel area for patient-centred care enhancement: the need to optimise the timing, content and interpersonal dynamics involved in patient-anaesthetist interactions about RA.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1136/rapm-2023-esra.407
Athmaja Thottungal, Velliyottillom Parameswaran
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Olfactory dysfunction/anosmia is a very difficult condition to treat and can be debilitating and dangerous for patients. Conventional management produces very poor outcome and cervical sympathetic chain block/’Stellate ganglion block’ (SGB) has shown dramatic effects for some patients. This is a case report of 50 year old male with history of anosmia for 15 years due to diabetes and sinus diseases treated successfully with ultrasound guided cervical sympathetic block.
Methods
He had right cervical sympathetic chain block at the level of C6 vertebra using ultrasound guidance (HF linear probe, 50 mm echogenic needle). 5 ml 1% lignocaine was given and left sided block done after 5 days using 0.5% Levo-bupivacaine under strict strict asepsis. Both times he developed Horner’s syndrome which is a sign of cervical sympathetic block.
Results
He started to get few range of smells after nearly 24 hours post procedure. Second procedure improved the response and the range of smell increased. It is still continuing after 2 months and he is doing smell retraining to improve it further.
Conclusions
Olfactory bulb is one part of brain with the ability to regenerate. Sympathetic block is shown to increase the blood flow to olfactory bulb and nerves area promoting regeneration which is the postulated mechanism of return of smell. Cervical sympathetic block/‘SGB’ block is a relatively simple and safe procedure to do especially under ultrasound guidance which can be used for not only treating various pain conditions, but for many other medical conditions including olfactory dysfunction.
{"title":"#36476 Cervical sympathetic chain/‘stellate ganglion’ block under ultrasound guidance to treat 15 year old olfactory dysfunction/anosmia","authors":"Athmaja Thottungal, Velliyottillom Parameswaran","doi":"10.1136/rapm-2023-esra.407","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.407","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Olfactory dysfunction/anosmia is a very difficult condition to treat and can be debilitating and dangerous for patients. Conventional management produces very poor outcome and cervical sympathetic chain block/’Stellate ganglion block’ (SGB) has shown dramatic effects for some patients. This is a case report of 50 year old male with history of anosmia for 15 years due to diabetes and sinus diseases treated successfully with ultrasound guided cervical sympathetic block. <h3>Methods</h3> He had right cervical sympathetic chain block at the level of C6 vertebra using ultrasound guidance (HF linear probe, 50 mm echogenic needle). 5 ml 1% lignocaine was given and left sided block done after 5 days using 0.5% Levo-bupivacaine under strict strict asepsis. Both times he developed Horner’s syndrome which is a sign of cervical sympathetic block. <h3>Results</h3> He started to get few range of smells after nearly 24 hours post procedure. Second procedure improved the response and the range of smell increased. It is still continuing after 2 months and he is doing smell retraining to improve it further. <h3>Conclusions</h3> Olfactory bulb is one part of brain with the ability to regenerate. Sympathetic block is shown to increase the blood flow to olfactory bulb and nerves area promoting regeneration which is the postulated mechanism of return of smell. Cervical sympathetic block/‘SGB’ block is a relatively simple and safe procedure to do especially under ultrasound guidance which can be used for not only treating various pain conditions, but for many other medical conditions including olfactory dysfunction.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1136/rapm-2023-esra.413
Maria José de Barros e Castro Bento Soares, Joana van der Kellen, Paula Ribeiro
Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission
Background and Aims
Intravenous regional anesthesia, commonly known as Bier Block (BB), consists of administering a local anesthetic into the venous system of an exsanguinated limb that is isolated from the systemic circulation by a tourniquet. It is a simple technique that does not require the use of an ultrasound device, provides a blockade that is quickly installed and reversed and a surgical field with minimal blood loss. For this reasons it has a lot o potencial in ambulatory surgery.
Methods
We gathered perioperative information concerning every adult patient that was subjected to a BB in Egas Moniz Hospital’s Ambulatory Surgery Unit between the january first 2022 ant March 30th 2023. The data was analyzed using Microsoft Excel®.
