ACCP PERIOP PRN @AccpPeriopPRN
Account for the ACCP Perioperative Practice Research Network. Advancing care for surgical and perioperative patients United States Joined October 2017-
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👀 check out the @PharmacyToDose podcast on both Perioperative Emergencies I & II where you can hear @SaraJPharmD, @GoBig303, Gourang Patel, & Rachel Wolfe share their insights!
We love how supportive and collaborative our members are! Great job 🙌🏻
We love how supportive and collaborative our members are! Great job 🙌🏻
Meet your 2022-2023 PeriPRN Chair-Elect Dustin Carneal!
Thank you for joining us for another #PeriPRNJC and thanks to our presenter @Kidd_AtPlay for preparing today's journal club! We'll check back to answer any remaining questions!
For the audience: Do you have any questions for our presenter @Kidd_AtPlay ❓ Please comment below!!
❓Question for the audience ❓Would you consider using a different agent such as ticagrelor prior to CAS placement? #PeriPRNJC
Further studies to evaluate other options such as ticagrelor to CAS are also warranted when sustained clopidogrel treatment is not possible. (5) #PeriPRNJC
An option for future practices or trials, may be to use higher doses and measure platelet reactivity point of care testing after clopidogrel bolus to ensure adequate platelet inhibition before CAS. (4) #PeriPRNJC
Some limitations of the study include: (3) #PeriPRNJC
Results do not support the use of clopidogrel bolus as used in the CREST as a substitute for sustained clopidogrel pretreatment. The primary end point–free survival and stroke-free survival were lower in patients who received clopidogrel bolus. (2) #PeriPRNJC
Discussion: Compared with patients who are on sustained pretreatment for ≥48 hours, patients who received boluses (≥4 hours) were more likely to have periprocedural stroke and composite of stroke, MI, or death or ipsilateral stroke within 4 years after randomization.
❓Question for the audience ❓ Did you expect that clopidogrel bolus doses were more common amongst symptomatic patients?
In the Cox proportional hazards analysis, the risk of primary end point was significantly higher in patients who received clopidogrel bolus (7) #PeriPRNJC
The stroke-free survival rates were 88% and 94% at 5 years for patients who received clopidogrel bolus and for those who received sustained clopidogrel pretreatment respectively. (6) #PeriPRNJC
Primary end-point-free survival rates were 86.7% and 93.2% at 5 years for patients who received clopidogrel bolus and sustained clopidogrel pretreatment respectively. (5) #PeriPRNJC
Patients who received clopidogrel bolus were more likely to be symptomatic. Among asymptomatic patients, there was a higher rate of death associated with patients who received clopidogrel bolus at 10 years. (4) #PeriPRNJC
The rate of peri-procedural stroke and primary end point was significantly higher among patients who received clopidogrel bolus. (3) #PeriPRNJC
Here is a synopsis of the baseline characteristics of patients that were included in this study’s population (2) #PeriPRNJC
Results: 933 patients were enrolled in the study with 150 patients receiving a clopidogrel bolus and 843 patients receiving sustained clopidogrel pre-treatment. #PeriPRNJC
❓Question for the audience ❓ Would you have included any secondary outcomes? If so, what would they be? #PeriPRNJC
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@AccpPeriopPRN @journalchest Bill Dager, a PeriOp PRN member, is the only pharmacist panelist. Congrats, Bill!
@AccpPeriopPRN Hello, my name is Michael La Porte. I am a 4th year pharmacy student from Virginia Commonwealth University School of Pharmacy in Richmond VA. Thank you for giving me the opportunity today!
The use of cangrelor as bridge therapy in high-risk perioperative liver transplant patients appears to be a viable option when dual anti-platelet therapy is warranted. buff.ly/3IGx7CK @accpimtrprn @accpGILNprn @AccpPeriopPRN
What is the incidence of torsades de pointes or death following perioperative administration of low-dose, 4 mg, ondansetron for postoperative nausea and vomiting? buff.ly/3GKERCi @AccpPeriopPRN
#TwitteRx, #MedTwitter I’m presenting on #SocialMedia in #PharmEd and want to discuss Twitter journal clubs. So far, I’ve got @IDJClub, @GeriMedJC, @NephJC, @GIMJournal, @Heart_BMJ, #HeartJC. Which others am I missing? #PharmTwitter
@Julia_G_Rx @Heart_BMJ @AccpPeriopPRN has started doing journal clubs!
@AccpPeriopPRN @KayleeJoelle7 Hi! My name is Serena Tabbaa. I am a fourth year pharmacy student at The Ohio State University. I am also new to Twitter so please bare with me. Thank you for having me today! ☺️
@AccpPeriopPRN It appears to be safe and effective from this small study of 4⃣4⃣ patients
@AccpPeriopPRN 💊Mg sulfate is an option to aid with multi modal pain control in TKA patients 🏥
@AccpPeriopPRN The results of this small trial suggest that the use of 💊magnesium sulfate may aid in managing surgical pain caused by multiple surgeries within a short time period ⏱
@AccpPeriopPRN 🤯 Post-operative pain scores and analgesia consumption of second TKA are higher than first TKA #PeriPRNJC
@AccpPeriopPRN 🏃🏼♀️ The benefits of magnesium demonstrated in the trial include post-operative pain reduction & attenuation of increased pain intensity 🤯
@AccpPeriopPRN How does your institution use Mg? Answer 👇
@AccpPeriopPRN Significantly⬇️pain in the magnesium group at 24 & 48 hours. VAS scores done on a scale of 0⃣ to💯 Scores were 44 in the control group at 24 hours & 20 in the Mg group for 2nd TKA. Scores were 43 versus 25 at 48 hours 🦿#PeriPRNJC
@AccpPeriopPRN 👭mostly females in their early 70s 🙅♀️ no significant difference between baseline characteristics
@AccpPeriopPRN 2⃣ndary endpoint results: 👍 significantly⬇️ketoprofen use at 48 hours in magnesium group (80mg±53mg versus 11mg ±21mg for the 2nd TKA, p=0.001) 🙌 significantly⬇️PCA consumption in magnesium group after second TKA (870 mcg of fentanyl ±375mcg versus 495 mcg ± 315 mcg, p=0.001)
@AccpPeriopPRN 1⃣ endpoint ☠️ Post-operative pain score at rest on the most recently operated knee at 24 and 48 hours 2⃣ endpoint 🚑 Amount of rescue analgesics at 24 and 48 hours 💉 Cumulative amount of IV PCA after 48 hours after surgery
@AccpPeriopPRN 🥅 To evaluate the use of magnesium sulfate (Mg) in acute post-op pain after staged bilateral total knee replacement (left 1st, right 2nd)
@AccpPeriopPRN 📋 Block randomized, double blind, placebo-controlled, parallel group trial of 44 patients 🏥 Seoul National University Hospital 💊 Mg 15mg/kg over 15 mins followed by 15 mg/kg/h continuous infusion through the operation #PeriPRNJC
@AccpPeriopPRN Inclusion & exclusion ✔️ASA physical status I or II, undergoing staged bilateral total knee arthroplasty (TKA) ✖️contraindication to spinal anaesthesia, chronic pain, hx of stroke, BMI of >35 kg/mg, cardiovascular disease, neuromuscular disease, or CCB use
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