Scholars@Duke
Timothy Ellis Miller

Timothy Ellis Miller

Professor of Anesthesiology
Anesthesiology, General, Vascular, High Risk Transplant & Critical Care
timothy.miller2@duke.edu
Box 3094 Med Ctr, DUMC, Durham, NC 27710
DUMC 3094, Durham, NC 27710

Selected Publications

Perioperative Quality Initiative consensus statement on goal-directed haemodynamic therapy.

Journal Article Br J Anaesth · September 2025 Perioperative goal-directed haemodynamic therapy (GDHT) includes a variety of protocolised approaches to the assessment and management of the circulatory system and blood flow for patients undergoing surgery. Here we present updated consensus statements on ... Full text Link to item Cite

Transforming the logistics of liver transplantation with normothermic machine perfusion: Clinical impact versus cost.

Journal Article Liver Transpl · June 1, 2025 Normothermic machine perfusion (NMP) facilitates the utilization of marginal liver allografts. It remains unknown whether clinical benefits offset additional costs in the real-world setting. We performed a comparison of outcomes and hospitalization costs f ... Full text Link to item Cite

Perioperative fluid management: evidence-based consensus recommendations from the international multidisciplinary PeriOperative Quality Initiative.

Journal Article Br J Anaesth · December 2024 Fluid therapy is an integral component of perioperative management. In light of emerging evidence in this area, the Perioperative Quality Initiative (POQI) convened an international multiprofessional expert meeting to generate evidence-based consensus reco ... Full text Link to item Cite

Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)/perioperative quality initiative (POQI) consensus statement on prehabilitation in oesophagogastric surgery.

Journal Article Br J Surg · October 1, 2024 BACKGROUND: Prehabilitation is safe, feasible and may improve a range of outcomes in patients with oesophago-gastric cancer (OGC). Recent studies have suggested the potential of prehabilitation to improve body composition, sarcopenia and physical fitness, ... Full text Link to item Cite

Reduce intraoperative albumin utilisation in cardiac surgical patients: a quality improvement initiative.

Journal Article BMJ Open Qual · April 24, 2024 BACKGROUND: Albumin continues to be used routinely by cardiac anaesthesiologists perioperatively despite lack of evidence for improved outcomes. The Multicenter Perioperative Outcomes Group (MPOG) data ranked our institution as one of the highest intraoper ... Full text Link to item Cite

Essential right heart physiology for the perioperative practitioner POQI IX: current perspectives on the right heart in the perioperative period.

Journal Article Perioper Med (Lond) · April 9, 2024 As patients continue to live longer from diseases that predispose them to right ventricular (RV) dysfunction or failure, many more patients will require surgery for acute or chronic health issues. Because RV dysfunction results in significant perioperative ... Full text Link to item Cite

Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society.

Journal Article J Thorac Cardiovasc Surg · December 2023 BACKGROUND: Opioid-based anesthesia and analgesia is a traditional component of perioperative care for the cardiac surgery patient. Growing enthusiasm for Enhanced Recovery Programs (ERPs) coupled with evidence of potential harm associated with high-dose o ... Full text Link to item Cite

A multidisciplinary opioid-reduction pathway for robotic prostatectomy: outcomes at year one.

Journal Article Perioper Med (Lond) · August 1, 2023 BACKGROUND: Opioid use has come under increasing scrutiny, driven in part by the opioid crisis and growing concerns that up to 6% of opioid-naïve patients may become chronic opioid users. This has resulted in a revaluation of perioperative practice. For th ... Full text Link to item Cite

Systematic reviews and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: mortality, morbidity, and organ failure.

Journal Article Br J Anaesth · April 2023 BACKGROUND: Mortality, morbidity, and organ failure are important and common serious harms after surgery. However, there are many candidate measures to describe these outcome domains. Definitions of these measures are highly variable, and validity is often ... Full text Link to item Cite

Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons.

Journal Article Surg Endosc · January 2023 The American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) are dedicated to ensuring high-quality innovative patient care for surgical patients by advancing the science, prevention ... Full text Link to item Cite

Pain management, fluid therapy and thromboprophylaxis after pancreatoduodenectomy: a worldwide survey among surgeons.