Results
A total of 11 patients underwent surgery under BB. The duration of the surgical procedure was less than 60 min in 8 of the surgeries and lasted between 60-90 min in the remaining 3. No complications were registered, namely LAST or pain associated with tourniquet. Discharge time after surgery was on average 147 minutes after surgery. Only 5 patients had pain 24h after surgery, and all were able to control the pain with oral analgesics. No patient had pain 48h after surgery.
Conclusions
Intravenous regional anesthesia has a high potential to be used in an outpatient setting, as it allows adequate anesthesia for short-term surgeries and is rapidly reversed, allowing the limb to be mobilized before discharge.
Attachment
Estudo BLOQUEIOS DE BIER EM AMBULATÓRIO » Parecer da CES do CHLO.pdf
背景和目的静脉局部麻醉，通常被称为Bier Block (BB)，包括将局部麻醉剂注入失血肢体的静脉系统，该肢体通过止血带与体循环隔离。这是一种简单的技术，不需要使用超声波设备，提供了一个快速安装和逆转的封锁，以及最小失血的手术区域。因此，它在门诊手术中有很大的潜力。方法:我们收集了2022年1月1日至2023年3月30日期间在Egas Moniz医院门诊外科接受BB手术的所有成年患者的围手术期信息。使用Microsoft Excel®对数据进行分析。结果11例患者行BB手术。8例手术持续时间小于60分钟，其余3例手术持续时间在60-90分钟之间。无并发症记录，即LAST或止血带相关疼痛。术后平均出院时间147分钟。5例患者术后24h疼痛，均能通过口服镇痛药物控制疼痛。术后48小时无疼痛。结论静脉区域麻醉在门诊有很大的应用潜力，因为它可以为短期手术提供足够的麻醉，并迅速逆转，使肢体在出院前能够活动。附件Estudo BLOQUEIOS DE BIER EM AMBULATÓRIO»parrecer da CES do chol .pdf
{"title":"#36262 Bier blocks in ambulatory surgery: a wellcomed comeback or old news?","authors":"Maria José de Barros e Castro Bento Soares, Joana van der Kellen, Paula Ribeiro","doi":"10.1136/rapm-2023-esra.413","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.413","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission <h3>Background and Aims</h3> Intravenous regional anesthesia, commonly known as Bier Block (BB), consists of administering a local anesthetic into the venous system of an exsanguinated limb that is isolated from the systemic circulation by a tourniquet. It is a simple technique that does not require the use of an ultrasound device, provides a blockade that is quickly installed and reversed and a surgical field with minimal blood loss. For this reasons it has a lot o potencial in ambulatory surgery. <h3>Methods</h3> We gathered perioperative information concerning every adult patient that was subjected to a BB in Egas Moniz Hospital’s Ambulatory Surgery Unit between the january first 2022 ant March 30th 2023. The data was analyzed using Microsoft Excel®. <h3>Results</h3> A total of 11 patients underwent surgery under BB. The duration of the surgical procedure was less than 60 min in 8 of the surgeries and lasted between 60-90 min in the remaining 3. No complications were registered, namely LAST or pain associated with tourniquet. Discharge time after surgery was on average 147 minutes after surgery. Only 5 patients had pain 24h after surgery, and all were able to control the pain with oral analgesics. No patient had pain 48h after surgery. <h3>Conclusions</h3> Intravenous regional anesthesia has a high potential to be used in an outpatient setting, as it allows adequate anesthesia for short-term surgeries and is rapidly reversed, allowing the limb to be mobilized before discharge. <h3>Attachment</h3> Estudo BLOQUEIOS DE BIER EM AMBULATÓRIO » Parecer da CES do CHLO.pdf","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1136/rapm-2023-esra.417
Julia Frederica Reichel, Haoyan Zhong, Jiabin Liu, Dale Langford
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Machine learning enables complex patient data to be distilled into predictive diagnostic tools. This review identified studies that applied machine learning to predict acute, subacute, or chronic pain or opioid use after any surgical procedure.
