74 timestamped statements
across 2 collections
— auto-found in recorded discussions, each timestamp jumps to the exact moment.
Featured diaries
▶Ep 2 · 29:00
It's better to underpromise and overdeliver, and many of us have limited resources, so I think it's really important to put this in place in a solid foundation in your own house, in your own division, before you start sending it to other places.
It's better to underpromise and overdeliver, and many of us have limited resources, so I think it's really important to put this in place in a solid foundation in your own house, in your own division, before you start sending it to other places.
The most important inflection point in their program was to prevent the residents from bolusing the patients in the postoperative period because they all gave them fluid afterwards.
The most important inflection point in their program was to prevent the residents from bolusing the patients in the postoperative period because they all gave them fluid afterwards.
Enhanced Recovery After Surgery (ERAS) Program: Update Course 2016
▶Ep 2 · 0:00
clinicalHenrik Kehlet published results 20 years ago showing open sigmoidectomy patients discharged within a couple of days with multimodal care, achieving rapid return to work without high readmission rates and with very low complication rates.↗
▶Ep 2 · 0:00
quoteThe ERAS concept is really um just applying consistently things that we've known about for 20 years.↗
▶Ep 2 · 3:00
host_summaryTraditional intraoperative fluid administration delivers 3 times the IV volume compared to enhanced recovery protocols, as demonstrated by studies monitoring fluid administration.↗
▶Ep 2 · 4:00
clinicalPatients receive high-sugar electrolyte solutions until 2 hours before surgery after stopping solids at midnight, avoiding bringing a dehydrated patient to the operating room.↗
▶Ep 2 · 4:00
guidelineNational anesthesia guidelines permit clear carbohydrate liquids until 2 hours before operation, though this is not widely practiced due to concerns about cancellations from patient misunderstanding.↗
▶Ep 2 · 5:00
opinionThe sooner an IV is removed and the patient leaves the hospital, the safer the patient becomes, because as long as humans are administering care in hospitals, patients remain at risk for medication errors involving the five rights (right patient, dose, medicine, mode, timing).↗
▶Ep 2 · 5:00
quoteThe sooner an IV is out of the patient's hand and the patient is out of the hospital, that patient becomes safer.↗
▶Ep 2 · 6:00
host_summaryAdult colorectal surgery has a large number of randomized controlled trials demonstrating ERAS reduces complications and length of stay without causing increased readmissions.↗
▶Ep 2 · 9:00
host_summaryMeta-analysis from adult colorectal surgery demonstrates significant decrease in length of stay, significant decrease in non-surgical complications (VTEs, urinary tract infections, surgical site infections), without increase in readmissions when ERAS protocols are used.↗
▶Ep 2 · 10:30
host_summaryPediatric ERAS literature consists of only 5-6 articles, most written by Ben-Oni Mathai, showing decreased length of stay with similar complication rates and no increase in readmissions, but each study implemented only about 5 of 20 protocol components (approximately 25% compliance).↗
▶Ep 2 · 11:30
clinicalAdult ERAS programs implement 17-20 protocol steps, whereas pediatric studies have only implemented about 5 steps, representing a significant implementation gap.↗
▶Ep 2 · 15:00
clinicalPreoperative pain medication cocktail includes gabapentin and acetaminophen in large quantities; adult programs add celecoxib to this regimen.↗
▶Ep 2 · 16:00
host_summaryGoal-directed fluid therapy using pressors and albumin helps limit fluid administration; the most important inflection point in MD Anderson's program was preventing residents from bolusing patients postoperatively.↗
▶Ep 2 · 17:00
quoteThe most important inflection point in their program was to prevent the residents from bolusing the patients in the postoperative period because they all gave them fluid afterwards.↗
▶Ep 2 · 17:30
clinicalFoley catheters are removed immediately after surgery for ileocecectomy; for J-pouch procedures they are left overnight and removed in the morning, with no urinary retention issues reported.↗
▶Ep 2 · 18:30
clinicalPatients are fed and given fluids on postoperative day 0; if they drink successfully once, they are advanced to solid food, with the rationale that dexamethasone increases hunger, ondansetron prevents nausea, and avoiding overhydration and narcotics allows the gut to function.↗
▶Ep 2 · 20:00
clinicalA 17-year-old patient with ulcerative colitis had colectomy and was ready for discharge the night of surgery, actually discharged postoperative day 2; same pattern occurred for J-pouch creation and ileostomy closure.↗
quoteI'm ready to go home. We have an ileostomy. We want to make sure you're not going to get dehydrated.↗
▶Ep 2 · 21:00
clinicalIBD patients on TPN, steroids, and other medications do not go home in 2 days but will go home in 3-4 days with ERAS protocol, compared to longer traditional stays.↗
▶Ep 2 · 22:00
opinionIndividual ERAS components may not have significant evidence bases by themselves, but when bundled together like other care bundles, they create a second-order change in outcomes.↗
▶Ep 2 · 22:30