Journal Article HPB (Oxford) · April 2022 BACKGROUND: The aim of this survey was to assess practices regarding pain management, fluid therapy and thromboprophylaxis in patients undergoing pancreatoduodenectomy on a global basis. METHODS: This survey study among surgeons from eight (inter)national ... Full text Link to item Cite

Wireless wearables for postoperative surveillance on surgical wards: a survey of 1158 anaesthesiologists in Western Europe and the USA

Journal Article Bja Open · March 1, 2022 Background: Several continuous monitoring solutions, including wireless wearable sensors, are available or being developed to improve patient surveillance on surgical wards. We designed a survey to understand the current perception and expectations of anae ... Full text Cite

Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative.

Journal Article Nat Rev Nephrol · September 2021 Postoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular event ... Full text Link to item Cite

Assisted Fluid Management Software Guidance for Intraoperative Fluid Administration.

Journal Article Anesthesiology · August 1, 2021 BACKGROUND: Excessive or inadequate fluid administration causes complications, but despite this, fluid administration during noncardiac surgery is highly variable. Goal-directed management helps optimize the amount and timing of fluid administration; howev ... Full text Open Access Link to item Cite

Duke University Medical Center Perioperative Diabetes Management Program.

Journal Article Clin Diabetes · April 2021 Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies ... Full text Link to item Cite

Association between perioperative fluid management and patient outcomes: a multicentre retrospective study.

Journal Article Br J Anaesth · March 2021 BACKGROUND: Postoperative complications increase hospital length of stay and patient mortality. Optimal perioperative fluid management should decrease patient complications. This study examined associations between fluid volume and noncardiac surgery patie ... Full text Link to item Cite

Systematic review and consensus definitions for the Standardized Endpoints in Perioperative Medicine (StEP) initiative: cardiovascular outcomes.

Journal Article Br J Anaesth · January 2021 BACKGROUND: Adverse cardiovascular events are a leading cause of perioperative morbidity and mortality. The definitions of perioperative cardiovascular adverse events are heterogeneous. As part of the international Standardized Endpoints in Perioperative M ... Full text Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on the Role of Neuromonitoring in Perioperative Outcomes: Cerebral Near-Infrared Spectroscopy.

Journal Article Anesth Analg · November 2020 Some neurological complications following surgery have been related to a mismatch in cerebral oxygen supply and demand that may either lead to more subtle changes of brain function or overt complications like stroke or coma. Discovery of a perioperative ne ... Full text Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention.

Journal Article Anesth Analg · June 2020 Postoperative delirium is a geriatric syndrome that manifests as changes in cognition, attention, and levels of consciousness after surgery. It occurs in up to 50% of patients after major surgery and is associated with adverse outcomes, including increased ... Full text Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on the Role of Neuromonitoring in Perioperative Outcomes: Electroencephalography.

Journal Article Anesth Analg · May 2020 Electroencephalographic (EEG) monitoring to indicate brain state during anesthesia has become widely available. It remains unclear whether EEG-guided anesthesia influences perioperative outcomes. The sixth Perioperative Quality Initiative (POQI-6) brought ... Full text Link to item Cite

Perioperative Quality Initiative (POQI) consensus statement on fundamental concepts in perioperative fluid management: fluid responsiveness and venous capacitance.

Journal Article Perioper Med (Lond) · 2020 BACKGROUND: Optimal fluid therapy in the perioperative and critical care settings depends on understanding the underlying cardiovascular physiology and individualizing assessment of the dynamic patient state. METHODS: The Perioperative Quality Initiative ( ... Full text Open Access Link to item Cite

The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.

Journal Article J Alzheimers Dis · 2020 BACKGROUND: Perioperative neurocognitive disorders (PND) are common complications in older adults associated with increased 1-year mortality and long-term cognitive decline. One risk factor for worsened long-term postoperative cognitive trajectory is the A ... Full text Open Access Link to item Cite

Evolving the management of acute perioperative pain towards opioid free protocols: a narrative review.

