|
Post by Amy Schutter on Jan 20, 2020 11:15:35 GMT -5
1. PPI's are more effective than H2 blockers and that is why most high risk patients are usually on PPI meds at home. It is in the best interest of the patient to continue taking their PPIs the day before and day of surgery. Both Preop clinic and surgeons office should be consistently instructing the patients to continue taking their PPIs as well as other meds (beta blockers, inhalers, etc.) In the outpatient setting, due to and the timing of preop meds given prior to surgery I will continue to write for H2 blockers and not PPIs. 2. I was trained to use cricoid pressure and will continue to use cricoid pressure in any RSI scenario.
|
|
|
Post by Christine Velarde on Jan 22, 2020 13:57:36 GMT -5
PPI are generally recommended to prevent GERD. If a patient is on a PPI they should be encouraged to take their medication preoperatively when or if they take a b/p med. Infusing a PPI is costly and best given preoperatively prior to induction. H2 blockers can be given but may not be as effective. It is, however readily available in our pixus system. 2. Cricoid pressure is recommended for RSI. Recent studies have shown that improper cricoid pressure is generally given thus being ineffective. I still give cricoid pressure because I think it serve some protection and I legally feel protected if an aspiration occurred.
|
|
|
Post by Jen Hannon on Jan 22, 2020 17:04:14 GMT -5
1) I agree with Jules that this article is a good teaching point, and reminder for us to check a high risk patients' PPI coverage, and maybe order for those inpatients. Coordination with many teams is a difficulty, esp here at Hopkins.
2) I still like to use cricoid pressure, but have noticed an increase in discussions during induction 'where it doesn't matter"
|
|
nanci
Junior Member
Posts: 57
|
Post by nanci on Jan 22, 2020 18:43:04 GMT -5
1) PPI's for inpatients would be great and if the surgeons would order it and have it given that would be even better. For outpatients I do not believe that preop nursing staff would get the medications administered early enough so my current practice would most likely not change until there is a systems change making things more efficient and effective.
2) I feel that cricoid pressure benefits has been in question for a long time. I was taught to use it with the caveat to be aware that may only be helpful 50% of the time. I have not found it to be harmful so will keep using it until better evidence comes out.
|
|
Kristen Praesel Lang
Guest
|
Post by Kristen Praesel Lang on Jan 23, 2020 10:17:46 GMT -5
1) If PPIs are deemed more effective than H2, how will this change you preop orders and how will you plan to administer? PPIs could be beneficial and should be considered preoperatively in inpatients where they can be given ahead of time with time to work. I would not change my pre op orders for outpatients as they would not be administered early enough to be effective.
2) Will you use cricoid pressure? Why or why not or why will it depend? I will continue to use cricoid pressure as I was trained to do. I do use cricoid pressure and feel it is useful, as well as effective. I use it in certain populations with symptomatic GERD prior to surgery, delayed gastric emptying, and full stomach emergent cases. There have been times when I have observed gastric contents when I go to perform laryngoscopy and I have immediately asked for cricoid pressure. In my practice, it has proved to be beneficial in these cases.
|
|
|
Post by Chuck Eder on Jan 24, 2020 23:10:42 GMT -5
Very tough to coordinate patients taking a PPI the night prior to surgery unless its an inpt an you can order a dose. For outpatients, you would have to have a coordinated effort from the surgeon to order it as their preop orders or have the PEC center order it for the patients that they evaluate. It still is easier to order some H2 meds for the preop day.
The cricoid pressure debate has gained popularity over the years. The majority of us were trained using the technique for our RSI cases. I continue to use cricoid pressure for my RSI and will keep using it until it is proven harmful and not effective.
|
|
|
Post by angie brooks on Jan 27, 2020 9:16:03 GMT -5
1) If PPIs are deemed more effective than H2, how will this change your preop orders and how will you plan to administer? In order for PPIs to be more effective they must be given the evening prior to and morning of surgery. To make this happen there has to be cooperation between the surgeons and the anesthesia team so that the patient takes it the evening prior to coming to the hospital. There could be more education done to inform surgeons of the advantages of using PPI in our higher risk population. Until the happens, I will continue to use the H2 in those that require it.