Methods
We searched PubMed using the following search strategy and terms: ‘machine learning’ OR ‘artificial intelligence’ AND ‘pain’ OR ‘opioid’ AND ‘surgery’ OR ‘postoperative’ AND ‘predict.’ The inclusion criteria were literature written in English that used machine learning and/or artificial intelligence to predict postoperative and/or opioid use after surgery. The exclusion criteria were reviews; protocol papers, commentaries; not a pain or opioid-related outcome; not a postoperative outcome; diagnostic or measurement tool.
Results
Thirty-nine studies were included (figure 1). Nineteen studies (48.7%) utilized machine learning to predict the outcome of chronic postoperative pain or function after any surgical procedure, followed by 12 studies (30.8%) utilizing machine learning to predict chronic postoperative opioid use. The most common algorithms were GBDT (n = 28), random forest algorithms (n = 23) and regularization algorithms (n = 22). 27 studies (69.2%) used preoperative pain as a predictor in the initial model. 22 studies (69.2%) used preoperative pain as a predictor in the final model. 25 studies (64.1%) used preoperative opioid use as a predictor in the initial model. 19 studies (54.3%) used preoperative opioid use as a predictor in the final model.
Conclusions
Machine learning can contribute to personalized perioperative pain management approaches. Patient-reported variables are important, salient predictors of acute, subacute, or chronic pain or opioid use after any surgical procedure.
{"title":"#36260 Machine learning to predict postoperative pain and opioid outcomes: promise or pitfall?","authors":"Julia Frederica Reichel, Haoyan Zhong, Jiabin Liu, Dale Langford","doi":"10.1136/rapm-2023-esra.417","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.417","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Machine learning enables complex patient data to be distilled into predictive diagnostic tools. This review identified studies that applied machine learning to predict acute, subacute, or chronic pain or opioid use after any surgical procedure. <h3>Methods</h3> We searched PubMed using the following search strategy and terms: ‘machine learning’ OR ‘artificial intelligence’ AND ‘pain’ OR ‘opioid’ AND ‘surgery’ OR ‘postoperative’ AND ‘predict.’ The inclusion criteria were literature written in English that used machine learning and/or artificial intelligence to predict postoperative and/or opioid use after surgery. The exclusion criteria were reviews; protocol papers, commentaries; not a pain or opioid-related outcome; not a postoperative outcome; diagnostic or measurement tool. <h3>Results</h3> Thirty-nine studies were included (figure 1). Nineteen studies (48.7%) utilized machine learning to predict the outcome of chronic postoperative pain or function after any surgical procedure, followed by 12 studies (30.8%) utilizing machine learning to predict chronic postoperative opioid use. The most common algorithms were GBDT (n = 28), random forest algorithms (n = 23) and regularization algorithms (n = 22). 27 studies (69.2%) used preoperative pain as a predictor in the initial model. 22 studies (69.2%) used preoperative pain as a predictor in the final model. 25 studies (64.1%) used preoperative opioid use as a predictor in the initial model. 19 studies (54.3%) used preoperative opioid use as a predictor in the final model. <h3>Conclusions</h3> Machine learning can contribute to personalized perioperative pain management approaches. Patient-reported variables are important, salient predictors of acute, subacute, or chronic pain or opioid use after any surgical procedure. <h3>Attachment</h3> ESRA 2023 Machine Learning Abstract_5.21.2023_final.pdf","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Kyphoplasty for osteoporotic vertebral compression fractures (OVCF) is a short but painful intervention. Several anesthetic techniques (local, regional (paravertebral block (PRV)/Erector Spinae block (ESP) or general anesthesia(GA)) have been proposed to control pain during kyphoplasty, although in our center GA is preferred.
Methods
A 76-year-old male, with T11 OVCF and intractable pain was proposed for kyphoplasty. Medical history: ASA IV, dilated cardiomyopathy (left ventricular ejection fraction 15%), myasthenia gravis, COPD Gold 4, obstructive sleep apnea, obesity (BMI 35), hypertension and diabetes mellitus. Patient was initially turned down for kyphoplasty due to the high anesthetic risk of GA, but the pain was unbearable. We decided underwent surgery under bilateral ESP at T11 level in prone position using ropivacaine 0,5% + dexamethasone 4mg (20ml/side) without sedation.