opinionPatient and family education with goal sheets may be on equal footing with physiologic interventions in terms of impact, as empowering patients and giving them control over their care drives compliance and outcomes.↗
▶Ep 2 · 24:00
clinicalCreating a formal multidisciplinary team (anesthesia, perioperative nursing, floor nursing, nurse clinician) dramatically improved protocol compliance; before team formalization, 5-8 components were achieved, afterward compliance increased substantially.↗
▶Ep 2 · 25:00
clinicalMonthly team meetings review compliance for each individual patient, identify upcoming cases, discuss needed improvements, and provide ongoing education; this audit process is critical to program success.↗
▶Ep 2 · 26:00
opinionAnesthesiologists view ERAS as part of their future through the 'surgical home' concept, making them natural partners in implementation.↗
▶Ep 2 · 27:00
opinionEngaging partners through data demonstration rather than just advocacy is more effective; showing improved outcomes leads to adoption, whereas simply talking about the protocol has different results.↗
▶Ep 2 · 28:00
quoteHow many surgeons at your hospital are using us? My response was 11%.↗
▶Ep 2 · 29:00
quoteIt's better to underpromise and overdeliver, and many of us have limited resources, so I think it's really important to put this in place in a solid foundation in your own house, in your own division, before you start sending it to other places.↗
▶Ep 2 · 30:00
clinicalGabapentin is an anti-seizure medication that influences neurologic pain and works well as part of multimodal analgesia; pediatric dosing is 10 mg/kg.↗
▶Ep 2 · 31:00
clinicalIV lidocaine given intraoperatively attenuates the inflammatory response to surgical wounding, helping patients recover more quickly; this is used in some adult programs.↗
▶Ep 2 · 34:00
host_summaryA Journal of Pediatric Surgery study showed that 70% of patients are NPO longer than necessary when coming to the operating room, arriving dehydrated despite standard NPO guidelines.↗
▶Ep 2 · 35:00
host_summaryThe most recent literature on mechanical bowel preparation suggests that combining both mechanical prep and oral antibiotics provides the best outcomes, though this recommendation has changed yearly.↗
▶Ep 2 · 37:00
clinicalChewing gum given to school-aged patients generates saliva that goes down the GI tract, stimulating bowel function and gas passage; this is a cheap addition to the protocol.↗
▶Ep 2 · 39:00
clinicalWhen patients develop complications such as bowel obstruction or anastomotic leak, they come off the ERAS protocol and are treated as traditional patients; this occurred in approximately 10% of cases in the speaker's series.↗
▶Ep 2 · 40:00
host_summaryGawande's checklist manifesto demonstrated that a 30% compliance rate with a protocol dropped mortality in half, suggesting that partial ERAS compliance still provides benefit.↗
▶Ep 2 · 41:00
host_summarySleeve gastrectomy patients implementing ERAS components, particularly gabapentin, have gone home on postoperative day 1 in all but one case, compared to previous average of closer to 2 days.↗
▶Ep 2 · 43:00
clinicalNG tubes prolong ileus because they suction out material that would otherwise go downstream and stimulate bowel function.↗
Enhanced Recovery After Surgery (ERAS) Program: Update Course 2016
▶Ep 4 · 0:00
quoteThe ERAS concept is really um just applying consistently things that we've known about for 20 years.↗
▶Ep 4 · 0:00
clinicalHenrik Kehlet published results 20 years ago showing open sigmoidectomy patients discharged within a couple of days with multimodal care, achieving rapid return to work without high readmission rates and with very low complication rates.↗
▶Ep 4 · 3:00
host_summaryTraditional intraoperative fluid administration delivers 3 times the IV volume compared to enhanced recovery protocols, as demonstrated by studies monitoring fluid administration.↗
▶Ep 4 · 4:00
guidelineNational anesthesia guidelines permit clear carbohydrate liquids until 2 hours before operation, though this is not widely practiced due to concerns about cancellations from patient misunderstanding.↗
▶Ep 4 · 4:00
clinicalPatients receive high-sugar electrolyte solutions until 2 hours before surgery after stopping solids at midnight, avoiding bringing a dehydrated patient to the operating room.↗
▶Ep 4 · 5:00
opinionThe sooner an IV is removed and the patient leaves the hospital, the safer the patient becomes, because as long as humans are administering care in hospitals, patients remain at risk for medication errors involving the five rights (right patient, dose, medicine, mode, timing).↗
▶Ep 4 · 5:00
quoteThe sooner an IV is out of the patient's hand and the patient is out of the hospital, that patient becomes safer.↗
▶Ep 4 · 6:00
host_summaryAdult colorectal surgery has a large number of randomized controlled trials demonstrating ERAS reduces complications and length of stay without causing increased readmissions.↗
▶Ep 4 · 9:00
host_summaryMeta-analysis from adult colorectal surgery demonstrates significant decrease in length of stay, significant decrease in non-surgical complications (VTEs, urinary tract infections, surgical site infections), without increase in readmissions when ERAS protocols are used.↗
▶Ep 4 · 10:30
host_summaryPediatric ERAS literature consists of only 5-6 articles, most written by Ben-Oni Mathai, showing decreased length of stay with similar complication rates and no increase in readmissions, but each study implemented only about 5 of 20 protocol components (approximately 25% compliance).↗
