MM Chapter 48 Flashcards
What is the Enhanced Recovery Program (ERP)?
Utilizes evidence-based practices to ensure continuity of care, reduce clinical variations, decrease variation in clinical management, minimize organ dysfunction, decrease postoperative complications, and enhance recovery while minimizing complications and costs.
What is the Perioperative Surgical Home (PSH)?
A team-based, interdisciplinary approach to managing surgical patients from initial diagnosis through full recovery, incorporating ERP elements tailored to local clinical environments.
What is Persistent Postsurgical Pain?
Chronic pain lasting beyond 1–2 months post-surgery, which is a common and vexing problem.
What factors contribute to the surgical stress response?
Surgical stimulus, hypothermia, and psychological factors.
How can the surgical stress response be mitigated?
Through perioperative interventions such as neural blockade and reduction in invasiveness.
What is Neuraxial Blockade?
Epidural and spinal anesthetics that blunt the metabolic, inflammatory, and neuroendocrine stress response to surgery.
What is Epidural Analgesia?
A combination of local anesthetics and low-dose opioids that improves pain control for postoperative patients at rest and with movement.
What are Peripheral Nerve Blocks (PNBs)?
Local anesthetics (single or continuous infusion) effective in blocking nociceptive pathways, reducing opioid use, and minimizing opioid-related side effects.
What is Intravenous Lidocaine used for?
Has analgesic, antihyperalgesic, and anti-inflammatory effects, commonly used as a continuous infusion for pain management.
What is Multimodal Analgesia?
Combines different pharmacologic classes for additive/synergistic pain relief while reducing opioid dependency and related side effects.
How do NSAIDs contribute to pain management?
Effective in reducing postoperative pain, PONV, sedation, urinary retention, and opioid use but carry risks such as gastrointestinal bleeding, renal impairment, and delayed wound healing.
What is Patient-Controlled Analgesia (PCA)?
Offers superior pain control and patient satisfaction compared to nurse-administered opioids.
What is the role of Peripheral Nerve Blockade in Orthopedic Surgery?
Enhances pain management, accelerates recovery, and is widely used for ambulatory and inpatient orthopedic procedures.
What is Postoperative Ileus?
Delays feeding and is one of the most common causes of prolonged hospital stays, often worsened by opioid use.
What is the goal of Perioperative Fluid Management?
To optimize fluid therapy as both excessive and restricted fluid therapy contribute to postoperative ileus.
What is the significance of Improved Surgical & Anesthetic Management?
Advances in perioperative care have significantly reduced mortality and morbidity, with ongoing progress depending on integrated, multidisciplinary approaches.
What is Team-Based Perioperative Care?
Combining various evidence-based interventions into a coordinated effort leads to synergistic benefits.
What are Enhanced Recovery Programs (ERPs)?
Focus on optimizing perioperative care to improve recovery, reduce complications, and lower costs.
How does ERP effectiveness manifest?
A well-implemented ERP minimizes variations in clinical management, reduces organ dysfunction, decreases postoperative complications, and accelerates recovery.
What is involved in Outcome Assessment for ERPs?
Tracking hospital length of stay, readmission rates, and perioperative complications.
What role do anesthetic interventions play in recovery?
Effective anesthesia reduces pain, supports early mobilization, and enables quicker resumption of oral intake.
How have Enhanced Recovery Programs evolved?
Originally designed for colorectal and cardiac surgeries, ERPs are now widely used across various major surgical procedures.
What is the role of anesthesiologists in the Perioperative Surgical Home?
Anesthesiologists play a key coordinating role, necessitating expanded training in perioperative medicine, pain management, and surgical care integration.
What is Persistent Postsurgical Pain (PPSP)?
Chronic pain lasting beyond 1–2 months post-surgery, affecting over 30% of patients after certain procedures.
What is recommended as a preventive strategy for PPSP?
Multimodal perioperative pain control.
What is the importance of Patient Education in ERPs?
Active participation and clear communication are crucial for effectiveness.
What is the benefit of preoperative risk assessment?
Optimizing patient health preoperatively improves surgical recovery.
How does smoking cessation impact postoperative outcomes?
Reduces postoperative complications by 41%, especially for wound healing and lung function.
What are the guidelines for food and fluid intake before surgery?
Clear fluids allowed up to 2 hours before anesthesia for low-risk patients.
What is Antithrombotic Prophylaxis?
Reduces perioperative venous thromboembolism risk and associated mortality.
What is the purpose of Antibiotic Prophylaxis?
Preoperative antibiotics reduce surgical site infections (SSIs).
What strategies minimize the surgical stress response?
Minimally invasive surgery, maintaining normothermia, neural blockade, and reducing procedural invasiveness.
What are the benefits of Minimally Invasive Surgery (MIS)?
Lower stress response, fewer SSIs & surgical complications, less postoperative pain, and better respiratory function.
What is the role of Regional Anesthesia/Analgesia Techniques?
Epidural analgesia is effective in major open surgery but may delay recovery in MIS.
What are the benefits of Intravenous Lidocaine Infusion?
Analgesic, anti-inflammatory, and opioid-sparing properties.
What is β-Blockade Therapy?