Results
The procedure was well tolerated by the patient, without any sedation. No postoperative complications occurred. Numerical rating pain scale (NRPS) were before/during/24 hours and month postoperatively: 10/0/2/1. Patient was discharged the day after surgery. Kyphoplasty was successful improving pain, mobility and quality of life.
Conclusions
Many of patients with OVCF indicated for kyphoplasty are elderly with severe comorbidities, which puts them at high risk for GA. Surgery performed under RA associated or not to mild sedation offers an interesting alternative to GA. ESP at the level of the vertebral fracture achieves optimal analgesic conditions as PRV for kyphoplasty. The advantages of ESP are its ease of performance and a better safety profile. Therefore, in this patient, considering medical history, ESP could be the best anesthetic strategy.
{"title":"#35807 Erector spinae block for percutaneous kyphoplasty anesthetic management in high-risk patients: a case report","authors":"Mireia Rodríguez Prieto, Angelica Villamizar Avendaño, Marisa Moreno Bueno, Clara Martínez García, Irina Millan Moreno, Gerard Moreno Giménez, Teresa Fonseca Pinto, Sergi Sabaté Tenas","doi":"10.1136/rapm-2023-esra.432","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.432","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Kyphoplasty for osteoporotic vertebral compression fractures (OVCF) is a short but painful intervention. Several anesthetic techniques (local, regional (paravertebral block (PRV)/Erector Spinae block (ESP) or general anesthesia(GA)) have been proposed to control pain during kyphoplasty, although in our center GA is preferred. <h3>Methods</h3> A 76-year-old male, with T11 OVCF and intractable pain was proposed for kyphoplasty. Medical history: ASA IV, dilated cardiomyopathy (left ventricular ejection fraction 15%), myasthenia gravis, COPD Gold 4, obstructive sleep apnea, obesity (BMI 35), hypertension and diabetes mellitus. Patient was initially turned down for kyphoplasty due to the high anesthetic risk of GA, but the pain was unbearable. We decided underwent surgery under bilateral ESP at T11 level in prone position using ropivacaine 0,5% + dexamethasone 4mg (20ml/side) without sedation. <h3>Results</h3> The procedure was well tolerated by the patient, without any sedation. No postoperative complications occurred. Numerical rating pain scale (NRPS) were before/during/24 hours and month postoperatively: 10/0/2/1. Patient was discharged the day after surgery. Kyphoplasty was successful improving pain, mobility and quality of life. <h3>Conclusions</h3> Many of patients with OVCF indicated for kyphoplasty are elderly with severe comorbidities, which puts them at high risk for GA. Surgery performed under RA associated or not to mild sedation offers an interesting alternative to GA. ESP at the level of the vertebral fracture achieves optimal analgesic conditions as PRV for kyphoplasty. The advantages of ESP are its ease of performance and a better safety profile. Therefore, in this patient, considering medical history, ESP could be the best anesthetic strategy.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135685776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1136/rapm-2023-esra.409
Melita Buljan
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Optimum transfusion trigger for elderly patients undergoing hip fracture repair is still uncertain. During the last decade „patient blood management’ (PBM) and its three treatment „pillars’ has emerged as a part of surgical patients care. The aim of this study was to evaluate the reason for transfusion in elderly surgical hip fracture patients, with preexisting anemia – strategy addressed to the 3. pillar of PBM.
Methods
Elderly patients (age 65 or over) with preexisting anemia (WHO definition) undergoing surgery for hip fracture between February 2020 and December 2022 were retrospectively evaluated. Only patients receiving blood transfusion perioperatively were included in this study: because of hemoglobin level (<80 g/L), sign and symptoms indicative of anemia (physiological trigger), patients‘ comorbidities, or combination of each. Mercuriali algorithm was used for all patients, calculating tolerated red blood cell loss, (tlRCV), and perioperative red blood cell loss (plRCV). Patients perioperative data were statisticly analyzed.
