Journal of perioperative practice最新文献

Perioperative medication management in patients who are nil by mouth for surgery or endoscopy is often suboptimal. Inappropriate medication management can prolong postoperative recovery and increase morbidity and mortality. This quality improvement study, carried out in general surgical patients at an 800-bed general hospital, aimed to improve perioperative medication management in accordance with the recommendations of the UK Clinical Pharmacy Association Handbook of Perioperative Medicine. Increasing awareness and educating general surgical team members, including doctors and non-medical prescribers, about perioperative medication management led to a non-significant improvement in medication management. However, a statistically significant improvement was achieved when nursing staff were also included. This study highlights the importance of involving different members of the multidisciplinary team in perioperative medication management.

Background: Nasotracheal intubation is challenging for anaesthesiologists in faciomaxillary injuries due to the anticipated difficult airways. The effectiveness of a non-channelled McGrath video laryngoscope was compared with a conventional Macintosh laryngoscope during nasotracheal intubation.

Methods: Sixty American Society of Anaesthesiologists I-II patients aged between 18 and 60 years of both sexes undergoing elective faciomaxillary surgeries from September 2019 to February 2020 were prospectively randomised into two groups (Macintosh laryngoscope Group, McGrath video laryngoscope Group) of 30. The primary outcome was ease of intubation (Modified Intubation Difficulty Scale) and Nasotracheal intubation time (T1 time: from nostril to nasopharynx, T2 time: from nasopharynx until the first ETCO2, total time: T1 + T2). The secondary outcomes were Cormac Lehane grade, additional manoeuvres requirement, intubation failure, tracheostomy incidence and associated complications.

Results: T1, T2 and total (T1 + T2) time (mean ± SD) were statistically prolonged in the McGrath video laryngoscope than Macintosh laryngoscope group, with p = 0.044, p = 0.000 and p = 0.000, respectively. The McGrath video laryngoscope facilitated a better laryngoscopic view (p = 0.002), favourable intubation difficulty scale scores, less lifting force (p = 0.002), reduced lip trauma (p = 0.002) and decreased Magill's forceps use (p = 0.002) than the Macintosh laryngoscope group.

Conclusion: Despite longer intubation time, the non-channelled McGrath video laryngoscope offered favourable intubating conditions with superior glottis view, less lifting force and reduced Magill's forceps requirement, causing decreased airway trauma, lower intubation difficulty scale scores than Macintosh laryngoscope for nasotracheal intubation.

Abdominal aortic aneurysm poses a significant risk of rupture, with mortality rates of 80% to 90% if untreated. Management focuses on identifying and repairing the aneurysm before rupture, considering factors like size, type and symptoms. We report successful anaesthetic management in a case of intertrochanteric fracture of femur of an elderly patient who was to undergo elective surgery for abdominal aortic aneurysm. Few cases detail abdominal aortic aneurysm management during non-cardiac surgery, emphasising careful anaesthesia titration. This case report underscores the importance of precise intraoperative anaesthesia management in emergency non-cardiac surgery for abdominal aortic aneurysm patients.

Background: Clonidine and dexmedetomidine are alpha-2 receptor blockers administered for haemorrhage control during surgery in limited settings. Functional endoscopic sinus surgery (FESS) may be associated with bleeding, thus making it challenging. This study aims to evaluate the effect of dexmedetomidine and clonidine on haemorrhage control during FESS and surgical outcomes.

Methods: This three-blinded prospective study included 102 patients who underwent FESS at the Imam Khomeini public referral hospital at the Imam Khomeini public referral hospital, in Urmia, Iran. It was either American Society of Anaesthesiologists (ASA) class I or II. They were divided into three groups (clonidine, dexmedetomidine, and placebo). The volume of blood loss, mean arterial pressure, surgical field visualisation, and surgeon satisfaction were assessed in the three groups. Data analysis was performed using SPSS version 23.0.

