Perioperative Medicine最新文献

Background: Postoperative delirium is a common and significant consequence in patients with type A aortic dissection following surgery; however, there is currently no effective postoperative care plan.

Objective: The purpose of this study is to develop and evaluate the practical implementation of a stratified nursing intervention program for postoperative delirium in patients undergoing surgery for Stanford type A aortic dissection.

Methods: A stratified nursing intervention program for postoperative delirium was created using a literature review, group discussions, and the Delphi method via expert mail inquiry. A quasi-experimental design was used, with patients admitted to the general ward of a tertiary hospital in Wenzhou, China, functioning as subjects. From September to December 2022, 43 patients were included in the control group and given standard treatment. From January to June 2023, 37 patients were recruited in the intervention group, receiving both routine care and the intervention plan. The intervention's effects were compared in the two groups.

Results: The intervention group had considerably shorter delirium and hospital stays than the control group (P < 0.05), as well as higher patient satisfaction levels. There were no inadvertent extubations in the intervention group. When the incidence and beginning time of delirium in the general ward were compared, there were no significant differences between the two groups (P > 0.05).

Conclusion: Implementing this nurse intervention in the ward context can shorten postoperative delirium and hospital stays, increase patient satisfaction with care, and improve patient prognosis and quality of life. This intervention will also serve as a great resource for future clinical management of postoperative delirium.

Trial registration: The National Health Security Information Platform's Medical Research Registration Information System has registered this study under the registration number MR-33-22-022978.

Music therapy, known for its profound impact on human emotions and physiology, has gained increasing attention for its applications in medical settings, particularly in surgery. This study conducted a bibliometric analysis of publications on the application of music therapy in surgery from 2009 to 2023, utilizing the Web of Science Core Collection (WoSCC) as the primary database. A total of 479 publications were analyzed using VOSviewer, CiteSpace, Microsoft Excel, and online bibliometric tools. Findings indicate a steady increase in annual publications since 2009, peaking in 2021. The USA leads global research efforts with 31.7% of publications, followed by China (17.7%) and Italy (10%). Harvard University was identified as the top contributing institution, while the Journal of Perianesthesia Nursing was the primary publishing journal, and the Cochrane Database of Systematic Reviews was the highest co-cited journal. Cao Hua contributed the most publications, and Nilsson U was identified as the most co-cited author (n = 131). Keyword analysis highlighted anxiety, therapy, music therapy, and pain as primary research trends. This study provides valuable insights into the evolving landscape of music therapy research in surgical contexts. Future efforts should focus on expanding interdisciplinary collaborations, exploring advanced technologies for personalized interventions, and investigating optimal implementation strategies to enhance the integration of music therapy into surgical practice.

Background: The unfamiliar atmosphere of the operating room, waiting for anesthesia, and the process of surgery and anesthesia are some of the factors causing fear and anxiety in patients. It leads to physical and psychological pressure on patients. Better understanding of patients' feelings, beliefs, or fears and recording their experiences for optimal care after surgery is helpful. This study explains the experiences of clients in the first entry to the operating room.

Methods: This qualitative study was conducted using a descriptive phenomenological method. In this study, 17 patients who had the experience of entering the operating room for the first time as an elective surgery under general anesthesia over the last 6 months were purposefully selected as participants. Then, they underwent an in-depth and semi-structured interview. After conducting the interview, the participants' statements were qualitatively analyzed using the seven-step Colaizzi method. During the steps of this study, Lincoln and Guba's four reliable criteria were observed.

Results: By continuous analysis of interviews about patients' experiences, 308 codes, 10 sub-themes, 6 primary themes, and 3 general themes were obtained. Themes included unpleasant emotions experienced, unpleasant atmosphere factors, and the induction of relaxation and hope.

Conclusion: Patients' exposure to an unfamiliar place with new and unknown equipment, personnel with different clothing, stress, worry, psychosomatic reactions following stress, and annoying environmental factors can lead to an unpleasant experience for patients, if they are not managed. Also, the effective communication of the surgical team with the patients leads to reducing or removing the stress and complications caused by it.

Background: Subglottic stenosis is a significant clinical challenge in pediatric anesthesia, often necessitating interventions that can lead to various postoperative complications. The aim of this study was to determine the effect of prophylactic continuous positive airway pressure (CPAP) application on recovery time and airway complications in pediatric patients with subglottic stenosis undergoing balloon dilatation.

Methods: A prospective, double-blinded, parallel-group, randomized controlled study was conducted at Health Sciences University Ümraniye Training and Research Hospital on pediatric patients with subglottic stenosis, aged from 0 to 12 years and who underwent elective balloon dilatation under general anesthesia. Patients were randomized in a 1:1 ratio into the CPAP or non-CPAP group. The primary outcome was the duration of recovery time. Secondary outcomes included bronchospasm, the number of desaturation episodes, intubation, tracheostomy, and the need for intensive care.

