Journal of perioperative practice最新文献

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.

Many patients experience perioperative anxiety due to a variety of different reasons. Essential processes of shared decision-making and informed consent may help to mitigate anxiety, yet language barriers may hinder this particularly in diverse patient populations. As such, language-specific approaches in anaesthesia care play a crucial role in reducing perioperative stress and anxiety among patients with limited English proficiency. This review examines which methods during anaesthetic assessments and shared decision-making processes enable anaesthetists to communicate effectively with patients who have limited English proficiency and thereby reduce perioperative stress. Findings suggest that collaborating with patients in their native language significantly reduces anxiety and improves understanding, while transcreation - culturally adapted translation - enhances the effectiveness of communication. To decrease perioperative anxiety among populations with limited English proficiency and improve surgical outcomes, it is important to enhance anaesthesia-focused training for interpreters, increase diversity in the anaesthesia field, and develop culturally relevant patient education materials.

Background: The rise in global cannabis use has led anaesthetists to encounter an increasing number of patients on cannabis and cannabinoids. With cannabis influencing the perioperative period, anaesthetists will face associated challenges managing these patients.

Objective: This review aims to summarise this literature on perioperative care for patients with long-term cannabis consumption or cannabis use disorder.

Methods: This review was conducted based on the PRISMA 2020 statement. A literature search was performed using Medline and Cochrane library databases to identify relevant reports published from 2003 to 2023. This search yielded 209 records. After screening, 17 articles were included.

Results: Preoperative screening of patients for chronic cannabis use or cannabis use disorder can be valuable, due to the increased risk of postoperative myocardial infarction, more postoperative pain and opioid use. Moreover, regarding respiratory management, anaesthetists should prepare to manage bronchospasm and consider adjustments in ventilation. During the perioperative period, attention should be paid to potential interactions between anticoagulant medications and cannabinoids.

Objective: Assess safety and efficacy of an Enhanced Recovery After Caesarean protocol.

Background: Caesarean sections are among the most commonly performed surgeries worldwide, but have been associated with postoperative chronic pain and opioid abuse.

Methods: ASA 2 females, over 18 years, non-primiparous, repeat elective LSCS. Primary outcomes were length of stay and opioid consumption. Secondary outcomes were pain scores, functional assessment scores, pruritus, nausea and vomiting.

Results: A total of 579 women divided into standard care (389 patients) and enhanced recovery after caesarean groups (190 patients). Enhanced recovery after caesarean associated with reduced length of stay, 50.8 hours (interquartile range 48.6, 53.6) versus 72.2 hours (interquartile range 53.2, 75.7) in standard care. Enhanced recovery after caesarean associated with reduced opioid consumption, median 10 (interquartile range 0, 27.5mg) versus 120mg (interquartile range 90, 145mg) in standard care at 24 hours and 30 (interquartile range 7.7, 67.5mg) versus 177.5mg (interquartile range 132.5, 222.5 mg) at 48 hours. Pain scores reduced from moderate to mild in the enhanced recovery after caesarean. functional assessment scores trend towards improved function in the enhanced recovery after caesarean group (Functional assessment scores B 8.9% in enhanced recovery after caesarean versus 147% in standard care). Increased pruritus in the enhanced recovery after caesarean with 41.6% compared with 9.3% in standard care. Nausea and vomiting increased in enhanced recovery after caesarean group 48.9% versus 11.6% in standard care.

Conclusion: Enhanced recovery after caesarean associated with a reduction in length of stay, opioid consumption and improved pain scores with an increase in side effects.

Robotic surgery in England is undergoing rapid expansion, with projected growth from 70,000 procedures in 2023-24 to over 500,000 annually by 2035. This shift not only affects surgical technology but redefines perioperative roles - particularly bedside assistance. Despite growing attention from national initiatives such as Getting It Right First Time, regulatory clarity remains lacking. The scope and responsibilities of bedside assistants - a role often conflated with surgical assistance - vary significantly depending on professional background and qualifications. Without clear governance, perioperative practitioners may face liability risks, and patients are left exposed to inconsistent practice. This viewpoint highlights the urgent need for perioperative bodies such as The Association for Perioperative Practice and the Perioperative Care Collaborative to lead the development of national guidance specific to bedside assistance in robotic surgery. Doing so is essential to ensure safe practice, appropriate delegation, and professional accountability in this evolving surgical landscape.

The patient's health and nature of the surgery are important considerations when selecting anaesthetic drugs. This report considers the anaesthetic drugs selected for a patient undergoing day case diagnostic laparoscopy for chronic pelvic pain. Appropriate drug selection for patients with a suspected history of cancer is crucial. Anaesthetic agent selection requires a balance between possible postoperative complications and long-term survival. Total intravenous anaesthesia was selected for its favourable long-term survival rate, its effect on reducing immunosuppression, and to aid with providing a bloodless field. Metaraminol was selected to prevent profound hypotension and to provide normotension when assessing bleeding. Sugammadex has a high binding affinity for steroidal hormones, potentially contributing to contraceptive failure. Neostigmine was selected as the reversal agent due to the childbearing age of the patient. A muscle relaxant was selected to improve surgical conditions via a pneumoperitoneum. Rocuronium was selected due to its rapid onset and rapid reversibility with sugammadex. A thorough understanding of anaesthetic drugs is required if they are to be used appropriately. Inappropriate anaesthetic drug selection may provide sub-optimal operating conditions, contribute to unplanned pregnancy, worsen patient outcomes, and delay discharge.

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.

Background: Anxiety affects the patient's perception of postoperative pain and causes a significant increase in the consumption of analgesia postoperatively.

Objective: This study assesses the relationship between preoperative anxiety, postoperative pain and postoperative pethidine consumption.

Methods: A prospective cohort design was used. Data were collected from 100 patients who were undergoing a laparoscopic cholecystectomy at St Joseph Hospital, Jerusalem. Pain-controlled analgesia with pethidine was utilised to manage pain throughout the postoperative period. The visual analogue scale scores and pethidine consumption of all patients were recorded.

Findings: Participants' mean level of pain was higher in the preoperative period (mean visual analogue scale = 1.3) compared with their mean level of pain in the postoperative period (mean visual analogue scale = 0.5). There is a statistically significant difference between the participants' level of anxiety and postoperative pain level (p < 0.001). Gender, weight, level of education and smoking were predictors of developing preoperative anxiety. Also, gender, smoking and medication were statistically significant predictors of developing postoperative pain. Furthermore, gender, medical history and medication were statistically significant predictors of pethidine consumption postoperatively.

Conclusions: The preoperative anxiety reduction intervention should be promoted and implemented as routine care for all surgical patients.

Introduction: Ensuring radiation safety in healthcare settings is crucial to minimising risks associated with ionising radiation exposure. This study aimed to evaluate the knowledge and behaviours of operating room personnel regarding protection from ionising radiation.

Materials and methods: This cross-sectional correlational study was conducted with 100 surgical team members in two hospitals in Türkiye. Data were collected using the Demographic Information Form and Healthcare Professional Knowledge of Radiation Protection Scale.

Results: The participants' overall knowledge level regarding radiation protection was an average score of 5.09 ± 2.35. A statistically significant difference was observed between the surgical team member role and the subscale of radiation physics, biology, and principles of radiation use (p = 0.008), as well as the total scale score (p = 0.025). The participants who had received training had significantly better knowledge and behaviours related to radiation protection (p < 0.05).

Conclusion: The surgical team members demonstrated an adequate level of awareness regarding radiation protection, but there were deficiencies in translating their knowledge into practice. Providing periodic training supported by interactive learning methods can reinforce the radiation safety practices of healthcare professionals.