Results
A total 65 anemic patients were included, average age 85 years, 85% female. Patients in group I (40 patients, tlRCV < plRCV) had lower preoperative hemoglobin (106±8 g/L vs 112±10 g/L), and had higher transfusion index (591±223 vs 335±158 mL) than group II (25 patients, tlRCV >plRCV). Physiological trigger was the main reason for transfusion in both groups. There was no statistically significant difference according to reason of transfusion between two groups.
Conclusions
Perioperative anemia in elderly patients poses a clinical chalenge. Despite intense research to identify an optimal transfusion trigger for patients, larger clinical trials are needed to prove the outcome benefit.
申请ESRA摘要奖项:我不希望申请ESRA奖项背景和目的对于接受髋部骨折修复的老年患者，最佳输血触发仍不确定。在过去的十年中，“患者血液管理”(PBM)及其三个治疗“支柱”已成为外科患者护理的一部分。本研究的目的是评估老年手术髋部骨折患者输血的原因，既往存在贫血-策略针对3。PBM的支柱。方法回顾性分析2020年2月至2022年12月间接受髋部骨折手术的既往存在贫血(WHO定义)的老年患者(65岁及以上)。本研究仅纳入围手术期输血的患者:因为血红蛋白水平(80 g/L)、贫血体征和症状(生理触发)、患者合并症或两者的组合。所有患者均采用Mercuriali算法，计算耐受红细胞损失(tlRCV)和围手术期红细胞损失(plRCV)。对患者围手术期资料进行统计学分析。结果共纳入65例贫血患者，平均年龄85岁，85%为女性。I组患者(40例，tlRCV <plRCV组术前血红蛋白(106±8 g/L vs 112±10 g/L)低于II组(25例，tlRCV >plRCV)，输血指数(591±223 mL vs 335±158 mL)高于II组(25例，plRCV)。生理触发是两组输血的主要原因。两组输血原因比较，差异无统计学意义。结论老年患者围手术期贫血的治疗具有临床挑战性。尽管为确定患者的最佳输血触发因素进行了大量研究，但需要更大规模的临床试验来证明结果的益处。
{"title":"#36356 Difference between ‘premature’ and ‘adequate’ transfusion- why is it so difficult?","authors":"Melita Buljan","doi":"10.1136/rapm-2023-esra.409","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.409","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Optimum transfusion trigger for elderly patients undergoing hip fracture repair is still uncertain. During the last decade „patient blood management’ (PBM) and its three treatment „pillars’ has emerged as a part of surgical patients care. The aim of this study was to evaluate the reason for transfusion in elderly surgical hip fracture patients, with preexisting anemia – strategy addressed to the 3. pillar of PBM. <h3>Methods</h3> Elderly patients (age 65 or over) with preexisting anemia (WHO definition) undergoing surgery for hip fracture between February 2020 and December 2022 were retrospectively evaluated. Only patients receiving blood transfusion perioperatively were included in this study: because of hemoglobin level (<80 g/L), sign and symptoms indicative of anemia (physiological trigger), patients‘ comorbidities, or combination of each. Mercuriali algorithm was used for all patients, calculating tolerated red blood cell loss, (tlRCV), and perioperative red blood cell loss (plRCV). Patients perioperative data were statisticly analyzed. <h3>Results</h3> A total 65 anemic patients were included, average age 85 years, 85% female. Patients in group I (40 patients, tlRCV < plRCV) had lower preoperative hemoglobin (106±8 g/L vs 112±10 g/L), and had higher transfusion index (591±223 vs 335±158 mL) than group II (25 patients, tlRCV >plRCV). Physiological trigger was the main reason for transfusion in both groups. There was no statistically significant difference according to reason of transfusion between two groups. <h3>Conclusions</h3> Perioperative anemia in elderly patients poses a clinical chalenge. Despite intense research to identify an optimal transfusion trigger for patients, larger clinical trials are needed to prove the outcome benefit.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Nerve blocks are commonly performed to prevent the chronicity of postherpetic neuralgia in the acute phase. This study investigated whether distal approaches of intercostal nerve block are effective for zoster-associated pain in the thoracic spinal cord region.
