It has been assumed that some elements of the ERAS protocol may contribute to the reduction of complications and improve the satisfaction of patients undergoing coronary artery bypass surgery. Elements of the ERAS strategy will be tested in this study. The elements that prove to be feasible and have a positive effect on the treatment process will be introduced into everyday clinical practice. In the next stage of the research, we are planning to investigate whether the introduction of the ERAS strategy has had a long-term positive effect on the quality of life after treatment (a survey 1 month and 6 months after leaving the hospital).
Evaluation of the impact of implemented elements of the ERAS strategy on the results of surgical treatment of coronary artery disease in the aspect of: * preoperative preparation (comprehensive information, premedication, hydration), * haemodynamic stability (discontinuation of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers immediately before surgery), optimal pre- and intraoperative fluid therapy, * occurrence of respiratory complications (assessment of the duration of mechanical ventilation and passive oxygen therapy), * demand for painkillers in the postoperative period, after introducing the preemptive strategy, * incidence of postoperative delirium, * time to recovery of the normal bowel function (nausea, vomiting), * possibility of early mobilisation on the first day after surgery, * patient's satisfaction with treatment assessed on the basis of a survey carried out on the day before leaving the hospital.
Study Type
OBSERVATIONAL
Enrollment
100
detailed information about surgery, anaesthesia and postoperative period
avoidance of prolonged fasting, intake of fluids with carbohydrates before surgery
administration of melatonin 5 mg in the evening and pregabalin 75 mg one hour before entering the operating theatre
Fluids 1 ml/kg/h; Discontinuation of propofol at the moment of drainage and cardiovascular system stabilization; Fluids administered orally 2 hours after extubation; Early mobilisation
deep temperature (necessity to maintain normothermia during the stay in the operating theatre 36 °C. Normothermia should be maintained rather than restored.
Pyralgin 1 g i.v. after induction of anaesthesia; in patients allergic to Pyralginum, Perfalgan 1 g i.v.
Ketamine 30 mg i.v. after induction of anaesthesia
Sevoflurane 1.5 MAC higher in patients \< 60 years old
Propofol infusion in patients at risk of postoperative vomiting (Apfel ≥ 2 points), sevoflurane administration at the moments of strong stimuli from the operating field
Continuous infusion of balanced multi-electrolyte fluids 1-3 ml/kg/h
Upper-Silesian Medical Centre of the Silesian Medical University
Katowice, Polska, Poland
ERAS bundle compliance in the first 72 hours post-op
Number of interventions for the ERAS protocol that are delivered to patient (numeric data e.g. 5 out of 10)
Time frame: 72 hours post operation
Shorter Length Of Hospitalization (LOH)
Total amount of days spent in hospital
Time frame: up to 4 weeks after operation
Preoperative anxiety
Assessment of patient's emotional status according to Anxiety Likert Scale (consisted of five evenly spaced numbers each anchored to a level of anxiety: 1="not at all anxious," 2="a little anxious," 3="moderately anxious," 4="very anxious," 5="extremely anxious)
Time frame: on admission to the operating unit
Time to extubation
Time taken until patient extubated post operation (in hours)
Time frame: 0 -72 hours
Assessment of postoperative pain
Pain scores at 6hours, Numeric scale 0 (no pain) - 10 (severe pain)
Time frame: 0-24 hours
Incidence of postoperative nausea and vomiting
To calculate the PONV Impact Scale score, add the numerical responses to questions 1 and 2. A PONV Impact Scale score of ≥5 defines clinically important PONV (Q1. Have you vomited: 0. No 1. Once 2. Twice 3. Three or more times Q2. Have you experienced a feeling of nausea :0. Not at all 1\. Sometimes 2. Often or most of the time 3. All of the time)
Time frame: At moment 0, 3, 6, 12 and 24 hours after extubation
Time to drink
Time until patient first drinks post extubation (in hours)
Time frame: 0-72 hours
Time to eating
Time until patient first eats post extubation (in hours)
Time frame: 0-72 hours
Time to bowel movement
Hours elapsed to event
Time frame: in hours after extubation, up to 1 week
Incidence of postoperative delirium
Delirium Screening according to Nursing Delirium Screening Scale, Each feature is scored on 0-2 based on severity, with 0=absent, 1=mild, and 2=severe. Positive Nu-DESC is score ≥2, maximum total score is 10
Time frame: in hours after extubation, up to 72 hours
Postoperative complications
Rate measurement
Time frame: up to 2 weeks after surgery
Time to mobilisation
First mobilisation with nurse/physiotherapist post-op (in hours)
Time frame: 0-72 hours
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