Impact of Gabapentin on PACU Length of Stay and Perioperative Intravenous Opioid Use for ERAS Hysterectomy Patients.

We investigated the impact of preoperative gabapentin on perioperative intravenous opioid requirements and post anesthesia care unit length of stay (PACU LOS) for patients undergoing laparoscopic and vaginal hysterectomies within an Enhanced Recovery After Surgery (ERAS) pathway. A multidisciplinary team retrospectively examined 2,015 patients who underwent laparoscopic or vaginal hysterectomies between October 2016 and January 2020 at a single academic institution. The average PACU LOS was 168 min among patients who did not receive gabapentin vs. 180 min both among patients who received ≤ 300 mg of gabapentin and patients who received > 300 mg of gabapentin. After adjusting for demographics and medical comorbidities, PACU LOS for patients given ≤ 300 mg gabapentin was 6% longer (rate ratio (RR) = 1.06, 95% CI = 1.01-1.11) than for patients who were not given gabapentin, and for patients who received > 300 mg of gabapentin was 7% longer (RR = 1.07, 95%CI = 1.01-1.13) than for those who did not receive gabapentin. Patients who received ≤ 300 mg gabapentin received 9% less perioperative intravenous hydromorphone than patients who did not receive gabapentin (RR = 0.91, 95% CI = 0.86 - 0.97); patients who received > 300 mg of gabapentin received 12% less perioperative intravenous hydromorphone than patients who did not receive gabapentin (RR = 0.88, 95% CI = 0.82 - 0.95). These findings represent an absolute difference of 0.09 mg intravenous hydromorphone. There were no statistically significant differences in total intravenous fentanyl received. Preoperative gabapentin given as part of an ERAS pathway is associated with statistically but not clinically significant increases in PACU LOS and decreases in total perioperative intravenous opioid use.

Code Blue in the Operating Room-pharmacy is on the way!

BACKGROUND: Pharmacists have become an integrated part of the cardiac arrest (Code Blue) response team in the emergency department and inpatient settings. However, the attendance of pharmacists at intraoperative codes is less established. OBJECTIVE: The purpose of this paper was to describe the creation of the Perioperative Pharmacy Attendance for Intraoperative Codes Safety Initiative, report the impact it had on the intraoperative emergency code team, and discuss the limitations and difficulties experienced by the pharmacy department so that other institutions may have a foundation on which to build similar programs. PRACTICE DESCRIPTION: A large academic medical center successfully incorporated pharmacists into the intraoperative emergency code team. PRACTICE INNOVATION: We began by obtaining collaborative leadership support by using a quality assurance and improvement focus. In an organized manner, we methodically developed workflow protocols, educational programming, and promotional material to ensure that our initiative was able to be effectively used by the institution. EVALUATION METHODS: A year after the implementation, clinicians evaluated the program and reported its impact on team performance. An evaluation regarding the difficulties experienced with the initiation of the program was also performed. RESULTS: Most clinicians stated that having pharmacists at intraoperative emergencies improved patient care as well as the code team's performance. The difficulties experienced during the development of this program included workflow disruptions and the need for a continued effort to effectively advertise it to clinicians. CONCLUSION: Our institution was able to create the successful Perioperative Pharmacy Attendance for Intraoperative Codes Safety Initiative. This paper describes the steps taken to create and implement this successful program as well as the integration of pharmacists into the intraoperative emergency setting.

Perioperative Emergencies: Who, What, When, Where, Why?

OBJECTIVE(S): Throughout the last several decades, the perioperative mortality rate from anesthesia care has declined, shifting focus to perioperative emergencies. Data on these emergencies, often referred to as "Anesthesia STAT" calls (STATs), are lacking at adult hospitals. The goal of this study was to determine the etiology of STATs at a major academic medical center and to determine surgical cases and patient comorbid conditions that increase the risk for STATs. DESIGN: This was a retrospective observational study. SETTING: This study took place at a large academic medical center. PARTICIPANTS: Patients who underwent anesthesia care were included in this study. INTERVENTIONS: No interventions were performed during this study. MEASUREMENTS AND MAIN RESULTS: Data collected included the etiologies of STATs, patient demographic information, patient comorbid conditions, and surgeries during which STATs occurred. Between February 1, 2019, and January 31, 2020, 92 STATs occurred during 58,547 anesthetic cases, with an incidence rate of 0.16%. The most common etiology for a STAT was cardiac arrest, followed by respiratory compromise. Surgical services associated with a significant increase of STATs included general, thoracic, oral/maxillofacial, and vascular surgery. Comorbid conditions that significantly increased the risk of STATs included hypertension, coronary artery disease, congestive heart failure, obstructive sleep apnea, diabetes, and chronic kidney disease. CONCLUSIONS: Cardiac arrest is the most common etiology of STATs. Specific surgical services and comorbid conditions are associated with an increased risk of STATs.

A Protocol for the Safe Use of Hazardous Drugs in the OR.

Hazardous drug (HD) use in the perioperative environment poses unique challenges and risks for exposure that can have adverse consequences for perioperative personnel. The United States Pharmacopeial Convention has implemented new standards to address the safe handling and administration of HDs by health care workers. To comply with these standards and minimize perioperative personnel's occupational exposure to HDs, a multidisciplinary team at an academic medical center in Boston that was performing an increased number and variety of operative and other invasive procedures using antineoplastic agents updated their protocol for the safe use of HDs in the OR. This article discusses HDs and the risks they pose to health care workers and outlines the new HD safety protocol for the OR that was part of a performance improvement plan to ensure compliance with new standards and staff member safety in the perioperative setting.