Journal of perioperative practice最新文献

Case: An active healthy 68-year-old male sustained a bilateral quadriceps tendon rupture while running. He underwent a simultaneous bilateral quadriceps tendon repair in a dual-surgeon approach. The right quadriceps tendon was repaired with a tourniquet, while the left quadriceps tendon tear was repaired without one. Postoperatively, the patient developed deep vein thrombosis in the right leg, which led to a bilateral pulmonary embolism. This case illustrates a potential complication of tourniquet use in patients undergoing quadriceps tendon repairs.

Conclusion: The use of tourniquets in orthopaedic surgeries may be associated with potential risks, such as development of venous thromboembolism including deep vein thrombosis and pulmonary embolism. This case highlights the importance of carefully considering tourniquet use for quadriceps tendon repairs and close postoperative monitoring, early mobility, and thromboprophylaxis to prevent severe complications.

Background: The incidence of perioperative cardiovascular morbidity and mortality in diabetic patients is due to impaired cardiovascular response to exercise caused by impairment in peripheral blood flow and oxygen diffusion to the exercising muscle. Preoperative bedside testing by 6-min walk for autonomic dysfunction in diabetic patients might reduce haemodynamic instability and cardiovascular complications.

Methods and materials: Sixty patients with American Society of Anaesthesiologists grade 1 classification and 60 diabetic patients (total of 120) of age 30-60 years, of either sex, undergoing elective surgery under general anaesthesia were recruited. A 6-min walk test, breath-holding time and five clinical bedside tests for autonomic dysfunction were performed. Based on that, patients were classified into non-diabetic patients (group C), diabetic patients without autonomic dysfunction (group D) and diabetic patients with autonomic dysfunction (group A).

Results: The incidence of autonomic dysfunction was 31.7%. Among all the parameters, breath-holding time, steps and distance covered by 6-min walk test was significantly less in group A. The incidence of intraoperative tachycardia and hypotension was significantly higher (78.9% and 57.9%, respectively) in group A.

Conclusion: The 6-min walk test can be used as one of the preliminary tests for detection of cardiac autonomic neuropathy in diabetes since it had association with distance covered and intraoperative haemodynamic disturbances.

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.

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: The choice of analgesic technique for total knee arthroplasty affects its rehabilitation and surgical outcomes. This study evaluates this choice on short-term postoperative quality of life.

Methods: In this prospective observational study, patients were categorised into two groups: epidural analgesia or peripheral nerve blocks. The medical and intraoperative data of 36 adult patients undergoing scheduled total knee arthroplasty was collected. The researchers applied the Knee Injury and Osteoarthritis Outcome Score (KOOS), EuroQoL 5 Dimension Score (EQ-5D) and Clinical Frailty Scale questionnaires, preoperatively and at 48 hours postoperatively.

Results: Both groups showed postoperative improvement in pain, mobility and perceived health status. However, no significant differences were observed between the groups across any of the outcome measures, suggesting comparable postoperative results.

Discussion: Although epidural analgesia has traditionally been favoured, no clear advantage was identified. These results support the consideration of both techniques in clinical practice and highlight the need for further research on long-term, patient-centred recovery indicators.

Myocardial injury after non-cardiac surgery is due to ischaemia either during non-cardiac surgery or within 30 days after it. Our surveillance protocol includes hip fracture template and high-sensitivity troponin stratification, as recommended in European countries. Our retrospective study cohort included surgical patients for hip fracture at our hospital in Japan. The primary outcome was the rate of myocardial injury after non-cardiac surgery in comparison to patients managed with (213) and without (176) hip fracture template. The hip fracture template was used more in patients with myocardial injury after non-cardiac surgery than those without myocardial injury after non-cardiac surgery. When hip fracture template was used, patients had a higher likelihood of myocardial injury after non-cardiac surgery after adjusting for age, time to operation, diabetes mellitus, and chronic kidney disease (odds ratio 41.3; 95% confidence interval: 12.1, 259.6). Patients with myocardial injury after non-cardiac surgery had higher in-hospital mortality than those without myocardial injury after non-cardiac surgery, even in adjusted analysis. There was a high detection rate of myocardial injury after non-cardiac surgery when patients with hip fractures were managed with hip fracture template. Myocardial injury after non-cardiac surgery was associated with in-hospital mortality.

Introduction: Effective postoperative wound care is essential in orthopaedic surgeries to minimise complications such as infection, swelling, and compartment syndrome. Postoperative oedema can delay healing and restrict mobility. SU-Mag ointment, known for its hygroscopic and anti-inflammatory properties, has been used in conditions like thrombophlebitis and intravenous infiltration, but its role in orthopaedic postoperative care is not well studied. This study evaluates the effectiveness of SU-Mag dressing in reducing postoperative oedema following limb fracture fixation surgeries.

Methodology: A 12-month prospective observational study was conducted at a tertiary care centre involving 233 patients undergoing upper or lower limb fracture fixation. Patients with open wounds, vascular disorders, immunosuppression, or hypersensitivity to SU-Mag components were excluded. Post-surgery, SU-Mag ointment was applied circumferentially around, but not on, the incision site, followed by sterile gauze, cotton padding, and a crepe bandage. The dressing was kept in place for 72 h unless an early change was needed.

Results: Among 233 patients (mean age 43.8 ± 13.2 years), 68.6% had no swelling and 31.7% had only mild oedema. Mean oedema score was 0.32 ± 0.12, with an average limb circumference difference of 0.42 ± 0.11 cm (p < 0.001). No major complications were noted.

Conclusion: SU-Mag dressing effectively reduced postoperative oedema and discomfort without adverse effects.

Background: Tourniquet use is ubiquitous in the operating theatre. However, optimal tourniquet usage is unclear, including type, pressure, inflation time, or whether a tourniquet should be used at all. This study reports a literature review of tourniquet use, comparing type, pressure, duration, effectiveness, and the spectrum of complications in an adult surgical population.

Results: Data regarding population size, surgery performed, tourniquet type, tourniquet location, total tourniquet inflation time, timing of inflation and deflation, pressure, and complications were recorded. Postoperative tourniquet-related pain was the commonest adverse event. Other complications included venous thromboembolism, wound healing issues, neuropathy, and abrasions. Findings suggest that most surgeons use standardised pressures.

Conclusion: Tourniquets are associated with a spectrum of complications. It is unclear whether tourniquet use provides better surgical outcomes. If tourniquets are used, surgeons should minimise the application pressure and duration. This may be achieved through a patient-centred approach and careful use of padding.

Background: Total hip replacement is a quality of life-enhancing procedure. Postoperative blood transfusion is a risk factor compromising the outcome of total hip replacement and increasing the risk of deep infection. The aim of this study is to determine the risk factors for postoperative blood transfusion after total hip replacement.

Methods: In this retrospective study, 3901 patients underwent primary total hip replacement, in the period between January 2015 and December 2023. The mean age of the participants was 67.3 (SD: 12.6) years, and 61% of them were females. Participants were divided into 'transfusion' and 'non-transfusion' groups.

Results: Forty-two patients (1.1%) received blood transfusion after total hip replacement. In a multivariable logistic regression analysis, preoperative haemoglobin was the only independent risk factor that reduced the odds of postoperative transfusion by 0.3 (95% confidence interval: 0.23-0.39) for every 1 g/dL increase.

Conclusion: Postoperative blood transfusion is a rare, yet potentially serious, occurrence after total hip replacement. In this study, preoperative haemoglobin level was the only independent risk factor associated with postoperative transfusion. We recommend aiming to achieve minimum preoperative haemoglobin level of 13 g/dL to minimise the risk of postoperative transfusion.