The surgical time-out, a core component of the WHO Surgical Safety Checklist, was introduced to prevent wrong-site surgery, patient misidentification, and other critical perioperative errors. While its theoretical effectiveness is supported by global data, recent evidence suggests that in many operating rooms, the practice has devolved into a symbolic and perfunctory routine. This commentary explores the gap between intention and real-world implementation, and offers practical, evidence-based strategies to reestablish the time-out as a meaningful safeguard in surgical care.
{"title":"Surgical time-outs: Ritual or real safety practice?","authors":"Seyed Abolfazl Hosseini , Bahador Pourdel , Erfan Rajabi , Amirali Alizadeh","doi":"10.1016/j.pcorm.2025.100573","DOIUrl":"10.1016/j.pcorm.2025.100573","url":null,"abstract":"<div><div>The surgical time-out, a core component of the WHO Surgical Safety Checklist, was introduced to prevent wrong-site surgery, patient misidentification, and other critical perioperative errors. While its theoretical effectiveness is supported by global data, recent evidence suggests that in many operating rooms, the practice has devolved into a symbolic and perfunctory routine. This commentary explores the gap between intention and real-world implementation, and offers practical, evidence-based strategies to reestablish the time-out as a meaningful safeguard in surgical care.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100573"},"PeriodicalIF":1.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgical counting is a critical, multi-professional safety practice aimed at preventing retained surgical items (RSIs), such as sponges, instruments, and sharps, during operative procedures. It is commonly defined as a rational, standardized, and replicable process designed to ensure that all items used intraoperatively are accurately accounted for at the time of wound closure. The failure of this process—retention of foreign bodies—is a rare but serious adverse event associated with significant clinical, organizational, and legal consequences, including infection, re-operation, prolonged hospitalization, increased costs, and, in severe cases, death. Despite the existence of numerous international guidelines, counting errors continue to occur, often despite a “correct count” being reported. Studies have shown that RSIs may occur in the presence of systemic factors such as time pressure, communication breakdowns, multitasking, and variable adherence to protocols. Internationally, surgical safety is guided by regularly updated, evidence-based recommendations issued by professional societies. In Italy, however, Recommendation No. 2/2008—based on WHO’s “Safe Surgery Saves Lives” initiative—remains the primary national reference document, yet it has not been updated in over 15 years and does not fully reflect evolving practices or recent literature.
Aim
this study aimed to explore current practices, perceptions, and critical issues related to surgical counting in Italy, drawing on the experience and knowledge of a multidisciplinary expert panel composed of operating room nurses, surgeons, and clinical risk managers.
Methods
to gather expert opinion, a three-round Delphi process was conducted to gather and refine expert opinions. A preliminary literature review informed the first-round questionnaire. Through iterative feedback and consensus thresholds, the study generated a set of validated statements aimed at improving surgical counting practices and informing future national guidelines.
Conclusion
the findings offer a structured, practice-informed contribution to updating Italy’s approach to surgical counting and promoting safer operative care.
