Journal of perioperative practice最新文献

Perioperative smoking cessation reduces wound-healing complications, yet its long-term effect on sustained abstinence after elective plastic surgery remains uncertain. This study examined patients who underwent elective plastic surgery and participated in a follow-up interview to assess whether adherence to short-term perioperative smoking cessation instructions was associated with continued abstinence post-surgery. All smokers were instructed to quit at least 4 weeks prior to surgery and remain abstinent for at least 4 weeks afterwards. Patients were categorised as either compliant or non-compliant with preoperative guidance. The findings suggest that elective plastic surgery may serve as a teachable moment that extends the immediate smoke-free period; however, short-term instructions alone seldom result in lasting abstinence. Integrating structured cessation programmes with perioperative counselling may be required to transform temporary compliance into enduring behavioural change.

Objective: The objective of this study was to evaluate the occurrence of postoperative sore throat, hoarseness, and cough after inflating the cuff using a manometer versus the traditional syringe-assisted cuff inflation method.

Methods: This study involved 56 patients of the American Society of Anesthesiologists (ASA) physical status (PS) classification system I and II undergoing elective laparoscopic surgeries under general anaesthesia. After obtaining ethics committee approval and informed consent, the patients were divided into two groups. In group A, cuff pressure was set to 25 cmH₂O using a Portex^® cuff inflator. In group B, the cuff was inflated with room air using a 10-ml syringe; adequacy was assessed by palpation and auscultation. Postoperatively, the patients were monitored for sore throat, hoarseness, and cough, graded using the Harding and McVey scoring system.

Results: The incidence of sore throat in the cuff manometer group was higher than in the syringe group at zero hour, possibly due to various factors. However, over time, the manometer group had more patients reporting no sore throat. A notable statistical and clinical difference was found between groups in sore throat and hoarseness. No statistical difference in cough was observed.

Conclusion: Continuous cuff pressure monitoring during surgery reduces postoperative sore throat and hoarseness.

The development of second-generation supraglottic airway devices in clinical practice has led to a progressively growing trend wherein supraglottic airway devices are favoured instead of tracheal intubation for airway management in laparoscopic surgeries. The clinical advantages of two large-volume gastric drainage channels to prevent aspiration and an integrated cuff pressure indicator called the Cuff pilot™ for application of higher respiratory pressure have resulted in the Laryngeal Mask Airway Protector™ rising in popularity. There are limited studies for the use of this device in obese patients. We describe our initial experiences with the use of the Laryngeal Mask Airway Protector in ten obese patients undergoing laparoscopic cholecystectomies at a tertiary care centre in India. In all patients, we found the Laryngeal Mask Airway Protector to have good first-attempt successful device placement, higher oropharyngeal leak or sealing pressures, adequate ventilation, excellent fibreoptic glottic views, and improved gastric drainage. This case series demonstrates that the Laryngeal Mask Airway Protector may be a safe and acceptable alternative for moderately obese patients when used by a clinically experienced anaesthetist.

Purpose: This systematic review analyses existing studies on organ donation rates from various countries to provide insights that may inform policy decisions and improve organ donation rates globally.

Design/methodology/approach: A systematic search was initially conducted on 3 October 2024 and updated on 20 October 2024 across electronic databases including PubMed, Scopus, Cochrane, and Science Direct. Following an initial pilot screening, all unique references were screened by title and abstract, then full text, by at least two independent reviewers against predefined inclusion criteria. Disagreements between reviewers were resolved by double-checking at each step. Extracted data were compiled and summarised.

Finding: Fifteen studies on organ donation policies were identified, with 13 high-quality studies included after rigorous screening. Based on these studies, opt-out consent systems show mixed outcomes across countries. Policy effectiveness varies significantly between nations. The COVID-19 pandemic substantially disrupted organ donation rates. Factors beyond legislation, such as public awareness, cultural attitudes, media campaigns, and health care infrastructure, also influence donation success.Practical impact:While presumed consent may increase deceased donor rates, it is not a universal solution. Effective organ donation strategies require a holistic approach involving public education, trust-building, and nuanced policy implementation tailored to specific national contexts.

