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Rabies - recovery phase — Clinical Guidelines

Overview

Rabies recovery phase involves managing the aftermath of clinical symptoms post-exposure or post-infection, focusing on supportive care and monitoring for complications. Recovery can be prolonged and requires close observation for neurological sequelae and other potential complications.

Diagnosis

Clinical observation for resolution of acute symptoms (fever, agitation, hydrophobia) 18.

Neurological assessments to detect delayed complications such as encephalitis or cognitive deficits 12.

Monitoring for signs of autonomic dysfunction or persistent neurological deficits 18.

Management

Supportive care including hydration, nutrition, and pain management 10 12.

Close monitoring in a controlled environment to detect early signs of complications 18.

Early identification and management of potential secondary infections 12.

Consideration of multidisciplinary rehabilitation approaches, especially for neurological recovery 17.

Special Populations

Elderly: Increased focus on nutritional support and monitoring for polypharmacy-related complications affecting recovery 4 10.

Pediatrics: Tailored rehabilitation programs focusing on developmental milestones post-recovery 17.

Comorbidities: Enhanced attention to comorbid conditions that may impact recovery trajectory, such as malnutrition or pre-existing neurological conditions 12 10.

Key Recommendations

Implement multidisciplinary care teams including anesthesiologists, surgeons, nurses, and physiotherapists to optimize recovery processes 17 (Evidence: Strong).

Enhance postoperative nutrition care processes aligned with Enhanced Recovery After Surgery (ERAS) guidelines to improve outcomes in older surgical patients 10 (Evidence: Moderate).

Utilize validated tools for assessing recovery quality, such as ObsQoR-10, to monitor patient progress effectively 3 (Evidence: Moderate).

Ensure thorough and standardized clinical handover processes between anesthesiologists and post-anesthesia care unit staff to prevent communication errors 11 16 (Evidence: Moderate).

Consider supplementary interventions like L-carnitine for metabolic support during recovery, though evidence varies 15 (Evidence: Weak).

References

1 Ma X, Liu J, Tang Y, Lian Q, Huai X, Liu W et al.. The efficacy of nalmefene on anesthetic recovery of patients: a study protocol for a multicenter randomized controlled trial. Trials 2023. link 2 Stretton B, Kovoor JG, Vanlint A, Maddern G, Thompson CH. Perioperative micronutrients, macroscopic benefits?. Journal of perioperative practice 2023. link 3 Mathias LAST, Carlos RV, Siaulys MM, Gabriades P, Guo N, Domingue B et al.. Development and validation of a Portuguese version of Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese). Anaesthesia, critical care & pain medicine 2022. link 4 Nakamura J, Kitagaki K, Ueda Y, Nishio E, Shibatsuji T, Uchihashi Y et al.. Impact of polypharmacy on oral health status in elderly patients admitted to the recovery and rehabilitation ward. Geriatrics & gerontology international 2021. link 5 Whitley DR, Crow PH, Gore PC, Gregory VK, Pfeiffer KG, Taylor YJ. Discerning Post Anesthesia Readiness for Transition (DPART): A Measurement Tool. Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses 2020. link 6 Liu J, Ai C, Zhang B, Wang Y, Brewer LM, Ting CK et al.. Tracheal sounds accurately detect apnea in patients recovering from anesthesia. Journal of clinical monitoring and computing 2019. link 7 Pengelly J, Pengelly M, Lin KY, Royse C, Royse A, Bryant A et al.. Resistance Training Following Median Sternotomy: A Systematic Review and Meta-Analysis. Heart, lung & circulation 2019. link 8 Collie A, Newnam S, Keleher H, Petersen A, Kosny A, Vogel AP et al.. Recovery Within Injury Compensation Schemes: A System Mapping Study. Journal of occupational rehabilitation 2019. link 9 Maney JK, Durham HE, Goucher KP, Little EL. Induction of anesthesia and recovery in donkeys sedated with xylazine: a comparison of midazolam-alfaxalone and midazolam-ketamine. Veterinary anaesthesia and analgesia 2018. link 10 Byrnes A, Young A, Mudge A, Banks M, Clark D, Bauer J. Prospective application of an implementation framework to improve postoperative nutrition care processes: Evaluation of a mixed methods implementation study. Nutrition & dietetics : the journal of the Dietitians Association of Australia 2018. link 11 Redley B, Bucknall TK, Evans S, Botti M. Inter-professional clinical handover in post-anaesthetic care units: tools to improve quality and safety. International journal for quality in health care : journal of the International Society for Quality in Health Care 2016. link 12 Ann DiMaria-Ghalili R. Development of an Integrated Theory of Surgical Recovery in Older Adults. Journal of nutrition in gerontology and geriatrics 2016. link 13 Grasso D, Lanteri P, Di Bernardo C, Mauri C, Porcelli S, Colombini A et al.. Salivary steroid hormone response to whole-body cryotherapy in elite rugby players. Journal of biological regulators and homeostatic agents 2014. link 14 Tweed N, Williams S, Williams D, Dingley J. Utility of a low-cost wireless force platform as a potential clinical test of balance recovery after neuraxial anaesthesia. International journal of obstetric anesthesia 2014. link 15 Huang A, Owen K. Role of supplementary L-carnitine in exercise and exercise recovery. Medicine and sport science 2012. link 16 Siddiqui N, Arzola C, Iqbal M, Sritharan K, Guerina L, Chung F et al.. Deficits in information transfer between anaesthesiologist and postanaesthesia care unit staff: an analysis of patient handover. European journal of anaesthesiology 2012. link 17 Carli F, Baldini G. Fast-track surgery: it is time for the anesthesiologist to get involved!. Minerva anestesiologica 2011. link 18 Chang DJ, Choi SH, Choi YS, Min KT. Effect of charcoal filter on the emergence from sevoflurane anesthesia in a semi-closed rebreathing circuit. Yonsei medical journal 2011. link 19 Karanikolas M, Swarm RA. Current trends in perioperative pain management. Anesthesiology clinics of North America 2000. link70181-4) 20 Takabayashi T, Sasaki H, Shintaku Y, Sasamoto K, Ozawa N, Hamazaki Y et al.. Effects of a medicinal herbal liqueur, "yomeishu", on post-operative gynecological patients. The American journal of Chinese medicine 1990. link 21 Whorley LW. Social recovery and therapeutic mission. The International journal of the addictions 1984. link

Rabies - recovery phase