{"title":"Proper management and execution of surgical counting: achieving consensus through a Delphi study","authors":"Francesco Silvestri , Caterina Cicala , Salvatore Pagliaro , Debora Formisano , Luca Ghirotto","doi":"10.1016/j.pcorm.2025.100574","DOIUrl":"10.1016/j.pcorm.2025.100574","url":null,"abstract":"<div><div>Surgical counting is a critical, multi-professional safety practice aimed at preventing retained surgical items (RSIs), such as sponges, instruments, and sharps, during operative procedures. It is commonly defined as a rational, standardized, and replicable process designed to ensure that all items used intraoperatively are accurately accounted for at the time of wound closure. The failure of this process—retention of foreign bodies—is a rare but serious adverse event associated with significant clinical, organizational, and legal consequences, including infection, re-operation, prolonged hospitalization, increased costs, and, in severe cases, death. Despite the existence of numerous international guidelines, counting errors continue to occur, often despite a “correct count” being reported. Studies have shown that RSIs may occur in the presence of systemic factors such as time pressure, communication breakdowns, multitasking, and variable adherence to protocols. Internationally, surgical safety is guided by regularly updated, evidence-based recommendations issued by professional societies. In Italy, however, Recommendation No. 2/2008—based on WHO’s “Safe Surgery Saves Lives” initiative—remains the primary national reference document, yet it has not been updated in over 15 years and does not fully reflect evolving practices or recent literature.</div></div><div><h3>Aim</h3><div>this study aimed to explore current practices, perceptions, and critical issues related to surgical counting in Italy, drawing on the experience and knowledge of a multidisciplinary expert panel composed of operating room nurses, surgeons, and clinical risk managers.</div></div><div><h3>Methods</h3><div>to gather expert opinion, a three-round Delphi process was conducted to gather and refine expert opinions. A preliminary literature review informed the first-round questionnaire. Through iterative feedback and consensus thresholds, the study generated a set of validated statements aimed at improving surgical counting practices and informing future national guidelines.</div></div><div><h3>Conclusion</h3><div>the findings offer a structured, practice-informed contribution to updating Italy’s approach to surgical counting and promoting safer operative care.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100574"},"PeriodicalIF":1.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-09DOI: 10.1016/j.pcorm.2025.100571
Ghada Mohammad AboElfadl , Manal Hassanien , Ahmed A. Hamed , Ahmed Mohamed Aboelfadl , Gehan I. Salem , Amr Mohamed Ahmed Thabet
Background
we aimed to evaluate the efficacy of ultrasound-guided distal and proximal greater occipital nerve (GON) radiofrequency approaches in patients with combined chronic migraine and cervicogenic headaches.
Methods
We studied 60 patients with combined chronic migraine and cervicogenic headache, aged between 18 and 65 years and met the specific diagnostic criteria of the International Classification of Headache Disorders (ICHD). Patients were divided into two groups: proximal (Group A) and distal (Group B). The primary endpoint measured changes in headache frequency per month, while secondary endpoints included pain intensity, changes in the Headache Disability Index (HDI), sleep disturbances, and patient satisfaction.
Results
The proximal approach had a lower nocturnal neck and migraine pain intensity compared to the distal approach. Both groups reduced headache episodes and sleep disturbances and improved HDI. However, the proximal approach showed a greater reduction in headache episodes (p = 0.000), fewer sleep disturbances (p = 0.001), more improvement in HDI, and higher patient satisfaction (p = 0.016).
Conclusion
The proximal and distal approaches for GON radiofrequency ablation effectively reduced headache episodes, disability, and sleep disturbance. However, the proximal approach had a more sustained impact on pain intensity, indicating better long-term relief for neck pain and migraines.
{"title":"Comparative efficacy of greater occipital nerve radiofrequency approaches for the treatment of combined migraine and cervicogenic headache: Randomized clinical trial","authors":"Ghada Mohammad AboElfadl , Manal Hassanien , Ahmed A. Hamed , Ahmed Mohamed Aboelfadl , Gehan I. Salem , Amr Mohamed Ahmed Thabet","doi":"10.1016/j.pcorm.2025.100571","DOIUrl":"10.1016/j.pcorm.2025.100571","url":null,"abstract":"<div><h3>Background</h3><div>we aimed to evaluate the efficacy of ultrasound-guided distal and proximal greater occipital nerve (GON) radiofrequency approaches in patients with combined chronic migraine and cervicogenic headaches.</div></div><div><h3>Methods</h3><div>We studied 60 patients with combined chronic migraine and cervicogenic headache, aged between 18 and 65 years and met the specific diagnostic criteria of the International Classification of Headache Disorders (ICHD). Patients were divided into two groups: proximal (Group A) and distal (Group B). The primary endpoint measured changes in headache frequency per month, while secondary endpoints included pain intensity, changes in the Headache Disability Index (HDI), sleep disturbances, and patient satisfaction.</div></div><div><h3>Results</h3><div>The proximal approach had a lower nocturnal neck and migraine pain intensity compared to the distal approach. Both groups reduced headache episodes and sleep disturbances and improved HDI. However, the proximal approach showed a greater reduction in headache episodes (p = 0.000), fewer sleep disturbances (p = 0.001), more improvement in HDI, and higher patient satisfaction (p = 0.016).</div></div><div><h3>Conclusion</h3><div>The proximal and distal approaches for GON radiofrequency ablation effectively reduced headache episodes, disability, and sleep disturbance. However, the proximal approach had a more sustained impact on pain intensity, indicating better long-term relief for neck pain and migraines.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov (identifier: NCT06121037)</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100571"},"PeriodicalIF":1.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Postoperative bleeding is a major cause of morbidity and mortality in CABG. While FFP is commonly used for bleeding management, high doses may increase the risk of acute lung injury and infection. PCC offers a safer alternative. This study compares low-dose PCC + FFP versus FFP alone in on-pump and off-pump CABG.