▶Ep 4 · 11:30
clinicalAdult ERAS programs implement 17-20 protocol steps, whereas pediatric studies have only implemented about 5 steps, representing a significant implementation gap.↗
▶Ep 4 · 15:00
clinicalPreoperative pain medication cocktail includes gabapentin and acetaminophen in large quantities; adult programs add celecoxib to this regimen.↗
▶Ep 4 · 16:00
host_summaryGoal-directed fluid therapy using pressors and albumin helps limit fluid administration; the most important inflection point in MD Anderson's program was preventing residents from bolusing patients postoperatively.↗
▶Ep 4 · 17:00
quoteThe most important inflection point in their program was to prevent the residents from bolusing the patients in the postoperative period because they all gave them fluid afterwards.↗
▶Ep 4 · 17:30
clinicalFoley catheters are removed immediately after surgery for ileocecectomy; for J-pouch procedures they are left overnight and removed in the morning, with no urinary retention issues reported.↗
▶Ep 4 · 18:30
clinicalPatients are fed and given fluids on postoperative day 0; if they drink successfully once, they are advanced to solid food, with the rationale that dexamethasone increases hunger, ondansetron prevents nausea, and avoiding overhydration and narcotics allows the gut to function.↗
▶Ep 4 · 20:00
clinicalA 17-year-old patient with ulcerative colitis had colectomy and was ready for discharge the night of surgery, actually discharged postoperative day 2; same pattern occurred for J-pouch creation and ileostomy closure.↗
quoteI'm ready to go home. We have an ileostomy. We want to make sure you're not going to get dehydrated.↗
▶Ep 4 · 21:00
clinicalIBD patients on TPN, steroids, and other medications do not go home in 2 days but will go home in 3-4 days with ERAS protocol, compared to longer traditional stays.↗
▶Ep 4 · 22:00
opinionIndividual ERAS components may not have significant evidence bases by themselves, but when bundled together like other care bundles, they create a second-order change in outcomes.↗
▶Ep 4 · 22:30
opinionPatient and family education with goal sheets may be on equal footing with physiologic interventions in terms of impact, as empowering patients and giving them control over their care drives compliance and outcomes.↗
▶Ep 4 · 24:00
clinicalCreating a formal multidisciplinary team (anesthesia, perioperative nursing, floor nursing, nurse clinician) dramatically improved protocol compliance; before team formalization, 5-8 components were achieved, afterward compliance increased substantially.↗
▶Ep 4 · 25:00
clinicalMonthly team meetings review compliance for each individual patient, identify upcoming cases, discuss needed improvements, and provide ongoing education; this audit process is critical to program success.↗
▶Ep 4 · 26:00
opinionAnesthesiologists view ERAS as part of their future through the 'surgical home' concept, making them natural partners in implementation.↗
▶Ep 4 · 27:00
opinionEngaging partners through data demonstration rather than just advocacy is more effective; showing improved outcomes leads to adoption, whereas simply talking about the protocol has different results.↗
▶Ep 4 · 28:00
quoteHow many surgeons at your hospital are using us? My response was 11%.↗
▶Ep 4 · 29:00
quoteIt's better to underpromise and overdeliver, and many of us have limited resources, so I think it's really important to put this in place in a solid foundation in your own house, in your own division, before you start sending it to other places.↗
▶Ep 4 · 30:00
clinicalGabapentin is an anti-seizure medication that influences neurologic pain and works well as part of multimodal analgesia; pediatric dosing is 10 mg/kg.↗
▶Ep 4 · 31:00
clinicalIV lidocaine given intraoperatively attenuates the inflammatory response to surgical wounding, helping patients recover more quickly; this is used in some adult programs.↗
▶Ep 4 · 34:00
host_summaryA Journal of Pediatric Surgery study showed that 70% of patients are NPO longer than necessary when coming to the operating room, arriving dehydrated despite standard NPO guidelines.↗
▶Ep 4 · 35:00
host_summaryThe most recent literature on mechanical bowel preparation suggests that combining both mechanical prep and oral antibiotics provides the best outcomes, though this recommendation has changed yearly.↗
▶Ep 4 · 37:00
clinicalChewing gum given to school-aged patients generates saliva that goes down the GI tract, stimulating bowel function and gas passage; this is a cheap addition to the protocol.↗
▶Ep 4 · 39:00
clinicalWhen patients develop complications such as bowel obstruction or anastomotic leak, they come off the ERAS protocol and are treated as traditional patients; this occurred in approximately 10% of cases in the speaker's series.↗
▶Ep 4 · 40:00
host_summaryGawande's checklist manifesto demonstrated that a 30% compliance rate with a protocol dropped mortality in half, suggesting that partial ERAS compliance still provides benefit.↗
▶Ep 4 · 41:00
host_summarySleeve gastrectomy patients implementing ERAS components, particularly gabapentin, have gone home on postoperative day 1 in all but one case, compared to previous average of closer to 2 days.↗
▶Ep 4 · 43:00
clinicalNG tubes prolong ileus because they suction out material that would otherwise go downstream and stimulate bowel function.↗
