Impact of an Enhanced Recovery after Surgery Protocol on Postoperative Outcomes in Cardiac Surgery.

Background: Enhanced recovery after surgery (ERAS) protocols are perioperative care pathways designed to achieve early recovery after procedures. ERAS protocols have shown shortened recovery time, and lower opioid utilization and postoperative complication rates. Evidence to support the use of ERAS protocols is robust, however, minimal data exists in cardiac surgery patients. Methods: This observational cohort compared adults receiving post-operative care after coronary artery bypass or valve procedures who received an ERAS protocol containing acetaminophen, gabapentin, and methocarbamol to historical controls. The primary outcome of this study was postoperative opioid use during the first 72-hours following cardiac surgery. Secondary outcomes included length of stay, average pain scores 72-hours postoperatively, and incidence of opioid-related complications. Results: Total cumulative 72-hour post-operative opioid consumption showed a trend toward reduction in opioid use in patients who received the ERAS protocol vs the historic control group [75.8 mg vs 105.4 mg oral morphine equivalents (P = .09)]. Median postoperative lengths of stay and pain scores were similar between groups. Opioid related complications including constipation and respiratory depression occurred more frequently in the control group compared to the ERAS group [47.7% vs 60.5% (P < .05) and 57.1% vs 62.7% (P < .05) respectively]. Conclusions: Use of an ERAS protocol shows a promising trend toward less postoperative opioid use in cardiac surgery patients. Lower rates of opioid-related adverse events, including constipation and respiratory depression, were observed in the ERAS protocol group. This study indicates that ERAS protocols have a potential role for cardiac surgery patients postoperatively.

Growth Response of an Osmotolerant Sorbate-Resistant Yeast, Saccharomyces rouxii , at Different Sucrose and Sorbate Levels.

Effects of preconditioning Saccharomyces rouxii to various sucrose and sorbate concentrations were investigated. Cells were preconditioned to 0 and 60% (wt/vol) sucrose without and with 0. 1% (wt/vol) sorbate by a series of four transfers in potato dextrose broth (PDB). The preconditioned cells were inoculated in growth medium containing 0, 30, or 60% (wt/vol) sucrose with 0. 0.05, or 0.1% (wt/vol) sorbate and in chocolate syrup without and with 0.1% (wt/vol) sorbate. Preconditioning of S. rouxii cells to 0 and 60% sucrose offered no advantage for growth in a medium containing 0, 30 or 60% sucrose. When S. rouxii cells were preconditioned in 0.1% sorbate, an increased resistance to sorbate occurred. S. rouxii cells preconditioned in 60% sucrose/0.1% sorbate were more sensitive to sorbate than cells preconditioned in 0% sucrose/0.1% sorbate. Regardless of the sucrose level, S. rouxii cells, preconditioned in 0. 1% sorbate showed an increased resistance to sorbate when inoculated into the growth medium and the chocolate syrup.

Effect of Acids and Sorbate Combinations on the Growth of Four Osmophilic Yeasts.

The effects of hydrochloric, citric, lactic, phosphoric and malic acids in combination with potassium sorbate on the growth of Saccharomyces bailii , Saccharomyces acidifaciens ( Saccharomyces bailii var. osmophilus ), Saccharomyces rouxii and Saccharomyces bisporus were evaluated. Double strength potato dextrose broth supplemented with 58% (wt/vol) sucrose, 14% (wt/vol) glucose, and 0.2% agar acidulated to a pH of 5.0 to a final aw of 0.88 to 0.89 was used as the growth medium. In general, at 0.05% potassium sorbate, S. rouxii and S. bisporus were more resistant than S. bailii and S. acidifaciens to the antimycotic agent independent of the acid used to acidulate the growth medium, whereas 0.1% potassium sorbate inhibited the growth of the four yeast strains. At 0.05% potassium sorbate, growth occurred (1 log number yeast cells/ml) for S. acidifaciens in the lactic acid/sorbate combination after 36 h of incubation, whereas a bacteriostatic relationship existed for the other acids employed. Citric acid potentiated the antimicrobial effectiveness of 0.05% potassium sorbate at pH 5.0 against the growth of S. rouxii and S. bisporus by either delaying the lag phase or reducing the growth rate.