scholarly journals Pre-operative fasting times for clear liquids at a tertiary children’s hospital; what can be improved?

2021 ◽  
Author(s):  
Alexander R. Schmidt ◽  
James Fehr ◽  
Janice Man ◽  
Genevieve D’Souza ◽  
Ellen Wang ◽  
...  
Keyword(s):  
Median Time ◽  
Primary Outcome ◽  
Arrival Time ◽  
Task Force ◽  
Pulmonary Aspiration ◽  
Clear Liquid ◽  
Preoperative Fasting ◽  
Parental Compliance ◽  
Secondary Outcomes ◽  
American Society

Background: The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes for prolonged NPO times with the aim to suggest improvement strategies by a newly founded fasting task force.Methods: Data from all electronic anesthesia records from 2019 at our institution were reviewed for fasting times. Our NPO instructions follow American Society of Anesthesiology guidelines and are calculated based on the patient’s arrival time (90 min before OR time). Primary outcome was the effective NPO time for clear liquids, secondary outcomes were incidence of delays and the parental compliance with the NPO instructions. Data are presented as median (interquartile range).Results: 9,625 cases were included in the analysis. NPO time was documented in 72.1% with a median effective NPO time of 7:13 h (7:36). OR in room times were documented in 72.8%, 2,075 (29.5%; median time 0:10 h [0:21]) were earlier and 4,939 (70.5%; median time 0:29 h [0:54]) were later than scheduled. Parental NPO compliance showed a median deviation for clear liquid intake of 0:55 h (8:30).Conclusions: This study revealed that effective NPO times were longer than current ASA guidelines. Contributing causes include case delays and parental non-compliance to NPO instructions. Thus, task force recommendations include change NPO instruction calculations to scheduled OR time versus arrival time, and encourage parents to give their child clear liquids at the instructed time.

scholarly journals Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas

2016 ◽  
Vol 16 (3) ◽  
pp. 276-284 ◽  
Author(s):  
Jacob A. Miller ◽  
Ehsan H. Balagamwala ◽  
Lilyana Angelov ◽  
John H. Suh ◽  
Toufik Djemil ◽  
...  
Keyword(s):  
Pain Relief ◽  
Stereotactic Radiosurgery ◽  
Median Time ◽  
Primary Outcome ◽  
Local Treatment ◽  
Hazard Ratio ◽  
Conventional Radiotherapy ◽  
History Of ◽  
Prescription Dose ◽  
Secondary Outcomes

Purpose: Despite advancements in local and systemic therapy, metastasis remains common in the natural history of sarcomas. Unfortunately, such metastases are the most significant source of morbidity and mortality in this heterogeneous disease. As a classically radioresistant histology, stereotactic radiosurgery has emerged to control spinal sarcomas and provide palliation. However, there is a lack of data regarding pain relief and relapse following stereotactic radiosurgery. Methods: We queried a retrospective institutional database of patients who underwent spine stereotactic radiosurgery for primary and metastatic sarcomas. The primary outcome was pain relief following stereotactic radiosurgery. Secondary outcomes included progression of pain, radiographic failure, and development of toxicities following treatment. Results: Forty treatment sites were eligible for inclusion; the median prescription dose was 16 Gy in a single fraction. Median time to radiographic failure was 14 months. At 6 and 12 months, radiographic control was 63% and 51%, respectively. Among patients presenting with pain, median time to pain relief was 1 month. Actuarial pain relief at 6 months was 82%. Median time to pain progression was 10 months; at 12 months, actuarial pain progression was 51%. Following multivariate analysis, presence of neurologic deficit at consult (hazard ratio: 2.48, P < .01) and presence of extraspinal bone metastases (hazard ratio: 2.83, P < .01) were associated with pain relief. Greater pain at consult (hazard ratio: 1.92, P < .01), prior radiotherapy (hazard ratio: 4.65, P = .02), and greater number of irradiated vertebral levels were associated with pain progression. Conclusions: Local treatment of spinal sarcomas has remained a challenge for decades, with poor rates of local control and limited pain relief following conventional radiotherapy. In this series, pain relief was achieved in 82% of treatments at 6 months, with half of patients experiencing pain progression by 12 months. Given minimal toxicity and suboptimal pain control at 12 months, dose escalation beyond 16 Gy is warranted.

