Journal of perioperative practice最新文献

Background: Surgical site infections are the second most common type of healthcare-associated infection.

Objective: This study aimed to assess the incidence and associated risk factors of surgical site infection after implementing surgical site infection bundles in cardiac surgery.

Methods: This study employed a quantitative descriptive methodology, encompassing a retrospective analysis of surgical site infection incidence following cardiac surgeries. It also included a prospective experimental approach to evaluate the effectiveness of surgical site infection bundles compared to routine care, conducted across hospitals in the West Bank. In total, 222 cardiac surgery patients were included in this study.

Findings: Among patients undergoing cardiac surgery, 70% underwent coronary artery bypass graft. Furthermore, males were the majority (70.3%), and 45% were either overweight or obese. Hypertension was the higher prevalent chronic disease (72.5%). The incidence rate of surgical site infection was 7.2%. Adherence to the surgical prophylaxis protocol (Bundle) was associated with a reduction in surgical site infection rates, and the incidence of surgical site infection was higher among the conventional group compared with surgical site infection bundle group (10.9% vs. 3.6%). Higher mean level of glucose, high BMI, and having respiratory chronic disease were factors associated with surgical site infection in patients who underwent cardiac surgery.

Conclusion: Adherence to the surgical prophylaxis protocol (Bundle) was associated with a reduction in surgical site infection rates.

Objective: To assess the relationship between consent signature timing and first-start case delay.

Study design: Consecutive first start patients who arrived on day-of-surgery from home at a single centre from 28 days in June 2021 were identified. First-case delay was defined as operating theatre (OT) in-room time greater than 5 minutes after scheduled start time.

Results: A total of 289 patients were eligible for the study. Surgical consent signing in the preoperative area and non-English primary language were significantly associated with OT delay; 234 patients (81%) had signed surgical consent on the day of surgery in the preoperative area. Patients who signed surgical consent on day- of- surgery were 3.2 times as likely to experience OT in-room time delay compared to those who signed surgical consent prior to day of surgery, odds ratio (OR) 3.2, 95% confidence interval (CI): 1.2, 8.5, p = 0.02. Patients with non-English primary language had 3.8 times greater risk for case delay (OR 3.8, 95% CI: 2.0, 7.4, p < 0.0001).

Conclusion: Same day consent signing among patients arriving for surgery from home may cause significant operating theatre start time delays. In addition to ethical reasons, obtaining consent in the preoperative area should be avoided to improve preoperative efficiency.

In the perioperative environment, local anaesthetics are commonly administered to patients to provide analgesia and anaesthesia for a large range of surgical procedures. Although rare, their use can result in systemic toxicity, which is a life-threatening complication, underscoring the importance of early recognition and prompt management to mitigate patient risks. This article evaluates the impact of human factors and other aspects such as insufficient monitoring, errors in drug administration and poor adherence to safety protocols on the development and management of local anaesthetic systemic toxicity and provides practical considerations to minimise its occurrence.

The oxygen dissociation curve is a critical concept in understanding how oxygen is transported in the blood and delivered to tissues. In anaesthesia, inhaled anaesthetic agents are the fundamental tools for managing anaesthesia during surgical procedures. These agents, such as desflurane, isoflurane, and sevoflurane, are known for effects on the central nervous system and cardiovascular stability. However, their impact on haemoglobin's oxygen-binding capacity, represented by shifts in the oxygen dissociation curve, can have significant effects on patient care. This discussion explores the interactions between inhaled anaesthetic agents and the oxygen dissociation curve, focusing on how these drugs alter haemoglobin's affinity for oxygen and the potential clinical consequences of such interactions. Clinical implications: oxygen dissociation curve shifts are crucial in patient management, especially in populations with compromised pulmonary function or those undergoing extensive surgeries. Anaesthesia providers must consider these effects when optimising oxygen delivery and anaesthetic depth.

Persistent hiccups in the perioperative setting, although uncommon, can substantially impact a patient's wellbeing and recovery after surgery. We present a case of a 51-year-old male who developed persistent hiccups during total knee replacement surgery under neuraxial anaesthesia. The hiccups persisted postoperatively, leading to multidisciplinary interventions, including the introduction of central-acting muscle relaxant, baclofen. This case highlights the complexity of managing persistent hiccups in the perioperative period, where both aetiology and treatment are multifactorial, emphasising the need for further research in this field.

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.