Methods
Medical records of CABG patients (2022–2023) were reviewed. Statistical analysis included Independent T-Test, Mann-Whitney U, and Chi-Square Test.
Results
The combination of low-dose PCC (500 IU) and FFP achieved significantly more rapid hemostasis within the first 3 hours postoperatively (277.00 ± 60.48 mL vs. 416.00 ± 34.00 mL; p < 0.0001), without any serious adverse events. However, no significant differences in bleeding volume were observed between the groups beyond the 3-hour mark. On-pump surgery patients had longer ICU stays (mean difference: 0.52 [0.31–0.73], p < 0.00001). In-hospital mortality was higher in the PCC group (RR 2.63 [1.25–5.59], p = 0.0149), particularly in on-pump cases, those with three anastomoses, and male patients, but 30-day mortality was similar between groups (RR 1.53 [0.90–2.63], p = 0.1681).
Conclusion
Low-dose PCC provides rapid hemostasis within 3 hours in CABG but should be used cautiously in male patients, multiple anastomoses, and on-pump surgeries.
背景：术后出血是冠状动脉搭桥术发病和死亡的主要原因。虽然FFP通常用于出血治疗，但高剂量可能会增加急性肺损伤和感染的风险。PCC提供了一个更安全的选择。本研究比较了低剂量PCC + FFP与单独FFP在有泵和无泵CABG中的作用。方法回顾我院2022-2023年冠脉搭桥患者的医疗记录。统计分析采用独立t检验、Mann-Whitney U检验和卡方检验。结果低剂量PCC （500 IU）联合FFP在术后前3小时内止血速度明显加快（277.00±60.48 mL vs. 416.00±34.00 mL; p < 0.0001），无严重不良事件发生。然而，3小时后各组之间的出血量没有显著差异。非泵手术患者的ICU住院时间更长（平均差异：0.52 [0.31-0.73],p < 0.00001）。PCC组住院死亡率较高（RR为2.63 [1.25-5.59],p = 0.0149），特别是非泵送组、三吻合口组和男性患者，但两组间30天死亡率相似（RR为1.53 [0.90-2.63],p = 0.1681）。结论小剂量PCC可在冠脉搭桥术后3小时内快速止血，但在男性患者、多处吻合口及无泵手术中应谨慎使用。
{"title":"Comparative efficacy of low-dose prothrombin complex concentrate + fresh frozen plasma combination and fresh frozen plasma in postoperative haemostasis after on-pump and off-pump coronary arterial bypass grafting surgery","authors":"Reza Widianto Sudjud, Erwin Pradian, Suwarman, Jenifer Kiem Aviani, Phillipus Andre, Dian Nuryanda","doi":"10.1016/j.pcorm.2025.100572","DOIUrl":"10.1016/j.pcorm.2025.100572","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative bleeding is a major cause of morbidity and mortality in CABG. While FFP is commonly used for bleeding management, high doses may increase the risk of acute lung injury and infection. PCC offers a safer alternative. This study compares low-dose PCC + FFP versus FFP alone in on-pump and off-pump CABG.</div></div><div><h3>Methods</h3><div>Medical records of CABG patients (2022–2023) were reviewed. Statistical analysis included Independent T-Test, Mann-Whitney U, and Chi-Square Test.</div></div><div><h3>Results</h3><div>The combination of low-dose PCC (500 IU) and FFP achieved significantly more rapid hemostasis within the first 3 hours postoperatively (277.00 ± 60.48 mL vs. 416.00 ± 34.00 mL; <em>p</em> < 0.0001), without any serious adverse events. However, no significant differences in bleeding volume were observed between the groups beyond the 3-hour mark. On-pump surgery patients had longer ICU stays (mean difference: 0.52 [0.31–0.73], p < 0.00001). In-hospital mortality was higher in the PCC group (RR 2.63 [1.25–5.59], p = 0.0149), particularly in on-pump cases, those with three anastomoses, and male patients, but 30-day mortality was similar between groups (RR 1.53 [0.90–2.63], p = 0.1681).