Nebulised liposomal-amphotericin-B as maintenance therapy in ABPA: a randomised, multicentre, trial

2021 ◽  
pp. 2102218
Author(s):  
Cendrine Godet ◽  
Francis Couturaud ◽  
Sylvain Marchand-Adam ◽  
Christophe Pison ◽  
Frédéric Gagnadoux ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Amphotericin B ◽  
Median Time ◽  
Liposomal Amphotericin ◽  
Primary Outcome ◽  
Immunoglobulin E ◽  
Liposomal Amphotericin B ◽  
Absolute Difference ◽  
Clinical Equipoise ◽  
Secondary Outcomes

BackgroundIn allergic bronchopulmonary aspergillosis (ABPA), prolonged nebulised antifungal treatment may be a strategy for maintaining remission.MethodsWe performed a randomised, single-blind, clinical trial in 30 centres. Patients with controlled ABPA after a 4-month attack treatment (corticosteroids and itraconazole) were randomly assigned to nebulised liposomal-amphotericin-B or placebo for 6 months. The primary outcome was occurrence of a first severe clinical exacerbation within 24 months following randomisation. Secondary outcomes included the median time-to-first severe clinical exacerbation, number of severe clinical exacerbations per patient, ABPA-related biological parameters.ResultsAmong 174 enrolled patients with ABPA from March 2015 through July 2017, 139 were controlled after 4-month attack treatment and were randomised. The primary outcome occurred in 33 (50.8%) of 65 patients in nebulised liposomal-amphotericin-B group and 38 (51.3%) of 74 in placebo group (absolute difference −0.6%, 95% CI −16.8% to +15.6%, odds ratio 0.98, 95% CI 0.50 to 1.90; p=0.95). The median time-to-first severe clinical exacerbation was longer in liposomal-amphotericin-B group, 337 days (IQR, 168 to 476) versus 177 (64 to 288). At the end of maintenance therapy, total immunoglobulin-E and Aspergillus precipitins were significantly decreased in nebulised liposomal-amphotericin-B group.ConclusionsIn ABPA, maintenance therapy using nebulised liposomal-amphotericin-B did not reduce the risk of severe clinical exacerbation. The presence of some positive secondary outcomes creates clinical equipoise for further research.

Case Report: The use of gastric ultrasound to assess risk of pulmonary aspiration

POCUS Journal ◽  
2016 ◽  
Vol 1 (2) ◽  
pp. 8-9
Author(s):  
James Cheng, PGY-4
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
General Anesthesia ◽  
Elective Surgery ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Aspiration ◽  
Preoperative Fasting ◽  
Patient Morbidity ◽  
Gastric Contents ◽  
American Society

Pulmonary aspiration of gastric contents is a dreaded complication of general anesthesia, as it carries significant patient morbidity and mortality. Subsequent aspiration pneumonia can lead to prolonged mechanical ventilation, and a mortality rate of up to 5%. To minimize the risk of pulmonary aspiration, patients are required – as per the American Society of Anesthesiology’s “Practice Guidelines for Preoperative Fasting” – to fast prior to elective surgery in order to ensure that the stomach is empty prior to induction of general anesthesia.

NPO Guidelines

2018 ◽  
pp. 407-414
Author(s):  
Glenn Mann ◽  
Dustin Liebling
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Practice Guidelines ◽  
Pulmonary Aspiration ◽  
Care Providers ◽  
Preoperative Fasting ◽  
Large Role ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Latin Term

Nil per os (NPO), a Latin term, that means “nothing by mouth” is used in medicine to describe the instruction to withhold fluids and solid foods from a person. Patients are kept NPO prior to a scheduled procedure in order to minimize the risk of emesis and pulmonary aspiration of gastric contents when placed under general anesthesia—the sequelae of which can have significant consequences on morbidity and mortality. The American Society of Anesthesiologists created practice guidelines for preoperative fasting that guides health care providers when a patient must abstain from drinking and eating prior to a procedure. NPO guidelines play a large role in the perioperative management of patients of all ages—from pediatrics to geriatrics—undergoing nonemergent procedures.

scholarly journals Efficacy and Safety of Azathioprine during Remission of Immune-Mediated Thrombotic Thrombocytopenic Purpura

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 773-773
Author(s):  
Christian Bichard ◽  
Ilaria Mancini ◽  
Pasquale Agosti ◽  
Pasqualina De Leo ◽  
Andrea Artoni ◽  
...  
Keyword(s):  
Adverse Events ◽  
Median Time ◽  
Clinical Remission ◽  
Primary Outcome ◽  
Clinical Relapse ◽  
Adamts13 Activity ◽  
Efficacy And Safety ◽  
Immune Mediated ◽  
Azathioprine Treatment ◽  
Secondary Outcomes

