Journal of perioperative practice最新文献

Background: Artificial intelligence holds the potential to transform perioperative medicine by leveraging complex datasets to predict risks and optimise patient management in response to rising surgical volumes and patient complexity.

Aim: This bibliometric analysis aims to analyse trends, contributions, collaborations and research hotspots in artificial intelligence and perioperative medicine.

Methods: A Scopus search on 11 October 2024 identified articles on artificial intelligence in perioperative medicine. Relevant peer-reviewed studies were screened by two reviewers, with a third resolving discrepancies. Data were analysed using VOSviewer, Biblioshiny and Microsoft Excel.

Results: A total of 240 articles were included; 84% of articles were published after 2018, indicating rapid recent growth. The United States, China and Italy led contributions. Single-country publications comprised 76.6% of the dataset, reflecting limited international collaboration. Key research areas included perioperative risk prediction, intraoperative monitoring, blood management and echocardiography.

Conclusion: Artificial intelligence in perioperative medicine is rapidly advancing but requires increased international collaboration to fully realise its potential.

Background: This study aimed to assess the feasibility of real-time ultrasound-guided thoracic epidural placement.

Methods: A prospective observational study was conducted in 20 patients undergoing elective abdominal and thoracic surgery. The procedure, performed with patients in a lateral position, involved three sequential steps: (1) identification of the interlaminar gap, (2) advancement of the Touhy needle, and (3) identification of the epidural space. Success was defined as the catheter insertion with achieving sensory blockade. The estimated and actual epidural depth, thoracic epidural placement success rate and procedural time were recorded.

Results: The average age and body mass index were 62.1 ± 8.9 years and 22.4 ± 4.4 kg/m². Thoracic epidural placement was successful in 18 patients (90%, 95% confidence interval: 77-100), and at first attempt in 12 of those (66.7%). The thoracic epidural placement times and total procedural time were 5 (4-6.75) min and 19.5 ± 5.4 min, respectively. The correlation between ultrasound-estimated epidural depth and actual depth was 0.81.

Conclusion: Ultrasound guidance enhances thoracic epidural success rates and reduces attempts and skin punctures.

Perioperative pulmonary aspiration is a critical complication linked to significant morbidity and mortality, particularly in high-risk populations such as patients with diabetes, obesity, gastroparesis, or those using Glucagon-Like-Peptide-1 receptor agonists (GLP-1 RAs). Standard fasting protocols may not be appropriate for these patients, as they have increased propensity of delayed gastric emptying, hence increasing the complex of the preoperative risk assessment. Gastric ultrasound (GUS) provides a non-invasive, reliable method for assessing gastric content and volume, enabling anaesthesia professionals to make informed decisions regarding aspiration risk, airway management, and surgical scheduling. By identifying patients with elevated gastric volumes, GUS has the potential to reduce aspiration-related complications and unnecessary surgical cancellations.Despite its clear clinical benefits, the adoption of GUS in anaesthetic practice remains limited, primarily due to the technical skill required for accurate quantitative assessments. Qualitative evaluations of gastric contents are simpler for beginners, but precise volume measurements, essential for risk stratification, demand more extensive training. Recent studies demonstrate that with structured training, even novice operators can achieve high diagnostic accuracy. Artificial intelligence (AI) can further enhance GUS utility by automating volume calculations, guiding probe placement, and providing real-time feedback. These capabilities could significantly shorten the learning curve and improve consistency in risk assessment.Incorporating GUS and AI tools into anaesthesia training can overcome adoption barriers, enabling clinicians to more accurately assess aspiration risk and enhance patient safety in perioperative care.

Background: This study aimed to evaluate the effect and influence of midazolam and cartoon on postoperative behaviour in reducing preoperative anxiety in preschool children.

Methods: Three hundred children undergoing monocular strabismus correction were divided into three groups: midazolam (M), cartoon (C), and CM. Preoperative anxiety scores, cooperation scores during anaesthesia induction, awakening time, emergence agitation, and postoperative adverse behaviours were recorded.

Result: The preoperative anxiety scores of group CM in the preoperative area and before anaesthesia induction were lower than those of group C and M. Compared with Group C, the cooperation scores of Group M and Group CM decreased significantly. And group M's awakening time was prolonged. The incidence of agitation during awakening and adverse behaviour 1 week after surgery and the cooperation scores in group CM was lower than in groups M and C. The anxiety levels were positively correlated with the agitation and behavioural changes.

Conclusion: Watching cartoon videos combined with a low-dose midazolam shows efficacy in reducing preoperative anxiety in children.

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.