Daniel Engelman, MD
Medical Director
Heart, Vascular & Critical Care Services
Baystate Medical Center
Associate Professor of Surgery
University of Massachusetts Medical School-Baystate
Springfield, Massachusetts
Medical Director
Heart, Vascular & Critical Care Services
Baystate Medical Center
Associate Professor of Surgery
University of Massachusetts Medical School-Baystate
Springfield, Massachusetts
Related Videos
In your discussions with many other cardiac surgery centers focused on reducing opioid use and pushing forward ERAS-based protocols, what consensus, if any, have you seen regarding IV acetaminophen use?
What is the mission statement of your ERAS group focused on cardiac surgery? And what is the foundational role of IV acetaminophen to push your ERAS goals, including reduced opioid consumption and reduced LOS, forward?
What is the role of nursing-focused education to facilitate introduction of IV acetaminophen into a multimodal pain management protocol? And what degree of reduction of IV opioid use did you observe after this protocol change?
Can patients be expected to absorb PO acetaminophen as soon as they are tolerating a liquid diet following cardiac surgery?
Based on your experience, how many doses of IV acetaminophen are required to optimize pain control after cardiac surgery? Do you individualize your approach and, if so, based on what factors?
Can such nonsteroidal agents as IV Toradol be safely used after cardiac surgery? What are the problematic aspects of this approach? And why might IV acetaminophen be preferable in certain patient populations?
What cardiac surgery patients — the elderly and others — are the ideal candidates for IV acetaminophen therapy? What clinical factors suggest this approach is especially appropriate as part of multimodal analgesia?
Why is IV acetaminophen your foundational multimodal agent? And, as a surgical patient transitions from IV to PO acetaminophen after cardiac surgery, what are some of the pitfalls and tips for making this transition?
What is the optimal dosing for IV acetaminophen and how should it be combined with other modalities? What is the safety profile of IV acetaminophen and what is its opioid-sparing profile for cardiac surgical patients?