Journal of Perianesthesia Nursing最新文献

Purpose: Opioids have long been an integral component of pain management in general anesthesia protocols. However, recent studies have increasingly supported the use of opioid-free anesthesia. This meta-analysis aimed to assess the effects of opioid anesthesia compared with opioid-free anesthesia on postoperative recovery.

Design: A systematic review and meta-analysis of randomized controlled trials, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Methods: We systematically searched Embase, PubMed, and the Cochrane Central Register of Controlled Trials up to June 18, 2023. Studies were included if they compared opioid-free anesthesia to opioid anesthesia and reported the quality of postoperative recovery. Meta-analyses primarily utilized a random-effects model.

Findings: In total, 13 randomized controlled trials, comprising 1,733 patients, were included in this analysis. The results indicated that opioid-free anesthesia improved the quality of postoperative recovery, with standardized mean difference of 0.46 (95% confidence intervals [CI]: 0.29 to 0.63, I² = 56%, P < .001) for quality of recovery. These benefits were evident in all types of surgeries. However, the clinical significance of these differences is limited. Furthermore, the opioid-free anesthesia group required less postoperative rescue analgesia and had a lower incidence of postoperative nausea and vomiting, with risk ratios of 0.54 (95% CI: 0.37 to 0.78), I² = 0%, P less than .001, and 0.39 (95% CI: 0.27 to 0.57), I² = 0%, P less than .001, respectively.

Conclusions: Combined analyses showed that opioid anesthesia was not superior to opioid-free anesthesia in terms of the quality of recovery, and the risk of nausea and vomiting was higher.

Purpose: To identify registered nurse anesthetists' (RNA) perceptions of learning within the profession and to test the feasibility of the research questions and design.

Design: This was a qualitative empirical study with a phenomenographic approach.

Methods: Interviews with open-ended questions.

Findings: Four descriptive categories were identified: (1) practicing as a clinician, (2) developing comprehensive understanding, (3) developing situational awareness, and (4) trusting in own competence. These descriptive categories indicate the perceptions of conditions for professional learning. Experience, comprehensive understanding of the perioperative process and the patient's situation, and having the courage to trust in own competence were described as essential for learning as a professional RNA.

Conclusions: The study demonstrated the feasibility of the research design and provided preliminary insights into RNAs' perceptions of professional learning. These findings may inform the implementation of a more comprehensive study, facilitate RNA learning in clinical settings, and provide insights into early RNA training.

Purpose: The purpose of this study was to evaluate the effectiveness of perioperative bundled care in reducing postoperative hypothermia and alleviating negative emotional responses in patients undergoing transoral endoscopic thyroidectomy.

Design: A retrospective analysis.

Methods: This study was conducted with 120 patients who underwent transoral endoscopic thyroidectomy at Beijing Tongren Hospital from January 2021 to December 2022. The patients were divided into two groups based on the perioperative nursing interventions. The control group (CG) consisted of 60 patients who received routine perioperative care, while the observation group (OG) comprised 60 patients who received perioperative bundled care. Vital signs, clinical indicators, negative emotions, and quality of life were compared between the two groups. The effectiveness of the perioperative bundled care in improving postoperative hypothermia and negative emotions was analyzed through clinical outcomes such as body temperature stability, emotional well-being, and satisfaction levels.

Findings: The observation group exhibited significantly lower rates of postoperative hypothermia and shivering compared to the control group. Additionally, the reduction in negative emotional symptoms such as anxiety and depression was more pronounced in the observation group. The OG also showed improved surgical outcomes, including shorter surgical duration, less blood loss, and shorter hospitalization time, compared to the control group.

Conclusions: Perioperative bundled care significantly reduces the incidence and severity of postoperative hypothermia and negative emotions in patients undergoing transoral endoscopic thyroidectomy. The study suggests that the implementation of bundled care protocols can improve clinical outcomes and patient satisfaction, making it a valuable approach in perioperative care for this type of surgery.

Purpose: This project aimed to improve patient smoking abstinence preoperatively by increasing linkage to existing smoking cessation medication prescription and counseling referral interventions.