Journal Article Curr Med Res Opin · December 2019 Objective: Identification of pain as the fifth vital sign has resulted in over-prescription and overuse of opioids in the US, with addiction reaching epidemic proportions. In Europe, and more recently in the US, a shift has occurred with the global adoptio ... Full text Link to item Cite

IV Fluids for Major Surgery: Reply.

Journal Article Anesthesiology · December 2019 Full text Link to item Cite

Implementation of a Successful Enhanced Recovery after Surgery Program in a Community Hospital.

Journal Article Cureus · October 30, 2019 Background Enhanced recovery after surgery (ERAS) protocols have been shown to be effective at accelerating return to functioning, reducing length of stay, and reducing cost per encounter at major medical centers and health systems across the United States ... Full text Link to item Cite

Paradox of age: older patients receive higher age-adjusted minimum alveolar concentration fractions of volatile anaesthetics yet display higher bispectral index values.

Journal Article Br J Anaesth · September 2019 BACKGROUND: Minimum alveolar concentration (MAC) and MAC-awake decrease with age. We hypothesised that, in clinical practice, (i) end-tidal MAC fraction in older patients would decline by less than the predicted age-dependent MAC decrease (i.e. older patie ... Full text Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy.

Journal Article Anesth Analg · August 2019 Enhanced recovery pathways have quickly become part of the standard of care for patients undergoing elective surgery, especially in North America and Europe. One of the central tenets of this multidisciplinary approach is the use of multimodal analgesia wi ... Full text Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative-4 Joint Consensus Statement on Persistent Postoperative Opioid Use: Definition, Incidence, Risk Factors, and Health Care System Initiatives.

Journal Article Anesth Analg · August 2019 Persistent postoperative opioid use is thought to contribute to the ongoing opioid epidemic in the United States. However, efforts to study and address the issue have been stymied by the lack of a standard definition, which has also hampered efforts to mea ... Full text Link to item Cite

Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine initiative: clinical indicators.

Journal Article Br J Anaesth · August 2019 BACKGROUND: Clinical indicators are powerful tools to quantify the safety and quality of patient care. Their validity is often unclear and definitions extremely heterogeneous. As part of the International Standardised Endpoints in Perioperative Medicine (S ... Full text Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Opioid Minimization in Opioid-Naïve Patients.

Journal Article Anesth Analg · August 2019 Surgical care episodes place opioid-naïve patients at risk for transitioning to new persistent postoperative opioid use. With one of the central principles being the application of multimodal pain interventions to reduce the reliance on opioid-based medica ... Full text Link to item Cite

Perioperative Quality Initiative consensus statement on the physiology of arterial blood pressure control in perioperative medicine.

Journal Article Br J Anaesth · May 2019 BACKGROUND: Perioperative arterial blood pressure management is a physiologically complex challenge influenced by multiple factors. METHODS: A multidisciplinary, international working subgroup of the Third Perioperative Quality Initiative (POQI) consensus ... Full text Link to item Cite

Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery.

Journal Article Br J Anaesth · May 2019 BACKGROUND: Postoperative hypotension and hypertension are frequent events associated with increased risk of adverse outcomes. However, proper assessment and management is often poorly understood. As a part of the PeriOperative Quality Improvement (POQI) 3 ... Full text Link to item Cite

Perioperative Quality Initiative consensus statement on preoperative blood pressure, risk and outcomes for elective surgery.

Journal Article Br J Anaesth · May 2019 BACKGROUND: A multidisciplinary international working subgroup of the third Perioperative Quality Initiative consensus meeting appraised the evidence on the influence of preoperative arterial blood pressure and community cardiovascular medications on perio ... Full text Link to item Cite

Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery.

Journal Article Br J Anaesth · May 2019 BACKGROUND: Intraoperative mortality is now rare, but death within 30 days of surgery remains surprisingly common. Perioperative myocardial infarction is associated with a remarkably high mortality. There are strong associations between hypotension and myo ... Full text Link to item Cite

Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: infection and sepsis.

Journal Article Br J Anaesth · April 2019 BACKGROUND: Perioperative infection and sepsis are of fundamental concern to perioperative clinicians. However, standardised endpoints are either poorly defined or not routinely implemented. The Standardised Endpoints in Perioperative Medicine (StEP) initi ... Full text Link to item Cite

Perioperative fluid management: moving toward more answers than questions-a commentary on the RELIEF study.

