Perioperative Medicine
The Future of Anesthesiology
Patient Experience
Maurice-Szamburski et al. Effect of Sedative Premedication on Patient Experience After General Anesthesia: A Randomized Clinical Trial. JAMA. 2015;313(9):916-925. doi:10.1001/jama.2015.1108
Bottom line:
Multi-centre randomized control trial of 1062 patients for elective surgery under general anesthesia. Administration of pre-operative lorazepam, compared with placebo and no pre-medication, did not improve self-reported patient experience on POD 1. The authors concluded there is insufficient evidence to support routine use of lorazepam as a pre-medication in the perioperative period.
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Major points:
1. Sedative premedication with lorazepam compared with placebo or no premedication did not improve the self-reported patient experience the day after surgery
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2. Lorazepam was associated with modestly prolonged time to extubation and a lower rate of early cognitive recovery
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​3. In a subgroup analysis of the most anxious patients, no significant differences were found in self reported patient satisfaction between the lorazepam group and the no premedication group or the placebo group
Roberts GP, Levy N, Lobo DN. Patient-centric goal-oriented perioperative care. Br J Anaesth. 2021 Mar;126(3):559-564. doi: 10.1016/j.bja.2020.12.004. Epub 2021 Jan 6. PMID: 33419527.
Bottom line:
Bottom Line
The paper focuses on shifting perioperative care to focus on patients’ holistic needs, health goals, and desired outcomes rather than problem-oriented care. This requires a fundamental change in shared decision making with consideration to patient selection, procedure impacts, rehabilitation, and recovery.
Major Points
1. Identifying achievable goals of the patient involves five major domains: life impact, patient satisfaction, functional status, well-being, and health-related quality of life (HRQOL). Patients and their families should also be aware of the best and worst possible outcomes of surgery.
2. An integrated, multidisciplinary team can help achieve patient-oriented goals throughout their perioperative trajectory: from the moment they decide on surgery, lifestyle modifications, optimization and ‘prehabilitation’, to recovery and potential post-operative complications.
3. While healthcare professionals can guide the process, patients are the real decision-makers; as such, their decision to do nothing or refuse surgery may be most congruent for their goals.
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4. Training health and social care professionals to engage in patient-centric goal-oriented care requires institutional support, resources, and processes to enable effective communication and shared-decision making.
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