Enhancing Emergency Department Pain Management for Older Adults with the Hip Fracture Fast-Track (HFFT) Protocol in a Middle-Income Country.

Purpose: This study aimed to evaluate the impact of the Hip Fracture Fast-Track (HFFT) protocol, designed specifically for older patients at our hospital, which commenced on January 1, 2022, on the management of emergency department (ED) pain in older adults with hip fractures. Patients and Methods: Retrospective pre- and post-study data from electronic health records (EHR) at our hospital, using the International Classification of Diseases (ICD)-10 codes S72.0, S72.1, S72.8, and S72.9, were utilized. The study included patients aged 65 years or older who presented to the ED with low-energy, non-pathologic isolated hip fractures or proximal femur fractures. The pre-HFFT period included patients from January 1, 2020, to December 31, 2021, and the post-HFFT period included patients from January 1, 2022, to October 31, 2023. Data were compared for the proportion of patients undergoing pain evaluation in the ED, before discharge, time to first analgesia, number of patients receiving pain relief in the ED, and the use of fascia iliaca compartment blocks (FICBs) and pericapsular nerve group blocks (PENGBs). Results: The final analysis involved 258 patients, with 116 in the pre-protocol group and 142 in the post-protocol group. The rate of analgesic use increased significantly in the post-HFFT group (78 [67.24%] vs 111 [78.17%], P = 0.049). The rate of pain score screening at triage increased from 51.72% before the HFFT protocol to 86.62% post-HFFT protocol (p < 0.001). Compared with the pre-HFFT protocol, the post-HFFT protocol exhibited a higher rate of FICB (0% vs 14.08%, p < 0.001) and PENGB (0% vs 5.63%, p = 0.009) administration. Conclusion: The HFFT protocol's implementation was associated with improved ED pain evaluation and analgesic administration in older adults with hip fractures. These findings indicate that tailored protocols, such as the HFFT, hold promise for enhancing emergency care for this vulnerable population.

No renal protection from volatile-anesthetic preconditioning in open heart surgery.

PURPOSE: Acute kidney injury (AKI) is a common complication of open heart surgery (OHS). Preconditioning with volatile anesthetics is well proven to provide myocardial protection. Renal protection provided by volatile-anesthetic preconditioning has also been investigated; however, it is still controversial at the clinical level. This study aimed to investigate whether preconditioning with volatile anesthetics could mediate renal protection in OHS. METHODS: A retrospective analytic study was designed. Medical records of patients (age ≥20 years) who had undergone OHS were reviewed. Types of anesthesia were classified as 'opioid-based anesthesia' (O group) and 'volatile-anesthetic-based anesthesia' (V group) according to the definitions given in the main text. Some medical records that had incomplete or ambiguous data were excluded. Renal protection was considered to be present if there was no clinical renal dysfunction as defined by the criteria given in the main text. AKI was considered to be present when there was a decrease of the postoperative estimated glomerular filtration rate (eGFR) that was >25 % of the preoperative eGFR. Also, postoperative 24-h oliguria (post-oliguria) and the provision of postoperative 48-h dialysis (post-dialysis) were considered. Differences between the O and V groups were tested by the appropriate statistics. A p value of <0.05 indicated significance. RESULTS: A total of 1,122 patients (702 males) were included in this study. The O and V groups included 704 and 418 patients, respectively. AKI was present in 9.52 and 8.37 % of the patients in the O and V groups, respectively (p = 0.532). Post-oliguria was found in 36.08 and 37.79 % of the patients in the O and V groups; and post-dialysis was provided in 3.98 and 4.31 %, respectively, of these patients; these two parameters showed no significant differences between the groups. CONCLUSIONS: This study could not demonstrate volatile-anesthetic-mediated renal protection in OHS. Therefore, in practice, pharmacological preconditioning with volatile anesthetics did not seem to be beneficial.