Journal of perioperative practice最新文献

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.

Background: Preoperative anxiety is one of the leading causes of morbidity in the perioperative period. Quality of Recovery (QoR)is a recent and valid questionnaire to assess recovery process in this time.

Methods: Ninety patients were visited by an anaesthetist twice in the preoperative period, by either the same or a different anaesthetist. The effect of the visits was evaluated on the basis of preoperative anxiety, and QoR.

Results: The mean APAIS (Amsterdam Preoperative Anxiety and Information Scale) result for the group with visits from different anaesthetists was significantly higher when compared to the group which received visits from the same anaesthetist (16.09 [14.51 to 17.67]) vs (12.40 [10.82 to 13.98]) (p = 0.002). However, time taken to discharge, QoR, and the Numeric Rating Scale (NRS) pain score were not significantly affected by the intervention.

Conclusion: Providing preoperative visits by the same anaesthetist may considerably lower preoperative anxiety.

Introduction: The choice of analgesic technique for total knee arthroplasty affects its rehabilitation and surgical outcomes. This study evaluates this choice on short-term postoperative quality of life.

Methods: In this prospective observational study, patients were categorised into two groups: epidural analgesia or peripheral nerve blocks. The medical and intraoperative data of 36 adult patients undergoing scheduled total knee arthroplasty was collected. The researchers applied the Knee Injury and Osteoarthritis Outcome Score (KOOS), EuroQoL 5 Dimension Score (EQ-5D) and Clinical Frailty Scale questionnaires, preoperatively and at 48 hours postoperatively.

Results: Both groups showed postoperative improvement in pain, mobility and perceived health status. However, no significant differences were observed between the groups across any of the outcome measures, suggesting comparable postoperative results.

Discussion: Although epidural analgesia has traditionally been favoured, no clear advantage was identified. These results support the consideration of both techniques in clinical practice and highlight the need for further research on long-term, patient-centred recovery indicators.

This report describes the anaesthesia provided for a class III obese patient with obstructive sleep apnoea, undergoing an elective laparoscopic cholecystectomy. Several adaptations were required to provide safe anaesthesia. A McGrath video laryngoscopy was utilised for intubation. The patient was positioned in the ramped position, thereby increasing time to desaturation on induction of anaesthesia. Pressure controlled ventilation - volume guaranteed mode was selected for ventilation to provide consistent tidal volumes. An increased level of positive end-expiratory pressure was utilised to minimise atelectasis. Drug doses were carefully considered and calculated with the aid of The Society for Obesity and Bariatric Anaesthesia dose calculator. The airway management adaptations provided an unobstructed view for intubation. Peak airway pressures during surgery remained within safe limits and no atelectasis was evident postoperatively. Pain was kept under control and desaturation was avoided during postanaesthetic care. The patient was discharged home later that evening.

In the highly specialised and rapidly evolving field of perioperative care, continuous professional development is essential for maintaining the competencies of healthcare professionals, directly impacting patient safety and the quality of care. This project aimed to assess the effectiveness of current continuous professional development approaches in meeting the learning needs of registered nurses and operating department practitioners within perioperative care in a United Kingdom National Health Service Trust hospital. A comprehensive self-assessment strategy was intended to evaluate the condition of current continuous professional development approaches, identify areas for improvement, and explore innovative uptake for improvement. Using a mixed-methods design, data were collected via an online survey of 76 participants. The data demonstrated significant knowledge, skill, and competency deficiencies, revealing that many current continuous professional development approaches lacked accessibility and relevance. This study may provide valuable insights for refining continuous professional development programmes to meet evolving learning needs better and improve patient outcomes.