</div></div><div><h3>Conclusion</h3><div>Low-dose PCC provides rapid hemostasis within 3 hours in CABG but should be used cautiously in male patients, multiple anastomoses, and on-pump surgeries.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100572"},"PeriodicalIF":1.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-03DOI: 10.1016/j.pcorm.2025.100567
Rafiat Omotayo ISHOLA , Olufemi Oyebanji OYEDIRAN , Iyanuoluwa Oreofe OJO , Johnson Adewale AKINOSO , Emmanuel Olufemi AYANDIRAN
Aim
This study assessed the perceived influence of burnout on the quality of perioperative care provided by surgical teams in selected teaching hospitals in Nigeria.
Background
Burnout among surgical teams is a significant issue that can negatively impact patient safety, team performance and the overall quality of perioperative care.
Design
This study adopted a descriptive cross-sectional design.
Methods
Conducted in January 2025, the study assessed the level of burnout among surgical teams and its perceived influence on the quality of perioperative care in selected teaching hospitals in Nigeria. A stratified random sampling technique was used to select 229 respondents from surgical teams. A structured questionnaire was used to collect the data, which was analysed using the Statistical Package for the Social Sciences (SPSS) version 27. Descriptive and inferential statistics were used to present the data at a significance level of p = 0.05.
Results
The results of this study revealed that more than two-thirds of respondents (62.6%) experienced a high level of burnout. Contributing factors included a lack of effective equipment, an imbalance in work-life experience, unmet job expectations, poor working relationships within the surgical team and an increased workload. Additionally, slightly more than half of the respondents (51.2%) perceived the quality of perioperative care to be good, while 48.8% reported poor quality. The results also showed that age, educational background, area of specialisation, and years of experience were predictors of burnout among the surgical team (P = 0.001, 0.009, 0.014, and 0.000, respectively). Additionally, no significant relationship was found between burnout and quality of perioperative care (t/f = 1.981, p = 0.161).
Conclusion
This study concluded that burnout levels among surgical teams are high. Therefore, there is a need to provide a support system and adequate equipment to ease the workload and reduce burnout among surgical team members in Nigeria.