Results: A total of 84 patients were enrolled in this randomized controlled trial, 81 of which received the allocated treatment and were analyzed (non-CPAP n = 41, CPAP n = 40). Compared to controls, the proportions of bronchospasm, tracheal secretion, need for intensive care, and tracheostomy were consistently lower in the CPAP group, whereas the requirement of intubation was higher. Further, the mean recovery time was significantly shorter in the CPAP group compared to the non-CPAP group (mean difference - 3.3 min, 95%CI - 5.16 to - 1.44, p = 0.0007). Despite lacking statistical significance, the CPAP group had reduced odds of developing bronchospasm, tracheal secretion, need for intensive care, and tracheostomy, but higher odds of requiring intubation when compared to the controls.

Conclusion: Prophylactic CPAP application following therapeutic balloon dilatation in pediatric patients who have developed subglottic stenosis due to acquired or congenital causes appears to effectively shorten recovery time and may have a role in decreasing postoperative pulmonary complications; however, more research is recommended to further confirm these findings.

Trial registration: The protocol for this clinical trial was retrospectively registered on clinicaltrials.gov with registration ID NCT06183515 on 30 November 2023.

Objective: This study aims to explore the analgesic effects and safety of periarticular injections of methylene blue (MB) combined with a cocktail formulation following total knee arthroplasty (TKA).

Methods: A total of 70 patients undergoing total knee arthroplasty were selected and divided into two groups based on the cocktail formula used for periarticular infiltration, including the methylene blue group (M group, n = 35) and the control group (C group, n = 35). Both groups underwent spinal anesthesia. At the end of the surgery, the M group received a 0.05% methylene blue combined cocktail for periarticular infiltration block, while the C group received a conventional cocktail infiltration block. Postoperatively, both groups used intravenous patient-controlled analgesia. Then, the rest and movement Numeric Rating Scale (NRS) scores, postoperative sufentanil consumption, postoperative inflammatory markers, and the occurrence of adverse reactions such as wound infection and poor wound healing were compared after postoperative 24 h, 48 h, 72 h, and 7-day, 14-day, 28-day between the two groups.

Results: The rest and during movement, NRS scores at postoperative 24 h, 48 h, 72 h, 7-day, 14-day, and 28-day were significantly lower in the C group compared with the M group (P < 0.05). The total sufentanil consumption at postoperative 72 h was less in the M group (98.9 ± 11.3 µg) compared to the C group (129.1 ± 12.3 µg) (P < 0.01). It also showed a lower IL-6 in the M group at postoperative 24 h and 72 h (P < 0.05). However, there were no significant differences in CRP levels between the two groups at 24 h and 72 h post-surgery (P > 0.05), and neither group experienced complications such as wound infection or poor wound healing.

Conclusion: Methylene blue combined with a cocktail can be safely used for local infiltration after knee arthroplasty, which reduces postoperative opioid consumption and suppresses the release of inflammatory factors. Moreover, it synergistically enhanced the local anesthetic analgesia and provided sustained pain relief for at least 4 weeks.

Background: Patients with a brain tumor experience high levels of anxiety because of the fear of remaining functional and neuropsychological sequelae. This situation affects the postoperative quality of recovery. This study was conducted to determine the effect of surgical fear and sleep quality on the postoperative quality of recovery and pain.

Method: This cross-sectional study was completed with 101 patients who met the inclusion criteria and underwent craniotomy under general anesthesia for a brain tumor between October 2020 and August 2021 in a university hospital. The data were collected using the Patient Information Form, Surgical Fear Scale, Richard Champell Sleep Scale, Quality of Recovery Questionnaire, and Patient Follow-up Form. Hierarchical regression analysis was used to reveal the determinants of postoperative quality of recovery.

Results: The mean fear of surgery score of women was higher than men, and sleep quality and postoperative quality of recovery were lower than men (p = 0.045). A moderate negative correlation between fear of surgery and sleep quality was found (r = -0.377; p = 0.000). There was a weak negative correlation between fear of surgery and postoperative recovery quality (r = -0.252; p = 0.011), and a weak positive correlation between preoperative sleep quality and recovery quality (r = 0.297; p = 0.003). The variables of fear, sleep, duration of hospital stay, pain, and age were found to be statistically the best predictors of postoperative quality of recovery (R2 = 0.295; p = 0.000).