Journal Article Perioper Med (Lond) · 2019 Perioperative fluid and hemodynamic management have been much-debated topics over the last few years. Recently, a number of large trials have been published to help inform this debate. The Restrictive versus Liberal Fluid Therapy for Major Abdominal Surger ... Full text Link to item Cite

Impact of an enhanced recovery pathway on length of stay and complications in elective radical cystectomy: a before and after cohort study.

Journal Article Perioper Med (Lond) · 2019 BACKGROUND: Enhanced recovery after surgery (ERAS) pathways aim to standardize and integrate perioperative care, incorporating the best available evidence-based practice throughout the perioperative period targeted at attenuating the surgical stress respon ... Full text Open Access Link to item Cite

Focused cardiac ultrasound in preoperative assessment: the perioperative provider's new stethoscope?

Journal Article Perioper Med (Lond) · 2019 Focused cardiac ultrasound (FoCUS)-a simplified, qualitative version of echocardiography-is a well-established tool in the armamentarium of critical care and emergency medicine. This review explores the extent to which FoCUS could also be used to enhance t ... Full text Open Access Link to item Cite

Surgical Prehabilitation: Nutrition and Exercise.

Journal Article Anesthesiol Clin · December 2018 Complications after major surgery account for a disproportionate amount of in-hospital morbidity and mortality. Recent efforts have focused on preoperative optimization in an attempt to modify the risk associated with major surgery. Underaddressed, but imp ... Full text Link to item Cite

In Response.

Journal Article Anesth Analg · December 2018 Full text Link to item Cite

Systematic review and consensus definitions for standardised endpoints in perioperative medicine: postoperative cancer outcomes.

Journal Article Br J Anaesth · July 2018 BACKGROUND: The Standardising Endpoints for Perioperative Medicine group was established to derive an appropriate set of endpoints for use in clinical trials related to anaesthesia and perioperative medicine. Anaesthetic or analgesic technique during cance ... Full text Open Access Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery.

Journal Article Anesth Analg · June 2018 The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but t ... Full text Open Access Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway.

Journal Article Anesth Analg · June 2018 Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care ... Full text Open Access Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway.

Journal Article Anesth Analg · June 2018 Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative c ... Full text Open Access Link to item Cite

American Society for Enhanced Recovery: Advancing Enhanced Recovery and Perioperative Medicine.

Journal Article Anesth Analg · June 2018 As the population ages, the increasing surgical volume and complexity of care are expected to place additional care delivery burdens in the perioperative setting. In this age of integrated multidisciplinary care of the surgical patients, there is increasin ... Full text Open Access Link to item Cite

A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications.

Journal Article Br J Anaesth · May 2018 BACKGROUND: There is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research. ... Full text Open Access Link to item Cite

Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: patient comfort.

Journal Article Br J Anaesth · April 2018 BACKGROUND: Maximising patient comfort during and after surgery is a primary concern of anaesthetists and other perioperative clinicians, but objective measures of what constitutes patient comfort in the perioperative period remain poorly defined. The Stan ... Full text Link to item Cite

Current concepts of fluid management in enhanced recovery pathways.

Journal Article Br J Anaesth · February 2018 Perioperative fluid management impacts outcomes and plays a pivotal role in enhanced recovery pathways (ERPs). There have been major advances in understanding the effects of fluid therapy and administration during the perioperative period. Improving fluid ... Full text Open Access Link to item Cite

The rising tide of opioid use and abuse: the role of the anesthesiologist.

Journal Article Perioper Med (Lond) · 2018 Opioid use has risen dramatically in the past three decades. In the USA, opioid overdose has become a leading cause of unintentional death, surpassing motor vehicle accidents. A patient's first exposure to opioids may be during the perioperative period, a ... Full text Open Access Link to item Cite

Fluid Management in the Elderly

Journal Article Current Anesthesiology Reports · December 2017 Full text Open Access Cite

Perioperative fluid and hemodynamic management within an enhanced recovery pathway.