Methods
This was a descriptive study conducted between January 2013 and January 2023, targeting patients who visited our department within three months of onset and received nerve blocks. Patients who underwent pulsed radiofrequency treatment were excluded. The Conventional (C) group received conventional treatments such as paravertebral, epidural, and intercostal nerve block, while the Peripheral (P) group received nerve blocks at distal sites of intercostal nerves, such as the serratus anterior plane block, rectus sheath block, and transversus abdominis plane block. The duration of nerve block required by patients was examined.
Results
There were 18 patients in the C group and 19 in the P group. There were no significant differences in age, affected spinal cord site, presence of sleep disorders, presence of risk factors for refractory cases, duration to initial visit, or EQ-5D score. The median duration of nerve block requirement was 35 (7-97) days in the C group and 18 (7-38) days in the P group.
Conclusions
The distal approaches of intercostal nerve block may also be a treatment option in patients with acute zoster-associated pain.
{"title":"#34113 Distal approaches of ultrasound-guided intercostal nerve block in patients with acute zoster-associated pain: A quantitative descriptive research","authors":"Hirotaka Hayashi, Noriko Yonemoto, Fumiaki Hayashi, Kei Kamiutsuri, Shunji Kobayashi","doi":"10.1136/rapm-2023-esra.401","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.401","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Nerve blocks are commonly performed to prevent the chronicity of postherpetic neuralgia in the acute phase. This study investigated whether distal approaches of intercostal nerve block are effective for zoster-associated pain in the thoracic spinal cord region. <h3>Methods</h3> This was a descriptive study conducted between January 2013 and January 2023, targeting patients who visited our department within three months of onset and received nerve blocks. Patients who underwent pulsed radiofrequency treatment were excluded. The Conventional (C) group received conventional treatments such as paravertebral, epidural, and intercostal nerve block, while the Peripheral (P) group received nerve blocks at distal sites of intercostal nerves, such as the serratus anterior plane block, rectus sheath block, and transversus abdominis plane block. The duration of nerve block required by patients was examined. <h3>Results</h3> There were 18 patients in the C group and 19 in the P group. There were no significant differences in age, affected spinal cord site, presence of sleep disorders, presence of risk factors for refractory cases, duration to initial visit, or EQ-5D score. The median duration of nerve block requirement was 35 (7-97) days in the C group and 18 (7-38) days in the P group. <h3>Conclusions</h3> The distal approaches of intercostal nerve block may also be a treatment option in patients with acute zoster-associated pain. <h3>Attachment</h3> (Form2) Approved by IRB #2022-024.pdf","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Pharyngeal anesthesia before esophagogastroduodenoscopy (EGD) reduces pain and discomfort. Many forms of lidocaine are used as local anesthesia. However, it remains unclear which method is the best. We aimed to assess effective each lidocaine’s form during EGD compared with spray.
Methods
We searched PubMed, Scopus, EMBASE, the Cochrane Central Register of Controlled Trials, CENTRAL, Web of Science Core Collection, World Health Organization, International Clinical Trials Registry Platform, and ClinicalTrials.gov databases in December 2022. Selection criteria were randomized controlled trials comparing lidocaine spray with other forms (gel, lozenges, nebulized, popsicle, and viscous) in EGD. Outcomes of interest included ease of instrumentation, participants’ satisfaction scores, tolerance scores, or pain, endoscopist’s satisfaction scores, and procedural time.
Results
We included 13 trials with 3,711 participants undergoing EGD. The quality of trials was poor. Lidocaine spray provided better ease of instrumentation (Risk ratio (RR) 1.19, 95% confident intervals (CI)1.06,1.34;I2=66%;very low certainty of evidence), decreased participants’ pain (Mean difference (MD) 0.38, 95% CI 0.25,0.5;I2=92%;very low certainty of evidence), and shorter procedural time (MD 0.22, 95% CI 0.10,0.35;I2=13%;low certainty of evidence). However, spray had lower participants’ highest satisfaction scores (RR 0.83, 95% CI 0.76,0.92;I2=62%;very low certainty of evidence), participants’ mean satisfaction scores (MD -0.61, 95% CI -0.29,-0.04; I2=92%;very low certainty of evidence), participants’ tolerance scores (RR 0.83, 95% CI 0.71,0.97; I2=0%;low certainty of evidence), and endoscopist’s satisfaction scores (MD -0.33, 95% CI -0.45,-0.21;I2=94%;very low certainty of evidence).
