AUGUST 31, 2016
Enhanced Recovery Programs: Perioperative Care Pathways to Improve Outcomes and Values
This monograph is based on the Annual Congress of the American Society for Enhanced Recovery held on April 20-22, 2016 in Washington, DC. It includes summaries of some of the key lectures and posters presented at the congress, as selected by the society.
Supported by educational grants from:
Download to read this article in PDF format:
Enhanced Recovery Programs: Perioperative Care Pathways to Improve Outcomes and Values
This article is in PDF format and it requires Adobe Reader.
If you do not have Adobe Reader installed on your computer then please download and install from the link below.
Download Adobe Reader
Please log in to post a comment
Nine words to dramatically improve postoperative outcomes:
1. Measure the brain; 2. Preempt the pain; Emetic drugs abstain (aka FrIedberg's Triad)
If no heart rate & blood pressure changes with skin incision are your guide to preemptive analgesia, you have already missed the boat to shield the cortex from noxious afferent PAIN input!
Failure to block NMDA receptors PRIOR to skin incision (or trocar puncture), will necessitate multi-modal approaches to postop care. Titrating propofol to BIS <75 WITH baseline EMG provides cerebral protection for negative ketamine outcomes.
Fifty mg ketamine 203 minutes prior to skin stimulation denies the cortex of the invasion of the protected world of self. Awake or anesthetized, the brain cannot differentiate between the malevolent intent of the mugger's knife & the therapeutic intent of the surgeon's scalpel or trocar.
Only free standing BIS units have the software to display real time EMG of the frontalis muscle. EMG spikes signal incipient arousal, allowing the anesthesiologist the opportunity to stay head of patient response as opposed to trying to catch up.
Not rocket science AND numerically reproducible across the 100 fold variation in patient propofol requirements.