目的本研究评估了尼日利亚选定教学医院外科团队提供围手术期护理质量的倦怠感影响。手术团队的职业倦怠是一个重要的问题，它会对患者安全、团队绩效和围手术期护理的整体质量产生负面影响。设计本研究采用描述性横断面设计。方法本研究于2025年1月在尼日利亚选定的教学医院进行，评估了外科团队的职业倦怠水平及其对围手术期护理质量的影响。采用分层随机抽样的方法，从外科团队中抽取229名受访者。使用结构化问卷来收集数据，并使用社会科学统计软件包（SPSS）第27版进行分析。采用描述性统计和推断性统计，p = 0.05为显著性水平。结果本研究结果显示，超过三分之二（62.6%）的受访者经历了高度的倦怠。造成这种情况的因素包括缺乏有效的设备、工作与生活经验的不平衡、无法满足工作期望、外科团队内部的工作关系不佳以及工作量增加。此外，略多于一半（51.2%）的受访者认为围手术期护理质量良好，48.8%的受访者认为质量较差。结果还显示，年龄、学历、专业领域和工作年限是外科团队倦怠的预测因素（P分别为0.001、0.009、0.014和0.000）。倦怠与围手术期护理质量无显著相关（t/f = 1.981, p = 0.161）。结论外科团队存在较高的职业倦怠水平。因此，有必要提供一个支持系统和足够的设备，以减轻尼日利亚外科团队成员的工作量和减少倦怠。
{"title":"The perceived influence of burnout on quality of perioperative care among surgical team in teaching hospitals in a peri-urban city in southwestern Nigeria","authors":"Rafiat Omotayo ISHOLA , Olufemi Oyebanji OYEDIRAN , Iyanuoluwa Oreofe OJO , Johnson Adewale AKINOSO , Emmanuel Olufemi AYANDIRAN","doi":"10.1016/j.pcorm.2025.100567","DOIUrl":"10.1016/j.pcorm.2025.100567","url":null,"abstract":"<div><h3>Aim</h3><div>This study assessed the perceived influence of burnout on the quality of perioperative care provided by surgical teams in selected teaching hospitals in Nigeria.</div></div><div><h3>Background</h3><div>Burnout among surgical teams is a significant issue that can negatively impact patient safety, team performance and the overall quality of perioperative care.</div></div><div><h3>Design</h3><div>This study adopted a descriptive cross-sectional design.</div></div><div><h3>Methods</h3><div>Conducted in January 2025, the study assessed the level of burnout among surgical teams and its perceived influence on the quality of perioperative care in selected teaching hospitals in Nigeria. A stratified random sampling technique was used to select 229 respondents from surgical teams. A structured questionnaire was used to collect the data, which was analysed using the Statistical Package for the Social Sciences (SPSS) version 27. Descriptive and inferential statistics were used to present the data at a significance level of p = 0.05.</div></div><div><h3>Results</h3><div>The results of this study revealed that more than two-thirds of respondents (62.6%) experienced a high level of burnout. Contributing factors included a lack of effective equipment, an imbalance in work-life experience, unmet job expectations, poor working relationships within the surgical team and an increased workload. Additionally, slightly more than half of the respondents (51.2%) perceived the quality of perioperative care to be good, while 48.8% reported poor quality. The results also showed that age, educational background, area of specialisation, and years of experience were predictors of burnout among the surgical team (P = 0.001, 0.009, 0.014, and 0.000, respectively). Additionally, no significant relationship was found between burnout and quality of perioperative care (t/f = 1.981, p = 0.161).</div></div><div><h3>Conclusion</h3><div>This study concluded that burnout levels among surgical teams are high. Therefore, there is a need to provide a support system and adequate equipment to ease the workload and reduce burnout among surgical team members in Nigeria.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100567"},"PeriodicalIF":1.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-02DOI: 10.1016/j.pcorm.2025.100569
Abdallfatah Abdallfatah , Bishoy Beshay , Mark Nasseem , Imad Samman Tahhan , Mohammad Kloub , Riddhi Machchhar , Samaa Daoud , Mohamed Hamed , Hazem Abosheaishaa
Background
Gastrointestinal endoscopy is one of the most performed procedures worldwide, and sedation is often necessary to enhance patient satisfaction and improve procedural outcomes. Although propofol is the preferred sedative due to its rapid onset and recovery, it is associated with adverse effects such as hypotension and respiratory depression. Recently, remimazolam has emerged as a promising alternative sedative. Our aim is to evaluate the efficacy and safety of remimazolam compared to propofol.
Methods
We performed a systematic review and meta-analysis following PRISMA guidelines, and our study was registered in the PROSPERO database (CRD42025635440). We performed a literature search across multiple databases up to January 2025. Two independent reviewers carried out data extraction and quality assessment, with a third author resolving any conflicts. We conducted the SRMA using RevMan version 5.4. The primary outcome was hypotension.