Conclusions
Lidocaine spray may be better for ease of instrumentation during EGD. However, evidence is still determined due to the quality of trials.
申请ESRA摘要奖项:我不希望申请ESRA奖项背景和目的食管胃十二指肠镜检查(EGD)前的咽麻醉可以减轻疼痛和不适。许多形式的利多卡因被用作局部麻醉。然而，目前尚不清楚哪种方法是最好的。我们的目的是评估在EGD期间，与喷雾相比，每种利多卡因形式的有效性。方法于2022年12月检索PubMed、Scopus、EMBASE、Cochrane Central Register of Controlled Trials、Central、Web of Science核心合集、World Health Organization、International ClinicalTrials Registry Platform和ClinicalTrials.gov数据库。选择标准是随机对照试验，比较利多卡因喷雾与其他形式(凝胶、含片、雾剂、冰棒和粘性)在EGD中的作用。感兴趣的结果包括器械的易用性、参与者满意度评分、耐受性评分或疼痛、内窥镜医师满意度评分和手术时间。结果我们纳入了13项试验，3711名受试者接受了EGD。试验的质量很差。利多卡因喷雾提供了更好的仪器方便(风险比(RR) 1.19, 95%可信区间(CI)1.06,1.34;I2=66%;证据确定性很低)，减少了参与者的疼痛(平均差(MD) 0.38, 95% CI 0.25,0.5;I2=92%;证据确定性很低)，缩短了手术时间(MD 0.22, 95% CI 0.10,0.35;I2=13%;证据确定性很低)。然而，喷雾疗法有较低的参与者最高满意度得分(RR 0.83, 95% CI 0.76,0.92;I2=62%;证据确定性非常低)，参与者平均满意度得分(MD -0.61, 95% CI -0.29，-0.04;I2=92%，证据确定性非常低)，参与者的容忍度评分(RR 0.83, 95% CI 0.71,0.97;I2=0%，证据确定性低)和内窥镜医师满意度评分(MD -0.33, 95% CI -0.45，-0.21;I2=94%，证据确定性极低)。结论利多卡因喷雾剂在EGD中便于仪器测量。然而，由于试验的质量，证据仍然是确定的。
{"title":"#34723 Lidocaine spray versus other forms for local anesthesia in upper gastrointestinal endoscopy: A systematic review and meta-analysis","authors":"Theerada Chandee, Sudsayam Manuwong, Saritphat Orrapin, Neranchala Soonthornkes, Prasit Mahawongkajit, Chuleerat Suptongchai, Thanatcha Luangmaneerat","doi":"10.1136/rapm-2023-esra.398","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.398","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Pharyngeal anesthesia before esophagogastroduodenoscopy (EGD) reduces pain and discomfort. Many forms of lidocaine are used as local anesthesia. However, it remains unclear which method is the best. We aimed to assess effective each lidocaine’s form during EGD compared with spray. <h3>Methods</h3> We searched PubMed, Scopus, EMBASE, the Cochrane Central Register of Controlled Trials, CENTRAL, Web of Science Core Collection, World Health Organization, International Clinical Trials Registry Platform, and ClinicalTrials.gov databases in December 2022. Selection criteria were randomized controlled trials comparing lidocaine spray with other forms (gel, lozenges, nebulized, popsicle, and viscous) in EGD. Outcomes of interest included ease of instrumentation, participants’ satisfaction scores, tolerance scores, or pain, endoscopist’s satisfaction scores, and procedural time. <h3>Results</h3> We included 13 trials with 3,711 participants undergoing EGD. The quality of trials was poor. Lidocaine spray provided better ease of instrumentation (Risk ratio (RR) 1.19, 95% confident intervals (CI)1.06,1.34;I2=66%;very low certainty of evidence), decreased participants’ pain (Mean difference (MD) 0.38, 95% CI 0.25,0.5;I2=92%;very low certainty of evidence), and shorter procedural time (MD 0.22, 95% CI 0.10,0.35;I2=13%;low certainty of evidence). However, spray had lower participants’ highest satisfaction scores (RR 0.83, 95% CI 0.76,0.92;I2=62%;very low certainty of evidence), participants’ mean satisfaction scores (MD -0.61, 95% CI -0.29,-0.04; I2=92%;very low certainty of evidence), participants’ tolerance scores (RR 0.83, 95% CI 0.71,0.97; I2=0%;low certainty of evidence), and endoscopist’s satisfaction scores (MD -0.33, 95% CI -0.45,-0.21;I2=94%;very low certainty of evidence). <h3>Conclusions</h3> Lidocaine spray may be better for ease of instrumentation during EGD. However, evidence is still determined due to the quality of trials.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1136/rapm-2023-esra.392
Gerard Kavanagh, John McDonnell, Brian Kinirons