Journal Article J Surg Oncol · October 2017 Goal-directed fluid therapy (GDFT) seeks to improve outcomes through individualized optimization of oxygen delivery using IV fluid and vasoactive infusions. Trials of GDFT show clinical benefits over traditional liberal fluid administration, but fail to de ... Full text Open Access Link to item Cite

Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen.

Journal Article Curr Med Res Opin · May 2017 BACKGROUND: Recovery from spine surgery is oriented toward restoring functional health outcomes while reducing resource use. Optimal pain management is a key to reaching these objectives. We compared outcomes of spine surgery patients who received standard ... Full text Open Access Link to item Cite

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery.

Journal Article Perioper Med (Lond) · 2017 BACKGROUND: Colorectal surgery (CRS) patients are an at-risk population who are particularly vulnerable to postoperative infectious complications. Infectious complications range from minor infections including simple cystitis and superficial wound infectio ... Full text Open Access Link to item Cite

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on measurement to maintain and improve quality of enhanced recovery pathways for elective colorectal surgery.

Journal Article Perioper Med (Lond) · 2017 BACKGROUND: This article sets out a framework for measurement of quality of care relevant to enhanced recovery pathways (ERPs) in elective colorectal surgery. The proposed framework is based on established measurement systems and/or theories, and provides ... Full text Open Access Link to item Cite

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1-from the preoperative period to PACU.

Journal Article Perioper Med (Lond) · 2017 BACKGROUND: Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver "optimal analgesia," which we define in this paper as a technique that optimizes patient comfort and facilitates f ... Full text Open Access Link to item Cite

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2-From PACU to the Transition Home.

Journal Article Perioper Med (Lond) · 2017 BACKGROUND: Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver "optimal analgesia", which we define in this paper as a technique that optimizes patient comfort and facilitates f ... Full text Open Access Link to item Cite

Enhanced recovery protocols for colorectal surgery and postoperative renal function: a retrospective review.

Journal Article Perioper Med (Lond) · 2017 BACKGROUND: While enhanced recovery protocols (ERPs) reduce physiologic stress and improve outcomes in general, their effects on postoperative renal function have not been directly studied. METHODS: Patients undergoing major colorectal surgery under ERP (F ... Full text Open Access Link to item Cite

Baseline Pulse Pressure, Acute Kidney Injury, and Mortality After Noncardiac Surgery.

Journal Article Anesth Analg · December 2016 BACKGROUND: Increased pulse pressure (PP) is an important independent predictor of cardiovascular outcome and acute kidney injury (AKI) after cardiac surgery. The objective of this study was to determine whether elevated baseline PP is associated with post ... Full text Open Access Link to item Cite

Could the Use of an Enhanced Recovery Protocol in Laparoscopic Donor Nephrectomy be an Incentive for Live Kidney Donation?

Journal Article Cureus · November 22, 2016 INTRODUCTION AND BACKGROUND: Gastrointestinal (GI) recovery after major abdominal surgery can be delayed from an ongoing need for narcotic analgesia thereby prolonging hospitalization. Enhanced recovery after surgery (ERAS) is a multimodal perioperative ca ... Full text Open Access Link to item Cite

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice.

Journal Article Acta Anaesthesiol Scand · March 2016 BACKGROUND: The present interdisciplinary consensus review proposes clinical considerations and recommendations for anaesthetic practice in patients undergoing gastrointestinal surgery with an Enhanced Recovery after Surgery (ERAS) programme. METHODS: Stud ... Full text Open Access Link to item Cite

Fluid resuscitation practice patterns in intensive care units of the USA: a cross-sectional survey of critical care physicians.

Journal Article Perioper Med (Lond) · 2016 BACKGROUND: Fluid resuscitation is a cornerstone of intensive care treatment, yet there is a lack of agreement on how various types of fluids should be used in critically ill patients with different disease states. Therefore, our goal was to investigate th ... Full text Open Access Link to item Cite

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative  (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery.

Journal Article Perioper Med (Lond) · 2016 BACKGROUND: Enhanced recovery may be viewed as a comprehensive approach to improving meaningful outcomes in patients undergoing major surgery. Evidence to support enhanced recovery pathways (ERPs) is strong in patients undergoing colorectal surgery. There ... Full text Open Access Link to item Cite

Evidence-Based Perioperative Medicine comes of age: the Perioperative Quality Initiative (POQI): The 1st Consensus Conference of the Perioperative Quality Initiative (POQI).

