Journal of perioperative practice最新文献

Health promotion has been made as one of the top priorities by the Lord Darzi's independent investigation of the NHS. Patients who smoke have increased risks of perioperative complications. Similarly, alcohol consumption is linked with higher rates of perioperative infections. Resident anaesthetists and the multidisciplinary team are in unique positions to positively influence patients and promote lifestyle modifications. Transformations of education, working culture and integration of primary and secondary health systems are vital in achieving true holistic perioperative care.

Background: Under general anaesthesia, the impact of body positioning on different organs is mostly determined by the subsequent changes in the cardiovascular system, which are monitored with standard monitors. However, there is no objective method of neuromonitoring, therefore impacts on brain homeostasis are mainly conjectural. Near-infrared spectroscopy is a non-invasive method for monitoring tissue cerebral oxygenation. In this study, we aimed to observe the effects of the prone position on cerebral oxygenation in patients under general anaesthesia.

Methods: The study involved 44 patients undergoing spine surgeries in a prone position under general anaesthesia. Regional oxygen saturation readings were initially taken in the supine position and monitored continuously after transitioning to the prone position. A decrease in regional oxygen saturation of more than 20% was considered clinically significant.

Results: A significant drop in blood pressure (p = 0.02) and heart rate (p = 0.04) was observed after positioning patients prone under general anaesthesia. In addition, end-tidal carbon dioxide levels rose notably after 30 min in the prone position (p = 0.017). Importantly, while no significant differences were found in cerebral oxygenation between the supine and prone positions, one patient did experience right-sided vision loss postoperatively.

Conclusion: Using near-infrared spectroscopy monitors is recommended for patients with comorbidities and those undergoing surgeries with extended durations in the prone position.

Objectives: This study investigates the outcomes after very early chest drain removal following off-pump endoscopic coronary artery bypass grafting.

Methods: A single-centre retrospective cohort study was conducted at our hospital. All patients undergoing a primary endoscopic coronary artery bypass grafting procedure between May 2021 and January 2025 were eligible. Both single- or multivessel endoscopic coronary artery bypass grafting procedures were analysed. Patients were excluded if they underwent a redo-operation, coronary unroofing procedure, or conversion to sternotomy.

Results: A total of 476 patients were included in the final analysis: 246 patients in the conventional drain removal protocol and 230 patients in the early drain removal protocol. Patients in the early drain removal group had significantly higher rates of preexisting comorbidities, preoperative antithrombotic therapy, and urgent procedures (52.6% vs. 36.2%, p < 0.001). The total drain time (5.1 vs. 22.4 h, p < 0.001) and the total drain volume (135 vs. 310 mL, p < 0.001) were both significantly lower in the early postoperative drain removal protocol. There were no significant differences between protocols in the incidence of cardiac tamponade in the first 30 postoperative days (1.3% vs. 0.4%, p = 0.569) and thoracentesis rates (8.7% vs. 5.3%, p = 0.199).

Conclusions: Very early chest drain removal after endoscopic coronary artery bypass grafting is safe and does not increase postoperative complications for both single- and multivessel revascularisation. This approach enables early ambulation and may contribute to enhanced postoperative recovery.

Background: The optimal length of epidural use following open pancreaticoduodenectomy has not been defined. The aim of this study was to investigate whether the length of patient-controlled epidural analgesia affected pain and ability to mobilise on epidural termination following open pancreaticoduodenectomy in the context of enhanced recovery after surgery.

Methods: A retrospective single-centre cohort analysis was performed between November 2015 and December 2021 on patients who underwent open pancreaticoduodenectomy. As part of a continual review process of the enhanced recovery after surgery protocol, patient-controlled epidural analgesia duration changed allowing stratification of patients into either three- or five-day patient-controlled epidural analgesia groups.

Results: Of the 196 patients identified, 157 were included with 80 (50.9%) and 77 (49.1%) allocated to the three-day and five-day patient-controlled epidural analgesia groups, respectively. Patient-controlled epidural analgesia termination on postoperative day 3 was associated with transiently higher pain and less mobilisation, although no greater rescue analgesia requirement. Conversely, longer patient-controlled epidural analgesia usage following open pancreaticoduodenectomy was associated with less pain and greater mobilisation in the immediate postoperative period.

Conclusions: Earlier patient-controlled epidural analgesia termination transiently leads to increased pain and decreased mobilisation following open pancreaticoduodenectomy. Ensuring appropriate analgesia requirements or longer patient-controlled epidural analgesia usage should be considered to avoid patient discomfort and enhance recovery.