Blunts sympathetic stress response during intubation and surgery.
What is the effect of α2-Agonist Therapy?
Reduces pain, opioid use, and extends local anesthetic effect.
What are the advantages of using short-acting intravenous & inhalation agents?
Preferred for high PONV-risk patients and can reduce recovery costs.
What is the significance of maintaining normothermia?
Prevents complications associated with hypothermia.
How does oxygen therapy impact surgical stress?
High intraoperative & postoperative oxygen may reduce wound infections and PONV.
What is the importance of postoperative nausea and vomiting (PONV) prophylaxis?
Delays recovery and impairs early feeding & postoperative mobilization.
What is Goal-Directed Fluid & Hemodynamic Therapy (GDFT)?
Uses noninvasive cardiac output monitoring to guide fluid administration.
What strategies minimize postoperative shivering?
Maintaining normothermia is the best strategy.
What is the goal of multimodal analgesia?
To use multiple pharmacological mechanisms to reduce opioid use and minimize side effects.
What are the risks associated with NSAIDs?
GI & wound bleeding, kidney impairment, and possible anastomotic leaks.
What is the role of Acetaminophen in pain management?
Reduces pain & opioid use, and is a safer alternative to NSAIDs.
What are Gabapentinoids used for?
Pre-op single dose may reduce postoperative pain.
What are the risks associated with certain analgesics?
Risks include GI & wound bleeding, kidney impairment, and possible anastomotic leaks.
What are COX-2 inhibitors and their risks?
COX-2 inhibitors (e.g., celecoxib) have fewer GI effects but pose uncertain kidney & cardiovascular risks.
What is the role of Acetaminophen (Paracetamol) in pain management?
Acetaminophen reduces pain & opioid use but is less effective than NSAIDs. It is a safer alternative to NSAIDs and can be used routinely in ERPs.
How do Gabapentinoids affect post-operative pain?
Pre-op single dose of Gabapentinoids (Gabapentin & Pregabalin) may reduce post-op pain & opioid needs, especially in the first 24 hours.
Risks include sedation, dizziness, and increased fall risk, especially in elderly patients.
What is the effect of NMDA Receptor Antagonists like Ketamine and Magnesium?
Ketamine reduces pain, opioid needs, and PONV, especially useful for chronic opioid users. Magnesium may reduce post-op pain and opioid use but has uncertain optimal dosing.
Risks include hypotension & neuromuscular blockade potentiation.
What are the benefits of Intravenous Lidocaine Infusion?
It is effective for multimodal analgesia, especially in major abdominal surgery, leading to faster return of bowel function & shorter hospital stay.
Requires monitoring, but newer protocols allow safe use in surgical wards.
What is the role of Opioids in pain management?
Opioids are essential for severe pain, but efforts are made to reduce use. Patient-Controlled Analgesia (PCA) is preferred over PRN Opioids for better pain control and fewer side effects.
What is the advantage of Epidural Analgesia?
Epidural Analgesia is best for open abdominal & thoracic surgery as it blunts stress response and reduces complications.
It is less useful for minimally invasive surgery and thoracic epidurals are preferred over lumbar epidurals.
What are Paravertebral & Truncal Nerve Blocks?
They are effective alternatives to epidural anesthesia and lower the risk of epidural-related complications.
How does Peripheral Nerve Blockade assist in recovery?
It is frequently used in orthopedic surgery for fast-track recovery and has an opioid-sparing effect that helps reduce PONV and respiratory depression.
What is the purpose of Local Anesthetic Wound Infiltration & Infusion?
Used in total joint replacement surgery as an alternative to nerve blocks, it reduces opioid needs, especially in open abdominal surgery.
What is the effect of Intraperitoneal Local Anesthetic Instillation & Nebulization?
It reduces pain & opioid use in abdominal and laparoscopic surgery.
What strategies facilitate recovery on the surgical unit?
Standardized, procedure-specific protocols should involve a multidisciplinary team including surgeons, anesthesiologists, nurses, physiotherapists, nutritionists, pharmacists, and case managers.
What is encouraged for early mobilization post-surgery?
Provide chairs and walkers near beds, avoid routine bed rest, and encourage sitting & walking within 24 hours post-op.
What is the goal of optimizing analgesia for functional recovery?
The goal is to keep patients comfortable for mobilization and physiotherapy with minimal side effects, as opioid-related PONV & ileus are leading causes of prolonged hospital stay.
What are the causes of post-operative ileus?
Causes include sympathetic inhibitory reflexes, local inflammation from surgery, systemic opioid use, and bowel edema from excessive IV fluids.
What are the prevention & treatment strategies for post-op ileus?
Avoid Nasogastric Tubes, use Minimally Invasive Surgery, Thoracic Epidural Analgesia, Laxatives, and consider Opioid μ-Receptor Antagonists.
Opioid μ-Receptor Antagonists reduce opioid-related bowel dysfunction and are more effective for open surgery than minimally invasive surgery.
What is Goal-Directed Fluid Therapy (GDFT)?
GDFT avoids excessive or restricted fluid therapy, maintaining optimal tissue perfusion and reducing bowel edema & ileus risk.
