Left atrial appendage occlusion in a mirror-image dextrocardia: A case report and review of literature

Table 1 Nursing procedures guided by the enhanced recovery after surgery model

Phase	Project	Level of evidence	Recommendation	Remarks
Preoperative	Hemoglobin	IIA, C-LD	Yes	Preoperative measurement of hemoglobin to assist risk stratification
	Albumin	IIA, C-LD	Yes	Preoperative assessment of albumin contributes to risk stratification
	Correcting malnutrition	IIA, C-LD	Yes	Recommend correcting nutritional deficiencies where feasible
	Smoking and drinking	I, C-LD	Yes	Patients were advised to stop 4 wk prior to elective surgery
	Carbohydrate load	IIB, C-LD	Yes	Carbohydrate loading (sugar prestocking) can be performed 2-4 h before general anesthesia
	Infection prevention	IA	Yes	Cephalosporins are recommended for 30-60 min before surgery
	E-health platform	IIA, C-LD	Yes	Establish electronic health education platform
	Cardiac preconditioning program	IIA, B-NR	Yes	These include education, nutrition optimization, sports training, social support, and mindfulness stress reduction training to reduce anxiety
Intraoperative	Implementation care package	I, B-R	Yes	Including local intranasal therapy to eliminate staphylococcal colonization
				Cephalosporins were injected within 60 min before skin incision and redone in cases over 4 h
				Skin preparation, depilation plan, dressing change after every 48 h
	Recovery temperature	III, B-R	No	Avoid high temperature during cardiopulmonary bypass reheating, that is the core temperature should not be > 37.9 °C
	Rigid sternum fraction	IIA, B-R	No	Rigid sternum fraction is beneficial in patients undergoing sternotomy
	Bleeding prevention	I, A	No	Tranexamic acid or amino hexic acid is recommended for cardiopulmonary bypass
Postoperative	Enhanced glycemic control	IIA, B-NR	Yes	Factors of postoperative hyperglycemia: glucose toxicity, oxidative stress, prethrombotic effect, inflammation
	Insulin infusion to treat hyperglycemia	IIA, B-NR	No	Insulin infusion is recommended to treat perioperative hyperglycemia
	Pain management	I, B-NR	No	Prescription of acetaminophen, tramadol, dexmedetomidine, pregabalin, gabapentin, etc.
	Hypothermia	I, B-NR	Yes	Warm blankets, elevated room temperature, heat perfusion and intravenous infusion are recommended for postoperative use
	Delirium	I, B-NR	Yes	At least one delirium screening is recommended for each nursing class
	Anticoagulant drugs	IIA, C-LD	Yes	Drug anticoagulation is recommended to reduce the risk of thrombosis
	Early extubation	IIA, B-NR	Yes	Strategies are recommended to ensure that the tube is extubated within 6 h of surgery
	Acute renal injury	IIA, B-R	Yes	Biomarkers are recommended for early identification of at-risk patients early and guide the reduction of AKI
	Goal-directed fluid therapy	I, B-R	Yes	Goal-directed fluid therapy is recommended to reduce postoperative complications
	Other	Unrated	Yes	Cardiopulmonary bypass, perfusion, mechanical ventilation at low tidal volume, early postoperative enteral feeding and postoperative mobilization are recommended
				It is recommended that the recommendations be adjusted to achieve the goals through multiteam collaboration (dietitians, early cardiac rehabilitation therapists, and physical therapists)

AKI: Acute kidney injury.