Journal of perioperative practice最新文献

Uterine perforation is one of the serious complications associated with the use of an intrauterine contraceptive device, and its migration can lead to complications involving neighbouring organs, including the appendix. We report an unusual case of a 22-year-old Pakistani woman, who presented to the emergency department with pain in the right iliac fossa and was diagnosed as a case of foreign body appendicitis resulting from migration of an intrauterine contraceptive device and entering the lumen of the appendix. This case adds to the limited literature, with only 17 previously documented cases of intrauterine contraceptive device-related appendicitis. To our knowledge, it is the first reported instance of an intrauterine contraceptive device found inside the lumen of the appendix without causing its perforation, making it very rare. These occurrences highlight the need for vigilant monitoring of potential complications following intrauterine contraceptive device insertion.

Introduction: Prone positioning in surgery, commonly used in orthopaedics and neurosurgery, carries a high risk of positioning-related injuries. In patients with achondroplasia, anatomical differences present unique challenges for safe surgical positioning.

Case summary: This case report describes the perioperative management of a 48-year-old woman with achondroplasia undergoing spinal decompression and posterolateral arthrodesis. A detailed preoperative assessment was conducted, including patient participation in testing positions and equipment to ensure both safety and surgical accessibility. A balanced approach was achieved, and intraoperative positioning was continuously monitored. Postoperative evaluation revealed no positioning-related injuries.

Conclusions: This case highlights the critical role of preoperative planning and intraoperative vigilance in preventing complications. It also underscores the need for specific guidelines addressing the positioning of individuals with achondroplasia during surgery, particularly in the prone position, to be incorporated into international standards and best practice recommendations.

Background: A critical incident is described as any unplanned event which causes, or has the potential to cause, injury to a patient. Critical incident debriefing is a team discussion to gather facts and analyse the experience, evaluate lessons learned and provide staff with support. However, this phase is often neglected.

Methods: This UK-based explorative qualitative study aims to explore perioperative practitioners' experiences of critical incident debriefing. Data were collected from six participants through audio-recorded, semi-structured interviews. Data were analysed using a thematic analysis framework.

Results: Five themes emerged detailing the advantages of critical incident debriefing, including addressing staff's personal needs and learning lessons from incidents, and the disadvantages such as time constraints and unsupportive/uninformative debriefs leading to poor-quality debriefs.

Conclusions: Implementation of a short debrief immediately post-incident to address immediate concerns, a later in-depth debrief and additional training for facilitators were recommended to improve debrief quality.

Background: Reusable surgical textiles have substantial environmental benefits over single-use, disposable items. However, staff satisfaction with the performance of reusable textiles is unclear. During a trial period using reusable drapes, staff were surveyed regarding satisfaction with the products.

Results: A total of 30 staff members responded to the survey. Overall, 90% of respondents were either satisfied/very satisfied (80%) or neutral (10%) when asked about their satisfaction with the reusable drapes, while 10% were unsatisfied/very unsatisfied; 87% of staff responded that reusable drapes were either as effective or more effective than disposable drapes. Reusable drapes showed very high levels of staff satisfaction in terms of durability (87%), fluid protection (70%) and provision of a sterile field (80%). There were no staff who did not support the ongoing use of reusable surgical drapes.

Conclusion: There is extremely high staff satisfaction with reusable surgical drapes.

Hip and knee arthroplasty are frequently associated with significant blood loss, often necessitating blood transfusions. A variety of methods are employed to minimise blood loss and consequently mitigate the necessity for transfusions. This review explores the incidence of blood loss in hip and knee arthroplasty alongside perioperative strategies aimed at its reduction in UK practice. Given the increasing prevalence of tranexamic acid utilisation, we systematically examine the extant literature concerning its application in patients undergoing hip and knee arthroplasty. Our analysis discerns a prevailing consensus within published studies favouring the implementation of tranexamic acid as a safe and efficacious measure for reducing blood loss during hip and knee arthroplasty procedures.

Von Willebrand disease stands as the most prevalent bleeding disorder seen in both medical and surgical practice. Due to recurrent bleeding episodes within the joints, many patients endure arthropathy, leading to substantial pain and restricted function. Total joint arthroplasty emerges as a final option for managing such cases. Nevertheless, the existence of von Willebrand disease presents several challenges in this regard. This review aims to explore the perioperative strategies tailored for patients with von Willebrand disease undergoing elective total joint arthroplasty.

Background: Considering the vasopressor drug categories and doses that can be used for elderly patients following hypotension are few, the present trial aimed to compare the effect of different doses of phenylephrine infusion on the prevention of hypotension in elderly patients undergoing orthopaedic lower extremities surgery.

Methods: This randomised, double-blind prospective clinical trial was conducted by including 60 elderly patients older than 60 years and classified as American Society of Anesthesiology class I and II who were candidates for femur fracture fixation surgery. White and black cards randomly allocated patients to: group A (25µg/kg/h phenylephrine) or group B (35µg/kg/h phenylephrine).

Results: At the T₃-T₇ time points, group A's systolic and diastolic blood pressure was significantly higher than in group B's (p < 0.05). However, after 27 minutes (T₀-T₇) of phenylephrine infusion, statistical analysis showed no significant difference between the two groups regarding blood pressure (T₈-T_end). The frequency of bradycardia and reactive hypertension in group B were significantly higher than in group A (p = 0.02) and (p = 0.03), respectively. There was no significant difference between the bleeding loss, blood transfusion and crystalloid volume in both groups (p > 0.05).

Conclusion: Our trial illustrated that high-dose phenylephrine infusion could not assure haemodynamic stability and may cause some side effects.

Guidelines for prophylactic antibiotic administration in total joint replacement vary considerably in terms of drug, dosage, route of administration and duration of cover. Despite the range of treatment options available, infection remains the most common reason for arthroplasty failure in the decades following a procedure, simultaneously increasing health care costs and lowering patient satisfaction considerably. This work aims to evaluate whether there are benefits to administering further doses of antibiotic post-arthroplasty, in addition to the recommendations of current protocols. We present a review of evidence surrounding infection rates in a variety of prophylactic regimens, and weigh this against further considerations such as cost to the patient and risks of nephrotoxicity. In summary, the available evidence does not suggest a benefit to administering additional doses post-arthroplasty in most cases. However, further doses may benefit those deemed at high risk of infection, or those in areas of high methicillin-resistant Staphylococcus aureus prevalence.

Aim: This study aimed to explore Australian health professionals' perceptions and experiences regarding built environment planning for operating rooms.

Methods: We conducted semi-structured interviews and a focus group using exploratory qualitative methods, involving 16 participants: anaesthetists, surgeons, nurses, theatre technicians and designers of operating rooms.

Findings: Four core concerns of participants were analysed: Engagement, Respect & Collaboration; Foreseeing & Responding to Safety Concerns; Enhancing Design Planning to Minimise Internal & External Consequences; and Ambiguous Application of Standards in Operating Room Design Planning.

Conclusion: Health professionals highlighted safety impacts related to patients and staff due to the built environment and emphasised the need for improved engagement, respect and collaboration in design processes. Consideration needs to be given to the lived experiences of health professionals in design planning to address safety concerns effectively. Hierarchies and cultural factors were identified as barriers to inclusive design processes.