Journal Article Perioper Med (Lond) · 2016 The 1st POQI Consensus Conference occurred in Durham, NC, on March 4-5, 2016, and was supported by the American Society of Enhanced Recovery (ASER) and Evidence-Based Perioperative Medicine (EBPOM). The conference focused on enhanced recovery for colorecta ... Full text Open Access Link to item Cite

Association between Initial Fluid Choice and Subsequent In-hospital Mortality during the Resuscitation of Adults with Septic Shock.

Journal Article Anesthesiology · December 2015 BACKGROUND: Currently, guidelines recommend initial resuscitation with intravenous (IV) crystalloids during severe sepsis/septic shock. Albumin is suggested as an alternative. However, fluid mixtures are often used in practice, and it is unclear whether th ... Full text Open Access Link to item Cite

Paravertebral Block for Inguinal Herniorrhaphy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Journal Article Anesth Analg · August 2015 BACKGROUND: Paravertebral block (PVB) is a safe and effective anesthetic technique for thoracotomy and mastectomy. However, no systematic review or meta-analysis has focused on PVB for inguinal herniorrhaphy. Our study compares PVB with general anesthesia/ ... Full text Open Access Link to item Cite

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs.

Journal Article J Am Coll Surg · August 2015 BACKGROUND: The purpose of this study was to examine the impact of the sequential implementation of the enhanced recovery program (ERP) and surgical site infection bundle (SSIB) on short-term outcomes in colorectal surgery (CRS) to determine if the presenc ... Full text Open Access Link to item Cite

Total intravenous anesthesia and anesthetic outcomes.

Journal Article J Cardiothorac Vasc Anesth · June 2015 Full text Open Access Link to item Cite

Lidocaine patch for acute pain management: a meta-analysis of prospective controlled trials.

Journal Article Curr Med Res Opin · March 2015 BACKGROUND: Local anesthetic is one of the cornerstones of multimodal analgesia. We investigated the efficacy of the lidocaine patch for acute pain management. METHODS: We searched MEDLINE, CINAHL, Scopus, and the Cochrane Controlled Trials Register for pu ... Full text Open Access Link to item Cite

Pathophysiology of major surgery and the role of enhanced recovery pathways and the anesthesiologist to improve outcomes.

Journal Article Anesthesiol Clin · March 2015 Enhanced recovery pathways have been increasingly adopted into surgical specialties with the aim of reducing the stress response and improving the metabolic response to surgical insult. Enhanced recovery pathways encompass a large range of perioperative el ... Full text Open Access Link to item Cite

Monitoring needs and goal-directed fluid therapy within an enhanced recovery program.

Journal Article Anesthesiol Clin · March 2015 Patients having major abdominal surgery need perioperative fluid supplementation; however, enhanced recovery principles mitigate against many of the factors that traditionally led to relative hypovolemia in the perioperative period. An estimate of fluid re ... Full text Open Access Link to item Cite

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS).

Journal Article Can J Anaesth · February 2015 Featured Publication Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase ... Full text Open Access Link to item Cite

In response.

Journal Article Anesth Analg · January 2015 Full text Link to item Cite

In response.

Other Anesth Analg · January 2015 Full text Link to item Cite

In response.

Other Anesth Analg · January 2015 Full text Link to item Cite

Perioperative fluid therapy: a statement from the international Fluid Optimization Group.

Journal Article Perioper Med (Lond) · 2015 Featured Publication BACKGROUND: Perioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. Maintaining effective circulating blood volume and pressure are key ... Full text Open Access Link to item Cite

Prevention of Hypothermia

Chapter · January 1, 2015 Mild perioperative hypothermia, defined as a core body temperature between 34 and 36 °C, is common and preventable. Without active interventions approximately 70 % of patient undergoing operations lasting 2 h or longer will become hypothermic. This is of c ... Full text Cite

Perioperative goal-directed therapy.