2) Will you use cricoid pressure? Why or why not or why will it depend? I will continue to use cricoid pressure. It has been proven to be useful when applied properly. It requires education of those that are assisting with intubation. Also there is no downside to using it. It can only help.
|
|
|
Post by aileenm4 on Jan 31, 2020 10:29:15 GMT -5
great review on aspiration.... 1) in pediatrics we are not routinely ordering pre medications on patients for aspiration risks, the issues are that they will not take PO meds easily for the most part and secondly we more than likely do not have and Iv prior to induction. 2) most of us in pediatrics are still using cricoid pressure with RSI inductions.
|
|
|
Post by Soo-Ok Kim on Jan 31, 2020 12:37:05 GMT -5
1. I am already doing some of that, so I would not change my practice.
2. I will continue to do cricoid since there is no compelling research not to, but understand of the inefficiency of cricoid.
Soo-Ok Kim
|
|
|
Post by Lu Lin on Jan 31, 2020 15:37:08 GMT -5
1. It seems like administering PPIs the night before surgery would most practically by done for the inpatient population. If there is a way to order them for the outpatients who are in the high risk population (obesity, DM, high opioid consumption), this would also be ideal. I think administering H2 blockers is a reasonable alternative.
2. I would still apply cricoid pressure for pts at risk of aspiration. I have found that in my own practice it has been helpful and can help prevent aspiration.
|
|
|
Post by Mary Clothier on Jan 31, 2020 22:21:43 GMT -5
1) The current culture of our times, outpatient population much larger than inpatient, not enough time for PPIs to be effective, the continued use of H2 blockers most appropriate/effective and my continued pre-op choice for decreased risk of aspiration in our GERD, obese, parturient, DM etc patient population.
2) The use of cricoid pressure has been effective since its inception for many years, if done appropriately, intubation done rapidly! Pump the breaks on not providing correct cricoid pressure on emergency full stomach, emergency C-section, morbidly obese diabetic with GERD etc! Hard yes to continued use of Cricoid Pressure with RSI!
|
|
|
Post by emedina1 on Jan 31, 2020 22:25:12 GMT -5
As my practice lean more on ambulatory surgery , i see it more unrealistic PPI for these patients. I will probably rely on H2 blockers for my peace of mind.
Cricoid pressure was the dogma for RSI in the early part of my training, however in the operating room few people can administer a effective cricoid pressure.
|
|
|
Post by Amy Swank on Feb 3, 2020 12:42:38 GMT -5
1). PPIs being prescribed by anesthesia the night before surgery would take some organization from pre-anesthesia interview, and so unlikely that it would occur seamlessly, unless good consultations with the high risk patient and education in this population. Bicitra would have to be the go to before surgery.
2). I am in agreement the the practice of cricoid pressure is not completely effective, but is still my practice for the high risk aspiration patient.
|
|
|
Post by LloydSardy on Nov 6, 2020 19:32:36 GMT -5
Hi, here on the forum guys advised a cool Dating site, be sure to register - you will not REGRET it <a href=https://bit.ly/384HTnk>https://bit.ly/384HTnk</a>
|
|
|
Post by Moises on Feb 19, 2021 19:51:59 GMT -5
I have been surfing online more than 3 hours as of late, but I by no means foumd any fascinating article like yours. It is pretty worth sufficient for me. In my opinion, if all web owners and bloggers made good content as you probably did, the web shall be a lot more helpful than ever before. coub.com/danaobrien1999Essay is a really reasonably reasonably priced essay creating services. Obtain yopur customized essays penned in time, and Assured rem markable grades with all the most affordable expense. good essay writing service good essay writing service
|
|