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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:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Study group | Implemented ERAS (Early Recovery After Surgery) elements |
| |
| Control group | The control group will consist of patients treated during the study in accordance with the current standards used in the Department |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Premedication visit | Behavioral | detailed information about surgery, anaesthesia and postoperative period |
|
| Measure | Description | Time Frame |
|---|---|---|
| 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) | 72 hours post operation |
| Shorter Length Of Hospitalization (LOH) | Total amount of days spent in hospital | up to 4 weeks after operation |
| Measure | Description | Time Frame |
|---|---|---|
| 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) | on admission to the operating unit |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of Recovery | This process resulted in the QoR-15 questionnaire ( Part A: How have you been feeling in the last 24 hours; 0-10 0-poor, 10 - excellent; rated areas: breath,food,feeling rested, sleep, hygiene,communicate, getting support, return to work, feeling comfortable, well-being; Part B Have you had any of following in the last 24h: modreate pain, severe pain, nause or vomiting, feeling worried, feeling sad; 10-0, 10 - none of the time, 0 - all of the time |
Inclusion Criteria:
Exclusion Criteria:
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Patients who meet the inclusion criteria will be eligible for the study. The perioperative period and anaesthesia will be supervised by anaesthesiologists trained to carry out the study. The study group will include 50 patients. The results obtained in the study group will be compared with the results of the control group. The control group will consist of patients treated during the study in accordance with the current standards used in the Department.
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| Name | Affiliation | Role |
|---|---|---|
| Ewa Kucewicz-Czech | Upper-Silesian Medical Centre; DEPARTMENT OF ANAESTHESIOLOGY AND INTENSIVE CARE WITH CARDIAC MONITORING | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Upper-Silesian Medical Centre of the Silesian Medical University | Katowice | Polska | 40-635 | Poland |
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| Preoperative period | Dietary Supplement | avoidance of prolonged fasting, intake of fluids with carbohydrates before surgery |
|
| Preoperative period | Drug | administration of melatonin 5 mg in the evening and pregabalin 75 mg one hour before entering the operating theatre |
|
| Postoperative period | Other | 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 |
|
| Intraoperative period | Other | deep temperature (necessity to maintain normothermia during the stay in the operating theatre 36 °C. Normothermia should be maintained rather than restored. |
|
|
| Intraoperative period | Drug | Pyralgin 1 g i.v. after induction of anaesthesia; in patients allergic to Pyralginum, Perfalgan 1 g i.v. |
|
| Intraoperative period | Drug | Ketamine 30 mg i.v. after induction of anaesthesia |
|
| Intraoperative period | Drug | Sevoflurane 1.5 MAC higher in patients < 60 years old |
|
| Intraoperative period | Drug | Propofol infusion in patients at risk of postoperative vomiting (Apfel ≥ 2 points), sevoflurane administration at the moments of strong stimuli from the operating field |
|
| Intraoperative period | Drug | Continuous infusion of balanced multi-electrolyte fluids 1-3 ml/kg/h |
|
| Time to extubation |
Time taken until patient extubated post operation (in hours) |
| 0 -72 hours |
| Assessment of postoperative pain | Pain scores at 6hours, Numeric scale 0 (no pain) - 10 (severe pain) | 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. Sometimes 2. Often or most of the time 3. All of the time) | At moment 0, 3, 6, 12 and 24 hours after extubation |
| Time to drink | Time until patient first drinks post extubation (in hours) | 0-72 hours |
| Time to eating | Time until patient first eats post extubation (in hours) | 0-72 hours |
| Time to bowel movement | Hours elapsed to event | 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 | in hours after extubation, up to 72 hours |
| Postoperative complications | Rate measurement | up to 2 weeks after surgery |
| Time to mobilisation | First mobilisation with nurse/physiotherapist post-op (in hours) | 0-72 hours |
| 1 and 6 months after operation |
| ID | Term |
|---|---|
| D003324 | Coronary Artery Disease |
| D023921 | Coronary Stenosis |
| ID | Term |
|---|---|
| D003327 | Coronary Disease |
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D001161 | Arteriosclerosis |
| D001157 | Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |
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| ID | Term |
|---|---|
| D057234 | Preoperative Period |
| D011184 | Postoperative Period |
| D007432 | Intraoperative Period |
| ID | Term |
|---|---|
| D059035 | Perioperative Period |
| D013514 | Surgical Procedures, Operative |
| D005791 | Patient Care |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
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