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Galway University Hospital has an established ambulatory patient pathway governed by a ‘Direct Access’ policy. This was designed to minimise in- hospital time, maximise patient safety and facilitate Trauma and Plastic Surgery procedures. We conducted a review of this service to quantify volume of use, determine adherence to policy guidance and establish the level of Regional Anaesthesia involvement. Our aims are to promote the policy as a safe sustainable model for ambulatory care that maximises patient safety while increasing local Block Bay throughput.
Methods
Operating Theatre records were interrogated to derive the patients recorded as ‘Direct Access’. This was cross-referenced with our Block Bay log to establish patients who were administered a regional block. Electronic records and bed management systems were reviewed to establish adherence to policy in relation to sedation use, conversion to general anaesthesia and length-of-stay. Data was stored within the hospitals network, password protected with vetted select access. Windows Excel was used to process the data.
Results
Of the 261 cases recorded as ‘Direct Access’; 233 were confirmed and included for analysis. Full results are included in attached image of Tables 1-5. Direct Access Pathway Review Abstract: Results Tables
Conclusions
Our review reflects a pathway that minimises in-hospital time as 91% cases admitted and discharged on the same day. Policy adherence is high with very low sedation, GA and Overnight-Admission rates. The overall number of ‘Direct Access’ cases highlights the need for promotion of this pathway locally to increase traffic through our Block Bay which will benefit both patients and Anaesthesia trainees alike. Direct Access service review Results Tables 1-5
{"title":"#35885 ‘Direct access’ patient pathway for ambulatory care – a service review. A safe sustainable access route to the operating theatre including via the block bay","authors":"Gerard Kavanagh, John McDonnell, Brian Kinirons","doi":"10.1136/rapm-2023-esra.392","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.392","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Galway University Hospital has an established ambulatory patient pathway governed by a ‘Direct Access’ policy. This was designed to minimise in- hospital time, maximise patient safety and facilitate Trauma and Plastic Surgery procedures. We conducted a review of this service to quantify volume of use, determine adherence to policy guidance and establish the level of Regional Anaesthesia involvement. Our aims are to promote the policy as a safe sustainable model for ambulatory care that maximises patient safety while increasing local Block Bay throughput. <h3>Methods</h3> Operating Theatre records were interrogated to derive the patients recorded as ‘Direct Access’. This was cross-referenced with our Block Bay log to establish patients who were administered a regional block. Electronic records and bed management systems were reviewed to establish adherence to policy in relation to sedation use, conversion to general anaesthesia and length-of-stay. Data was stored within the hospitals network, password protected with vetted select access. Windows Excel was used to process the data. <h3>Results</h3> Of the 261 cases recorded as ‘Direct Access’; 233 were confirmed and included for analysis. Full results are included in attached image of Tables 1-5. Direct Access Pathway Review Abstract: Results Tables <h3>Conclusions</h3> Our review reflects a pathway that minimises in-hospital time as 91% cases admitted and discharged on the same day. Policy adherence is high with very low sedation, GA and Overnight-Admission rates. The overall number of ‘Direct Access’ cases highlights the need for promotion of this pathway locally to increase traffic through our Block Bay which will benefit both patients and Anaesthesia trainees alike. Direct Access service review Results Tables 1-5","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135687227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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