BackgroundThe COVID-19 pandemic challenges the recommendations for patients' preoperative assessment for preventing severe acute respiratory syndrome coronavirus type 2 transmission and COVID-19-associated postoperative complications and morbidities.PurposeTo evaluate the contribution of chest computed tomography for preoperatively assessing patients who are not suspected of being infected with COVID-19 at the time of referral.MethodsCandidates for emergency surgery screened via chest computed tomography from 8 to 27 April 2020 were retrospectively evaluated. Computed tomography images were analysed for the presence of COVID-19-associated intrapulmonary changes. When applicable, laboratory and recorded clinical symptoms were extracted.ResultsEighty-eight patients underwent preoperative chest computed tomography; 24% were rated as moderately suspicious and 11% as highly suspicious on computed tomography. Subsequent reverse transcription polymerase chain reaction (RT-PCR) was performed for seven patients, all of whom tested negative for COVID-19. Seven patients showed COVID-19-associated clinical symptoms, and most were classified as being mildly to moderately severe as per the clinical classification grading system. Only one case was severe. Four cases underwent RT-PCR with negative results.ConclusionIn a cohort without clinical suspicion of COVID-19 infection upon referral, preoperative computed tomography during the COVID-19 pandemic can yield a high suspicion of infection, even if the patient lacks clinical symptoms and is RT-PCR-negative. No recommendations can be made based on our results but contribute to the debate.

Our understanding of the effects of anaesthesia is incomplete. Anaesthesia works primarily by causing widespread depression of the central nervous system. This article will consider the anaesthesia provided for a patient undergoing a hysteroscopy, endometrial ablation and biopsy for abnormal uterine bleeding. The relationship between physiology and the effects of anaesthesia is discussed. Several effects of anaesthesia are observed during the case. Relating to the respiratory system, preoxygenation increased end tidal oxygen by 39%, delaying desaturation during apnoea. Propofol had a profound effect on the patient's respiratory rate by inhibiting the ventilatory drive, resulting in apnoea. The cardiovascular system was affected by tracheal intubation. Stimulation of the sympathetic nervous system caused a 96% increase in heart rate. Induction of anaesthesia resulted in hypotension, treated with the administration of ephedrine, causing vasoconstriction. Modified rapid sequence induction required an increased dose of rocuronium, resulting in an increased duration of action at the neuromuscular junction. The prolonging muscle paralysis required sugammadex as a reversal agent. This case demonstrated the effects of anaesthesia on the respiratory, cardiovascular and nervous systems.

Difficult ventilation and intubation in anaesthesia are highly complex and challenging for the anaesthetist. We aim to present a case of successful nasotracheal intubation with surgical incision and video laryngoscope in a patient with anticipated difficult ventilation and intubation due to a limited mouth opening. A patient was an 81-year-old female scheduled for oral surgery for lip cancer. The patient's American Society of Anesthesiologists (ASA) physical classification was class III, and the oral airway was assessed as a Mallampati Class IV. A comprehensive preoperative evaluation of the patient revealed limited mouth opening (distance between incisors 1cm) and multiple decayed and broken teeth. A 2cm surgical incision of the skin was performed by plastic surgery under local anaesthesia and sedation without general anaesthesia. A high-flow nasal cannula (HFNO) was used for preoxygenation and to prevent desaturation during a difficult intubation. The oral cavity was topicalised with 2% lidocaine, and after the topical nasal vasoconstrictor to the nasal cavity, we selected a 7.0mm nasal flexible endotracheal tube (ETT). We inserted it into the right nostril with a video laryngoscope under local anaesthesia and sedation without general anaesthesia, and then, the patient's nasotracheal intubation was successfully performed. A multidisciplinary team approach to airway management should include all participants in planned patient care in the operating room, intensive care unit (ICU), post-anaesthesia care unit, or ward.

In this prospective randomised controlled trial, we compared the impact of the lateral versus supine position for tracheal extubation among infants aged two months to two years after intraabdominal surgery on the incidence of respiratory adverse events that may occur after extubation. The anaesthesia protocol was standardised. Among the 120 infants included (60 in each group), the demographic and perioperative data were comparable between both groups. The incidence of perioperative respiratory adverse events after tracheal extubation was 21.6% and 5% in the supine and lateral position groups, respectively, with p = 0.007 and odds ratio = 3.87; 95% confidence interval: 1.18-12.6. Lateral position also reduced the incidence of airway obstruction with p = 0.004 and odds ratio = 11.8; 95% confidence interval: 1.46-95.3 and oxygen desaturation below 92% with p = 0.008 and odds ratio = 11.8; 95% confidence interval: 1.46-95. The lateral position seems to be practical and beneficial for tracheal extubation among infants.