Conclusion: As a result, surgical fear, sleep deprivation, and pain during the perioperative period negatively impact recovery quality and prolong the healing process. Psychological preparation by starting from the pre-operative period, providing sleep and rest, evaluation, and management of postoperative pain would contribute to the early recovery and discharge of patients.

Background: Multimodal prehabilitation programs are effective at reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital.

Methods: In this observational cohort study with multiple case analyses, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting the criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise modalities and three nutrition modalities. Implementation fidelity was investigated by evaluating: (1) coverage (participation rate), (2) duration (number of days between the start of prehabilitation and surgery), (3) content (delivery of prescribed intervention modalities), and (4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence.

Results: Fifty-eight patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33-84 days). Adherence was high (84-100%) in five and moderate (72-73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled to execute the prehabilitation program due to multiple physical and cognitive impairments.

Conclusion: Implementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness.

Trial registration: NCT06438484.

Background: The integration of procedure-specific risks into preoperative patient assessment and optimization are crucial aspects of perioperative care. However, data on internists' knowledge of surgical and anesthetic principles and practices are limited. We thus sought to identify internists' knowledge gaps in terms of surgical- and anesthetic-specific risk factors and characteristics.

Methods: An open and voluntary e-survey was conducted via LimeSurvey between April and July 2021 to evaluate Canadian internists' knowledge of surgical and anesthetic principles and practices. The survey included the perceived importance and knowledge of several key surgical and anesthetic aspects, such as surgery duration, procedure-specific cardiac risk, bleeding risk, and thrombotic risk. It also assessed pre- and post-survey self-reported confidence levels in one's knowledge of these characteristics. Finally, we investigated how internists optimize some of the preoperative risks.

Results: A total of 173 Canadian internists opened the survey link, and 121 completed it (completion rate 70%). While the majority of respondents considered surgical and anesthetic principles and practices as important, most identified knowledge gaps. Participants generally estimated surgery duration and procedure-specific cardiac risk adequately. However, they tended to underestimate procedure-specific bleeding risk for general (58%) and orthopedic (76%) surgeries and to overestimate procedure-specific thrombotic risk for vascular (63%) and genitourinary (60%) surgeries. Furthermore, there is a lack of consensus regarding the appropriate hemoglobin A1c target and 0% of respondents reported using the guideline-suggested hemoglobin threshold for investigation and intervention.

Conclusions: Overall, our findings identify significant knowledge gaps among Canadian internists in preoperative assessment of procedure-specific risk factors and can be used to inform both the development of educational initiatives and future research to improve the quality of preoperative patient care.

Background: Irrespective of baseline diabetes status, preoperative hemoglobin A1c (A1C) influences perioperative care in patients undergoing metabolic and bariatric surgery (MBS). Accordingly, the American Society of Metabolic and Bariatric Surgery (ASMBS) endorses that patients undergoing MBS should receive a preoperative A1C test. We aimed to assess the proportion of MBS patients who received a preoperative A1C test and determine whether baseline diabetes status influences receipt of a test.

Methods: We queried the 2017 to 2022 MBSAQIP database for patients undergoing open, laparoscopic, or robotic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy. Using descriptive methods, we compared the clinical and demographic characteristics of patients who received a preoperative A1C test with patients who did not. We performed logistic regression analysis using diabetes status as a predictor variable and receipt of a test as the outcome, covarying for sociodemographic and clinical factors.

Results: We identified 996,217 patients who underwent RYGB or sleeve gastrectomy between 2017 to 2022. The average age of the cohort was 43.8 years (SD = 11.9) and 81.0% were female. Overall, 45.7% received a preoperative A1C test. The proportion who was tested increased over the six-year study period, from 35.5% in 2017 to 56.0% in 2022. Compared to those who were not tested, patients who were tested were more likely to have several cardiopulmonary comorbidities, including COPD (1.4% vs 1.2%, p < 0.001), PE (1.4% vs 1.2%, p < 0.001), sleep apnea (39.3 vs. 36.4%, p < 0.001), HTN (47.1% vs 44.0%, p < 0.001), and MI (1.2% vs. 1.0%, p < 0.001), though the differences in proportions were small and may not be clinically significant. Compared to patients who did not have diabetes or had diabetes controlled by diet alone, patients with non-insulin dependent diabetes had 77% increased odds of receiving a A1C test (adjusted OR (aOR) 1.77, p < 0.001); insulin dependent patients had 113% increased odds (aOR 2.13, p < 0.001).

Conclusion: Despite society recommendations endorsing measurement of preoperative A1C prior to MBS, less than half of patients undergoing MBS between 2017 and 2022 received a preoperative A1C test. Additionally, there were differential patterns in testing based on diabetes status. Preoperative glycemic evaluation is an area for continued quality improvement.