Results: Dexmedetomidine and clonidine decreased mean arterial pressure, heart rate, and blood loss volume while improving surgical field visualisation. The effect of dexmedetomidine was associated significantly statistically with surgeon satisfaction (p < 0.0001). Furthermore, dexmedetomidine improved the surgical field and reduced operating times in the dexmedetomidine group (p < 0.0001).

Conclusion: The present clinical trial findings indicated that the administration of dexmedetomidine during FESS decreased mean arterial pressure, provided balanced anaesthesia and appropriate analgesia, and improved the visibility of the surgical field and increased surgeon satisfaction.

Background: Females undergoing laparoscopic gynaecological surgeries have a high incidence of postoperative nausea and vomiting. Apart from the established risk factors, hormonal, psychological, genetic and ethnic factors may also contribute to postoperative nausea and vomiting. This study aimed to evaluate the relationship between preoperative anxiety and serum oestrogen level with postoperative nausea and vomiting in patients undergoing diagnostic laparoscopy - hysteroscopy for infertility.

Methods: In total, 100 female patients, between the ages of 20-40 years, undergoing diagnostic laparoscopy - hysteroscopy for infertility were recruited for this study. Preoperative anxiety level was assessed using Depression, Anxiety and Stress Scale-21 (DASS-21) Questionnaire. Serum oestrogen samples were taken before anaesthesia. Postoperative nausea and vomiting grading was rated with 0-3 Likert-type scale. An association of anxiety and oestrogen levels to postoperative nausea and vomiting was done.

Results: The analysis between median DASS 21 scores to postoperative nausea and vomiting grading showed no association between DASS 21 scores and postoperative nausea and vomiting grades. Comparing the mean oestrogen levels in patients among each grade of postoperative nausea and vomiting showed no significant difference in the mean oestrogen levels.

Conclusion: Our study did not find evidence of a significant association between serum oestrogen levels, preoperative anxiety, and postoperative nausea and vomiting.

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.

Following the COVID-19 pandemic, National Health Service trusts nationwide are faced with a significant backlog of patients to clear, furthering the strain on the National Health Service. In an era where sustainability and efficient management of National Health Services is of paramount importance, the introduction of a Golden Theatre Initiative could alleviate day-to-day pressures and assist in the smooth running of a modern-day theatre department. Preoperative burdens on patients can be both physical and psychological, resulting in fears and anxiety surrounding the unknown. It is not uncommon for elective procedures to be cancelled last minute due to pressures; however, this can hugely impact the willingness of a patient to comply in the future, with a potential adverse effect on their health. Cost-effectiveness, reduction on waiting lists and overall negative patient impact, in addition to an improvement on first case start times following the introduction of the Golden Patient Initiative, have been observed nationally. It is believed with the introduction of a Golden Theatre Initiative; these improvements could greatly change the current running of elective waiting lists nationally.

The WHO Surgical Safety Checklist has been instrumental in reducing surgical deaths by 47% globally since its inception in 2009. A study was conducted to assess the compliance of hospital staff with the Surgical Safety Checklist and identify potential barriers to its implementation at a large tertiary public hospital in Vietnam. The study analysed 135 surgical cases between February and September 2021 using the Pareto principle with eight error categories, including (1) patient identification, (2) equipment, (3) risk management, (4) blood loss, (5) allergy, (6) items left inside the patient, (7) surgical specimens and (8) patient safety and recovery management. Compliance with the Surgical Safety Checklist was between 77% and 93%, with five categories accounting for more than 80% of errors. Periodic monitoring and staff training can improve compliance and help reduce errors for better patient safety. Long-term solutions addressing infrastructure challenges are also crucial.

Throughout history, many innovations have contributed to the development of modern cardiothoracic surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern cardiothoracic surgery: cardiopulmonary bypass, surgical pacemakers, video assisted thoracic surgery, robotic surgery and mechanical circulatory support. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of cardiothoracic surgery and their ongoing relevance in contemporary and perioperative practice.