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Perioperative opioid sparing pathway versus standard care (February 2021)

Standardized protocols are increasingly used to reduce unnecessary opioid prescription after surgery. Benefits of such a protocol were demonstrated by a retrospective study of 600 surgical patients that compared patient reported outcomes in those who participated in an opioid sparing postoperative pathway versus those who received standard care [1]. Patients in the opioid sparing pathway received fewer opioid pills postoperatively (median 4 versus 20 oxycodone tablets), reported less postoperative pain, and had similar satisfaction. Forty percent of patients in the opioid sparing pathway received no postoperative opioids. Conclusions from this study are limited by the lack of data on intraoperative analgesic strategies.

Ventilation of COVID-19 patients using anesthesia machines in operating rooms (March 2021)

Due to shortages of ventilators and intensive care unit (ICU) beds, some patients with COVID-19 have been ventilated with anesthesia machine ventilators in operating rooms (ORs) or nearby areas. In a study in which individual ORs were used to accommodate multiple patients with COVID-19 who needed mechanical ventilation (133 patients over approximately 7 weeks), the estimated probability of survival 30 days after admission was 61 percent, which was comparable to rates reported in other settings. This result suggests that conversion of ORs to ICU beds is a reasonable option during critical shortages of ICU ventilators and beds [2]. Challenges related to this practice included obtaining adequate medical gas supply and converting positive pressure ORs into negative pressure rooms.

1
Anderson
M
,
Hallway
A
,
Brummett
C
, et al
.
Patient-Reported Outcomes After Opioid-Sparing Surgery Compared With Standard of Care
.
JAMA Surg
2021
;
156
:
286
.
2
Mittel
AM
,
Panzer
O
,
Wang
DS
, et al
.
Logistical Considerations and Clinical Outcomes Associated with Converting Operating Rooms into an Intensive Care Unit during the Covid-19 Pandemic in a New York City Hospital
.
Anesth Analg
2020
.

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