Design: Pre and Post intervention quality improvement project.

Methods: We analyzed data from before (June 14, 2020 to December 14, 2020) and after (December 15, 2020 to June 15, 2021) the smoking cessation intervention using descriptive statistics, and t tests for continuous variables and χ² tests for categorical variables. The multimodal intervention included training preoperative clinicians and medical assistants, recruiting champions, tailored patient outreach letters, preoperative-specific scripts for smoking cessation education, and operational workflow.

Findings: There were significant pre-to-post-intervention increases in nicotine replacement therapy prescriptions (2% to 40%, P < .001) and Wellness Coach referrals (10% to 30%; P < .001); nicotine replacement therapy prescriptions filled among those with orders (0.7% to 17%) and completed Wellness Coach appointments among those with referrals (4% to 11%) also increased postintervention. Among the 116 patients who received a smoking cessation letter, 6% quit smoking before surgery. Clinicians (75%) and medical assistants (100%) were very satisfied (62.5% and 67%) or satisfied (12.5% and 33%) with the project.

Conclusions: A multimodal preoperative-specific smoking cessation project increases clinician uptakes of interventions and patient smoking abstinence preoperatively.

Purpose: To educate perioperative nurses on the expedient identification of emergence delirium (EmD) and to recognize patients diagnosed with post-traumatic stress disorder (PTSD) as an at-risk population for the development of EmD.

Design: Quality Improvement project with single-group pre-post test.

Methods: Perioperative nurses participated in a 60-minute education and simulation intervention to introduce evidence-based practices when caring for patients diagnosed with PTSD with EmD. Participants completed a knowledge assessment and a self-reported confidence measure before and after the educational intervention.

Findings: Perioperative nurse participants (N = 36) had an increase in knowledge levels from 64% to 89.3% (P < .001) and confidence levels from 6.07 to 7.97 on a 10-point scale (P < .001) when caring for patients with PTSD with EmD.

Conclusions: This project found that educating nurses on EmD can increase their knowledge and confidence when caring for this patient population. The educational intervention has potential to improve patient safety and experiences of perianesthesia nursing care.

Purpose: To summarize the evidence on postoperative residual paralysis: what it is, how to recognize it, and how to intervene if suspected.

Design: This is a summary of the best evidence on postoperative residual paralysis.

Methods: Databases such as PubMed, Embase, CINAHL, and a University digital library were searched to collect the relevant guidelines for professional practice change, clinical practice update, systematic review, meta-analysis, evidence summary, and expert consensus about postoperative residual paralysis. The retrieval time was from June 2022 to December 2024. A reviewer evaluated the quality of the literature included and extracted and summarized the evidence that met the quality criteria. Randomized controlled trials were assessed utilizing the Cochrane RoB2 bias assessment tool and all extracted literature received a level of evidence grade via the Johns Hopkins Evidence-based Model for Nursing and Healthcare Professionals.

Findings: An initial search resulted in a total of 5,072 articles for review. A total of 22 studies, including 1 professional practice change, 1 clinical practice update, 1 expert consensus statement, 2 prospective observational studies, 1 retrospective observational study, 13 randomized controlled trials, 1 systematic review, and 2 meta-analyses, were included in the final assessment. The summary of evidence demonstrated (1) sugammadex administration reduced the incidence of postoperative residual paralysis when compared to neostigmine administration, (2) sugammadex provides a complete recovery of expiratory muscle strength compared to neostigmine, (3) time to recovery with a train-of-four ratio greater than or equal to 0.9 is faster with sugammadex administration, and (4) quantitative (objective) neuromuscular monitoring is superior to qualitative (subjective) neuromuscular monitoring.

Conclusions: Administration of sugammadex reversal appears to decrease the incidence of postoperative residual paralysis more efficiently than neostigmine with glycopyrrolate administration. However, it does not necessarily decrease the overall incidence of pulmonary complications compared to neostigmine with glycopyrrolate. Evidence emphasizes that the most important steps to reduce postoperative residual paralysis are to administer a reversal agent even if spontaneous muscle recovery has been achieved and to monitor a patient's train-of-four ratio with quantitative, not qualitative, neuromuscular monitoring.