Abstract Introduction Acquired immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare and life-threatening thrombotic microangiopathy caused by the development of anti-ADAMTS13 autoantibodies. Up to 50% of patients surviving an acute iTTP event experience one or more relapses. Recent guidelines suggest treatment with rituximab in clinical remission in iTTP patients with low ADAMTS13 activity to prevent acute iTTP relapses. A 10% of cases who do not respond to rituximab or develop allergic reactions requiring therapy discontinuation have been reported. In these patients, azathioprine might be an alternative treatment to prevent acute iTTP relapses. The aim of this study was to assess the efficacy and safety of azathioprine treatment in iTTP patients in clinical remission. Methods We designed a retrospective cohort study including all iTTP patients treated with azathioprine during clinical remission, enrolled in the Milan TTP Registry between May 2003 and October 2020 and followed for at least six months. The efficacy of azathioprine was assessed in patients with at least four weeks of treatment. The primary outcome was clinical relapse during azathioprine treatment. The secondary outcomes were the partial and complete responses of ADAMTS13 (an ADAMTS13 activity increase above 20% and 45%, respectively) in patients with ADAMTS13 activity below 20% before azathioprine start. ADAMTS13 relapse (an ADAMTS13 activity decrease below 20%) in patients with a prior ADAMTS13 response was also assessed. As for the safety analysis, adverse events (AEs), associated or not with treatment discontinuation, were retrieved from clinical charts of all patients. Lastly, we assessed the association between variables such as sex, age, and concomitant autoimmune diseases, and ADAMTS13 response, using logistic regression models. Results We enrolled 43 patients with iTTP treated with azathioprine during clinical remission (Table 1). Forty-two percent of the patients had at least one concomitant autoimmune disease. The median exposure to azathioprine was 16 months (interquartile range [IQR] 8-49 months), the median dosage 1.3 mg/kg/day (IQR 0.9-1.6 mg/kg/day). Thirty-five cases were available for the primary outcome analysis (Table 2). Seven patients relapsed after a median time of 14 months after azathioprine start (IQR 8-58 months). The cumulative incidence of clinical relapse during azathioprine treatment was 10% at 1 year (95% Confidence Interval [CI] 0-21%), 22% at 2 years (95% CI 6-38%). Twenty-one cases were available for the secondary outcomes analysis. An ADAMTS13 partial response occurred in 10 patients (48%), after a median time of 3 months (IQR 3-9 months) after azathioprine start and lasted for a median time of 40 months (IQR 16-56 months). An ADAMTS13 complete response was achieved in 33% of patients, after a median time of 8 months (IQR 3-16 months) after azathioprine start and lasted for a median time of 16 months (IQR 0-53 months). Of the 10 responders, 3 (30%) had a subsequent ADAMTS13 relapse at 22, 24 and 37 months after azathioprine start. Adverse events were observed in 30% of patients, after a median time of 50 days after azathioprine start (IQR 26-331 days). Liver and pancreas alterations with increased levels of ALT, AST, GGT, ALP and lipase were the most frequent, followed by nausea and leukopenia (Table 3). In one patient, acute myeloid leukemia was diagnosed 6 months after azathioprine start. Fifteen percent of the patients had to stop the treatment due to AEs. No demographic or anamnestic variables were associated with ADAMTS13 response to azathioprine. Conclusions Forty-eight percent of patients attained an ADAMTS13 activity above 20%, with a durable response lasting more than 3 years, while adverse events were generally mild in nature. Azathioprine could be a valid and safe alternative in case of ineligibility or failure to respond to rituximab. Figure 1 Figure 1. Disclosures Mancini: Instrumentation Laboratory, Sanofi: Honoraria. Peyvandi: Roche: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Sobi: Consultancy, Honoraria. OffLabel Disclosure: Azathioprine. It is an immunosuppressive drug used for the prevention of rejection in renal homotransplantation and for treatment of active rheumatoid arthritis.