Journal Article J Cardiothorac Vasc Anesth · December 2014 Full text Open Access Link to item Cite

State-of-the-art fluid management in the operating room.

Journal Article Best Pract Res Clin Anaesthesiol · September 2014 The underlying principles guiding fluid management in any setting are very simple: maintain central euvolemia, and avoid salt and water excess. However, these principles are frequently easier to state than to achieve. Evidence from recent literature sugges ... Full text Open Access Link to item Cite

A prospective comparison of a noninvasive cardiac output monitor versus esophageal Doppler monitor for goal-directed fluid therapy in colorectal surgery patients.

Journal Article Anesth Analg · May 2014 BACKGROUND: Goal-directed fluid therapy (GDFT) is associated with improved outcomes after surgery. The esophageal Doppler monitor (EDM) is widely used, but has several limitations. The NICOM, a completely noninvasive cardiac output monitor (Cheetah Medical ... Full text Open Access Link to item Cite

Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.

Journal Article Anesth Analg · May 2014 Featured Publication BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and co ... Full text Open Access Link to item Cite

Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey.

Journal Article Curr Med Res Opin · January 2014 OBJECTIVE: During the past two decades, professional associations, accrediting bodies, and payors have made post-surgical pain treatment a high priority. In light of the disappointing findings in previous surveys, a survey was conducted to assess patient p ... Full text Open Access Link to item Cite

Successful recovery after major surgery: moving beyond length of stay.

Journal Article Perioper Med (Lond) · 2014 There is strong evidence that Enhanced Recovery Pathways improve length of hospital stay, readmission rates, and complications after major surgery. However, recovery is a complex process that only finishes when the patient returns to normal function. Futur ... Full text Open Access Link to item Cite

Endpoints of goal directed therapy in the OR and in the ICU

Chapter · January 1, 2014 © Cambridge University Press 2014. Goals of goal directed therapy Ultimately, the aim of goal directed therapy (GDT) is to improve patient outcomes by optimizing tissue perfusion and end-organ function. Adverse outcomes are associated with both under- and ... Full text Cite

How to implement GDT in an institution and at the national level

Chapter · January 1, 2014 © Cambridge University Press 2014. Each year millions of pounds are spent around the world on health care research with the aim of developing interventions, practices, and guidelines that can improve human health. Yet only a small proportion of these innov ... Full text Cite

New evidence in trauma resuscitation - is 1:1:1 the answer?

Journal Article Perioper Med (Lond) · July 3, 2013 Featured Publication Traumatic injury is a common problem, with over five million worldwide deaths from trauma per year. An estimated 10 to 20% of these deaths are potentially preventable with better control of bleeding. Damage control resuscitation involves early delivery of ... Full text Open Access Link to item Cite

Anesthesia for vascular surgery

Chapter · March 1, 2013 Cite

Goal-directed fluid therapy

Chapter · January 1, 2011 High-risk surgery is associated with significant morbidity and mortality. From a database of over 4 million patients it has recently been shown that 80% of deaths occur in only 12.5% of surgical procedures [1]. In these high-risk patients the expected mort ... Full text Cite

Goal-directed or goal-misdirected - how should we interpret the literature?

Journal Article Crit Care · 2010 Goal-directed therapy (GDT) can be a vague term, meaning different things to different people and, depending on the clinical environment, sometimes even different things to the same person. It can refer to perioperative fluid management, clinicians driving ... Full text Open Access Link to item Cite

Goal-directed fluid management with trans-oesophageal Doppler.

Journal Article Best Pract Res Clin Anaesthesiol · September 2009 Major surgery is associated with significant trauma and is a potential cause of multiple system organ failure and death. Measurement of cardiac output using a variety of techniques during the perioperative period has enabled practitioners to proactively op ... Full text Link to item Cite

Definitions and epidemiology.

Journal Article Curr Opin Crit Care · August 2009 PURPOSE OF REVIEW: This is the first part of an eight paper review series on postoperative problems. This section will focus on common postoperative complications with an emphasis on definitions and epidemiology. The major topics covered are cardiovascular ... Full text Link to item Cite

Management of postoperative nausea and vomiting

Journal Article Current Reviews for Nurse Anesthetists · October 23, 2008 Cite