Context: Open abdominal procedures under combined general and epidural anaesthesia are at high risk of thermal loss due to prolonged operating times and significant exposure of internal organs.

Setting and design: In this prospective observational study, the effects of short-duration prewarming were assessed in participants who underwent open abdominal procedures with combined epidural and general anaesthesia.

Methods and materials: A total of 72 patients were observed, with 36 receiving 15 min of prewarming before surgery and 36 receiving warming only during surgery. Core temperature (tympanic) was measured with an infrared thermometer both before prewarming and at the end of surgery. The incidence of postoperative hypothermia (core temperature <36 °C) and shivering was also recorded.

Statistical analysis: Chi-square test, Student's t test or Pearson χ² were used for comparisons between two groups.

Results: The median temperature difference (baseline temperature - postoperative temperature) was lower in the prewarmed group (0.5 °C vs. 0.75 °C). The incidence of postoperative hypothermia and shivering was also lower in the prewarmed group than in the non-prewarmed group (22% vs. 50% and 5.56% vs. 25%, respectively).

Conclusion: A 15-min prewarming protocol is associated with a lower incidence of postoperative hypothermia and shivering in patients who undergo major abdominal surgery under combined general and epidural anaesthesia.

Introduction: The Hoobox OR© system is a digital automation platform designed to optimise communication and workflow efficiency in the operating theatre.

Purpose: This study specifically seeks to assess the level of process automation achieved with the implementation of the Hoobox OR© system.

Methods: This is a descriptive study conducted from August to November 2024 in a large private hospital in Brazil. Data were collected via process mapping and business intelligence reports.

Results: The implementation of the Hoobox OR© system significantly reduced communication inefficiencies and optimised workflow in the surgical theatre. The number of telephone calls per request decreased from an average of two to three calls to a single digital action, while the time required to request and receive materials was reduced to an average of 15 minutes across all departments. In addition, automated task coordination improved theatre turnover, minimising delays, and enhancing overall operational efficiency.

Conclusion: The adoption of the Hoobox OR© system in the operating theatre, through digital communication and process automation, significantly reduced response times and minimised rework, enhancing operational efficiency. Innovative technologies reinforce automation as a key strategy for continuous improvement in the surgical environment.

Polypharmacy is becoming more prevalent due to an ageing population. As more patients are undergoing surgical procedures, it is important to determine which group of patients are at higher risk of poorer outcomes. This review aimed to provide a summary of existing literature and to determine if polypharmacy is associated with poorer perioperative outcomes and to identify any gaps in the literature. This systematic review was conducted using electronic databases PubMed, Embase and Web of Science from their inception to December 2024. Statistical analysis was performed using generic inverse variance method. We identified 45 eligible studies from different countries and different surgical populations. Thirty-two studies (71.11%) defined polypharmacy as the use of five or more medications. Polypharmacy is significantly associated with postoperative delirium (odds ratio = 1.62, 95% confidence interval = 1.32-1.98, I² = 0%). Although polypharmacy is found to be significantly associated with postoperative delirium, the relationship between polypharmacy and postoperative delirium remains complex.

Operating department practitioners are registered health care practitioners who provide specialist care to patients across the perioperative environment in the disciplines of anaesthetics, surgery and post-anaesthetic care. There is a significant knowledge gap that surrounds the profession in terms of their career experiences. Using a methodology of interpretative phenomenological analysis, the lived career experiences of six senior operating department practitioners were investigated. Seven themes were identified across the experiences of participants addressing a wide range of topics including issues such as professional development, relationships with other health care professionals, sexual safety, student experiences and visibility. Recommendations based on this study include further investigation of operating department practitioner experiences across a wider demographic, an immediate review of how job adverts are constructed to be more inclusive and a call for increased professional visibility of operating department practitioners. Long-term recommendations include a resolution around the use of Patient Group Directives, workplace culture reviews and a review of theatre-attire appropriateness in relation to sexual safety in the perioperative environment.