Purpose: To determine the impact of perioperative surgical home (PSH) optimization of adult patients undergoing elective total joint arthroplasty on length of stay (LOS) and discharge destination.

Design: A retrospective observational study was conducted at an urban regional medical system located in the Pacific Northwest region of the United States.

Methods: A retrospective chart review was conducted for adult patients who underwent elective total joint arthroplasty between January 1, 2022 and June 30, 2022. A total of 285 participants were included, of which 133 were in the PSH program. LOS, discharge destination, incidence of postoperative anemia, blood transfusion, surgical site infections, and death were evaluated, comparing PSH program participants to those who received standard perioperative care.

Findings: Participants in the PSH program did not demonstrate any difference in LOS (P = .838) or discharge destination (P = .498). Additionally, there was no difference in postoperative anemia requiring blood transfusion or surgical site infections (P = .132). There were no associated postoperative deaths recorded. Age and COPD (P = .031) were significant factors in the likelihood of discharge to a skilled nursing facility. LOS was positively associated with operating room duration (P = .015), age (P < .001), and postoperative morphine equivalents (P < .001), while postanesthesia care unit morphine equivalents (P = .004) were negatively associated with LOS. PSH participants were more likely to visit the ER within 30 days of the procedure (P = .044).

Conclusions: Age and COPD diagnosis were predictive of discharge location, while age, operating room duration, postanesthesia care unit morphine equivalent, and postoperative morphine equivalent were associated with LOS in the overall population. However, the PSH program evaluated did not demonstrate an impact on LOS or discharge location. A larger sample size is required to determine the impact of PSH programs on reducing postoperative complications.

Purpose: To explore nurses' views, expectations, and needs regarding perioperative family involvement among frail older patients in the preoperative holding and postanesthesia care unit. Additionally, to explore anesthesiologists' perspectives as essential stakeholders in these settings.

Design: A descriptive exploratory qualitative study.

Methods: Semistructured interviews were conducted with 12 recovery nurses and 4 anesthesiologists after purposive sampling. An inductive thematic analysis was conducted using MaxQDA software. The study was reported according to the Consolidated criteria for reporting qualitative research.

Findings: Four main themes emerged: (1) embracing family involvement; (2) clarifying criteria for family involvement; (3) lacking facilities in the department; and (4) managing expectations toward family members. Family involvement among frail older patients was perceived positively, though met with specific conditions for implementation.

Conclusions: Nurses are open to perioperative family involvement but need clear criteria identifying frail older patients. Departmental adjustments are also necessary to facilitate family presence in the perioperative setting. Lastly, it is essential to manage family members' expectations. Anesthesiologists share this perspective. Family involvement in the perioperative care process can improve patient outcomes but must be carefully implemented to avoid practical issues.

Purpose: This study aimed to bibliometrically analyze nursing publications on aromatherapy used in surgery.

Design: The study is a bibliometric analysis.

Methods: The bibliometric analysis study was conducted using the Web of Science database, with the data analyzed up to April 1, 2025. The analysis was performed using the "Biblioshiny" tool from the Bibliometrix R package.

Findings: The bibliometric analysis identified 102 relevant studies on aromatherapy in surgical nursing, published between 2006 and 2025. The highest number of publications occurred in 2021 (n = 15). The most productive journal was Journal of Perianesthesia Nursing. Keywords frequently used included "aromatherapy," "anxiety," "pain," "lavender," and "nursing and surgery." The thematic analysis highlighted key research areas such as pain management, anxiety reduction, and the use of lavender oil in surgical settings. The most influential countries in this field were Iran, with notable contributions from journals focused on complementary therapies.

Conclusions: This bibliometric study provides a comprehensive overview of global research trends, focal topics, and thematic evolution concerning the use of aromatherapy in nursing. This bibliometric study provides a comprehensive overview of global research trends, focal topics, and thematic evolution concerning the use of aromatherapy in surgical nursing. The findings may guide future research directions and highlight areas requiring further exploration in evidence-based nursing practice.