Résumé
At Whipps Cross Hospital, multi-morbid (high-risk) patients undergoing urological surgery are routinely listed on the surgical inpatient pathway. The 'Getting it right first time' [1] review of anaesthesia recommended day-case surgery as the default for suitable procedures, to help with waiting lists as well as to provide patients with a safe environment. To improve patient choice and postoperative outcomes, an ambulatory spinal pathway was piloted. Methods An earlier scoping exercise identified a pool of urology high-risk patients who could potentially benefit from an ambulatory spinal pathway. Based on this, prilocaine use for ambulatory spinal anaesthetic was provisionally approved by the drugs and therapeutic committee. A pilot ambulatory pathway was put in place, which helped identify suitable patients. The pilot pathway was limited to a select group of anaesthetists to minimise variations. Postoperatively, patients were followed up at 3 and 24 h and assessed for postoperative nausea, vomiting, pain, mobilisation, neurological symptoms and cognitive impairment. Results The total number of patients was 19. Mean ASA was 2.9. Average age was 74 years. The mean dose of hyperbaric prilocaine 2% used was 2.9 ml, 21% of cases utilised additional intrathecal additives. Regarding intra-operative analgesia, only paracetamol was used in 15% of cases. There were no conversions to general anaesthetic. The most common procedure was a cystoscopy with or without biopsy (42%). With comorbidities, diabetes mellitus was the most common (58%), followed by cardiac disease (53%) and respiratory disease (42%). At 3 h, 100% of patients were eating and all sensation had returned, 0% had cognitive impairment, 47% were sitting out and 42% mobilising. Sixteen per cent had hypotension and 5% had pain at rest. At 24 h, 0% had cognitive impairment, 50% had required analgesia and 84% were mobilising. All patients reported they would have a spinal anaesthetic again in the future. Discussion With an ageing population, who have multiple comorbidities, there is huge benefit regarding providing the choice of a spinal anaesthetic rather than general anaesthetic, which allows patients to go home the same day. This will not only provide financial savings to the service provider but also help clear the backlog of surgeries due to the COVID-19 pandemic and enhance patient recovery.
Résumé
The surgical demand upon the NHS was of concern prior to the COVID-19 pandemic, it has now worsened. The waiting list may rise from 6 to 14 million. One in five of these patients require admission and potential access to more than level 1 care [1]. The anaesthesia and perioperative medicine Getting It Right First Time (GIRFT) report made recommendations for the introduction of enhanced care to minimise cancellations due to lack of critical care beds, reduce the burden placed upon the intensive care unit (ICU) and help the future recovery of elective surgery. Enhanced care lies between level 1 and level 2/3 care. It facilitates closer observation, monitoring and interventions than is offered on a general ward. It is multidisciplinary, integrating the anaesthetic, surgical and enhanced recovery teams [2]. Whipps Cross Hospital introduced a post-anaesthetic care unit (PACU) in a green recovery in line with these recommendations. Methods We reviewed the records of all patients with PACU admissions between April 2021 to April 2022. We looked at engagement in pre-operative pathways, pre-operative interventions and postoperative enhanced care interventions, engagement by the multidisciplinary team (MDT), outcomes and escalations to intensive care. Results Fifty-four patients admitted to the PACU were identified. All were seen in the pre-operative assessment clinic, 51 were seen in the pre-operative planning clinic. Twenty-five received pre-operative optimisation. In the PACU, 44 received blood gas analysis, four received cardiac output monitoring, one received vasopressors and 29 received additional pain management. All patients were reviewed by the anaesthetic registrar and consultant, 98% by the surgical team and 78% by the enhanced recovery team within 24 h of admission to the PACU. Four were escalated to the ICU. Discussion Our analysis shows the successful application of the GIRFT report's recommendations, demonstrates the effectiveness of enhanced care and shows a successful reduction of the burden on ICU. High-risk patients were identified, optimised and received enhance cared. MDT engagement was high and only four patients were escalated to the ICU. We delivered our model in recovery, showing it is the mental approach that matters, not the physical location. This model also helps us deliver care tailored to each patient's unique risk profile. The GIRFT report estimates financial opportunities from the reduction of critical care bed days. We aim to do a local cost analysis. (Figure Presented).
Résumé
The purpose of this study was to assess the Saudi population's perceptions about the use of herbal products to prevent coronavirus disease 2019 infection in Saudi Arabia. Here, 803 subjects participated in the online survey, which was cross-sectional in nature and self-administrated. The study included all Saudi Arabian adults, whereas pregnant women were excluded. Participants who decided to participate in the study filled out the questionnaire completed by 803 people. During the coronavirus disease 2019 pandemic, most participants were aware of alternative and complementary medicines, whereas 60.1 % obtained their knowledge from social media sites. Prior to online shops/pharmacies and homemade remedies, the traditional apothecary was the most common source for alternative and complementary medicines. About 56 % of participants (p<0.05) did not believe that the complementary and alternative therapies could prevent or treat coronavirus disease 2019 infection, whereas 53.9 % of them considered safe. Only 22 % of those who took part in the survey agreed that alternative and complementary therapies could successfully combat coronavirus disease 2019 and could be used as a substitute for vaccines. Finally, our study found that during coronavirus disease 2019, medicinal plants and other complementary and alternative therapies were used and considered to be more effective. © 2022 Indian Pharmaceutical Association. All rights reserved.
Résumé
Ending the COVID-19 pandemic requires achieving herd immunity, either by previous infection or by vaccination. However, concerns about the COVID-19 vaccine are growing around the globe. The current study was conducted to investigate young the adult population's hesitancy towards the vaccine. The study used a prospective cross-sectional design. Data was collected using an online self-administered questionnaire. A total of 862 Saudi adults participated. Information was gathered on the participants' perspectives towards the severity and susceptibility of the COVID-19 infection, reasons for their hesitancy to receive the vaccine, perceived benefits, and reasons for action. Just under a quarter (19.6%) of respondents had previously tested positive for COVID-19. A small minority of the participants had already received the vaccine (2.1%), while 20.3% had registered in the Sehaty app (application) to receive the vaccine. Just under half of them (48%) will take the vaccine when mass vaccination is achieved and approximately the same number (46.7%) will only take it if it is made mandatory. Vaccine reluctance is highly prevalent among the general public in Saudi Arabia during the COVID-19 pandemic. While many are aware of a high likelihood of getting the infection, the efficacy and safety of the COVID-19 vaccine were reported as barriers to vaccination.