Traditional Versus Instructing Standard Guidelines of Preoperative Fasting Times on Associated Discomforts in Patients undergoing Elective Cesarean Section: Orotta Maternity National Referral and Teaching Hospital and Sembel Hospital, Eritrea

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Michael Beraki ◽  
Yosief Yohannes ◽  
Goetz Geldner ◽  
John McDonough
Keyword(s):  
Cesarean Section ◽  
Randomized Clinical Trials ◽  
Task Force ◽  
Elective Cesarean Section ◽  
Preoperative Fasting ◽  
Fasting Time ◽  
Comparison Groups ◽  
Elective Cesarean ◽  
American Society ◽  
American Society Of Anesthesiologists

AbstractIntroduction: Preoperative fasting is vital in preventing pulmonary aspiration, regurgitation and vomiting during the induction of anesthesia. Every patient scheduled for surgery including pregnant mothers need to be on fasting for certain period of time. Women undergoing cesarean section need full energy for themselves and the fetus to overcome the stress of birth. However, fasting time in Eritrea is generally longer than is recommended by American Society of Anesthesiologists. Prolonged fasting time has undesirable effects including, nausea, vomiting, dizziness, thirst, hunger etc. Objectives: This study compared the associated discomforts between traditional versus instructing standard guidelines of fasting times among mothers undergoing elective cesarean section. Methods: A non-randomized clinical trials among 106 mothers was conducted. Two groups for comparisons in two different hospitals were selected. One group received instructions of preoperative fasting according to the American Society of Anesthesiologists Task Force guidelines and the other group followed through the traditional approaches, i.e. “nothing by mouth after mid-night”. Results: Mild to moderate degrees of discomforts was seen in the study participants. Feelings of thirst and hunger were the serious discomforts experienced. The associated discomforts were not determined to be significantly different (p=0.256) among the two groups of comparison. Conclusion: The study concluded that the associated discomforts were not statistically different between the traditional and standard groups. There was mild to moderate degrees of discomforts in both groups of study. Though the finding shows similar magnitude of discomforts between the two comparison groups, postoperative discomforts appear to worsen as the timing of fasting increases.

scholarly journals Healthy eating and lifestyle in pregnancy (HELP): a cluster randomised trial to evaluate the effectiveness of a weight management intervention for pregnant women with obesity on weight at 12 months postpartum

2021 ◽  
Author(s):  
Sharon A. Simpson ◽  
Elinor Coulman ◽  
Dunla Gallagher ◽  
Karen Jewell ◽  
David Cohen ◽  
...  
Keyword(s):  
Weight Management ◽  
Healthy Eating ◽  
Primary Outcome ◽  
Intervention Group ◽  
Control Group ◽  
Risky Drinking ◽  
Management Intervention ◽  
Cluster Randomised ◽  
Secondary Outcomes ◽  
Weight Management Intervention

Abstract Objective To assess whether a weight management intervention for pregnant women with obesity was effective in reducing body mass index (BMI) 12 months after giving birth. Methods Pragmatic, cluster randomised controlled trial (RCT) with embedded cost-effectiveness analysis. 598 women with a BMI of ≥30 kg/m2 (between 12 and 20 weeks gestation) were recruited from 20 secondary care maternity units in England and Wales. BMI at 12 months postpartum was the primary outcome. A range of clinical and behavioural secondary outcomes were examined. Interventions Women attending maternity units randomised to intervention were invited to a weekly weight management group, which combined expertise from a commercial weight loss programme with clinical advice from midwives. Both intervention and control participants received usual care and leaflets on diet and physical activity in pregnancy. Results Mean (SD) BMI at 12 months postpartum was 36.0 kg/m2 (5.2) in the control group, and 37.5 kg/m2 (6.7) in the intervention group. After adjustment for baseline BMI, the intervention effect was −0.02 (95% CI −0.04 to 0.01). The intervention group had an improved healthy eating score (3.08, 95% CI 0.16 to 6.00, p < 0.04), improved fibre score (3.22, 1.07 to 5.37, p < 0.01) and lower levels of risky drinking at 12 months postpartum compared to the control group (OR 0.45, 0.27 to 0.74, p < 0.002). The net incremental monetary benefit was not statistically significantly different between arms, although the probability of the intervention being cost-effective was above 60%, at policy-relevant thresholds. Conclusions There was no significant difference between groups on the primary outcome of BMI at 12 months. Analyses of secondary outcomes indicated improved healthy eating and lower levels of risky drinking. Trial registration: Current Controlled Trials ISRCTN25260464.

Sign in / Sign up

Export Citation Format

Share Document