Results
We included 29 Randomized controlled trials; the overall risk of bias was low to moderate. Remimazolam significantly reduced the risk of hypotension (27 studies, OR: 0.26, 95 % CI: 0.21–0.33; P < 0.00001). Additionally, remimazolam was associated with lower rates of respiratory depression (OR: 0.33; P < 0.00001) and bradycardia (OR: 0.36; P < 0.00001), and reduced injection site pain (OR: 0.09; P < 0.00001. There was no significant difference in the sedation success rate for remimazolam and propofol (13 studies, OR: 0.44, 95 % CI: 0.28–0.69; P = 0.0004; I² 0 %). Moreover, patients reported higher satisfaction with remimazolam (8 studies; MD: 0.43, 95 % CI: 0.16–0.70; P < 0.00001).
Conclusion
Our systematic review and meta-analysis demonstrated that remimazolam is clinically comparable to propofol for sedation in gastrointestinal endoscopy, offering superior hemodynamic stability, greater safety, and higher patient satisfaction. However, caution is advised in interpreting these findings.
背景胃肠内窥镜检查是世界范围内执行次数最多的手术之一，镇静通常是提高患者满意度和改善手术结果所必需的。虽然异丙酚因其起效快、恢复快而成为首选的镇静剂，但它与低血压和呼吸抑制等不良反应有关。最近，雷马唑仑已成为一种有前途的替代镇静剂。我们的目的是比较雷马唑仑与异丙酚的疗效和安全性。方法我们按照PRISMA指南进行了系统评价和荟萃分析，我们的研究在PROSPERO数据库中注册（CRD42025635440）。我们对截至2025年1月的多个数据库进行了文献检索。两名独立审稿人进行数据提取和质量评估，第三作者解决任何冲突。我们使用RevMan 5.4版本进行SRMA。主要结局是低血压。结果纳入29项随机对照试验；总体偏倚风险为低至中等。雷马唑仑显著降低低血压的风险（27项研究，OR: 0.26, 95% CI: 0.21-0.33; P < 0.00001）。此外，雷马唑仑与较低的呼吸抑制（OR: 0.33; P < 0.00001）和心动过缓（OR: 0.36; P < 0.00001）发生率相关，并减少注射部位疼痛（OR: 0.09; P < 0.00001）。雷马唑仑和异丙酚的镇静成功率无显著差异（13项研究，OR: 0.44, 95% CI: 0.28-0.69; P = 0.0004; I²0 %）。此外，患者对雷马唑仑的满意度更高（8项研究；MD: 0.43, 95% CI: 0.16-0.70; P < 0.00001）。我们的系统回顾和荟萃分析表明，雷马唑仑在胃肠内镜镇静方面的临床效果与异丙酚相当，具有更好的血流动力学稳定性、更高的安全性和更高的患者满意度。然而，在解释这些发现时建议谨慎。
{"title":"Remimazolam versus propofol for gastrointestinal endoscopic sedation: A systematic review and meta-analysis of randomized controlled trials with GRADE assessment","authors":"Abdallfatah Abdallfatah , Bishoy Beshay , Mark Nasseem , Imad Samman Tahhan , Mohammad Kloub , Riddhi Machchhar , Samaa Daoud , Mohamed Hamed , Hazem Abosheaishaa","doi":"10.1016/j.pcorm.2025.100569","DOIUrl":"10.1016/j.pcorm.2025.100569","url":null,"abstract":"<div><h3>Background</h3><div>Gastrointestinal endoscopy is one of the most performed procedures worldwide, and sedation is often necessary to enhance patient satisfaction and improve procedural outcomes. Although propofol is the preferred sedative due to its rapid onset and recovery, it is associated with adverse effects such as hypotension and respiratory depression. Recently, remimazolam has emerged as a promising alternative sedative. Our aim is to evaluate the efficacy and safety of remimazolam compared to propofol.</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis following PRISMA guidelines, and our study was registered in the PROSPERO database (CRD42025635440). We performed a literature search across multiple databases up to January 2025. Two independent reviewers carried out data extraction and quality assessment, with a third author resolving any conflicts. We conducted the SRMA using RevMan version 5.4. The primary outcome was hypotension.</div></div><div><h3>Results</h3><div>We included 29 Randomized controlled trials; the overall risk of bias was low to moderate. Remimazolam significantly reduced the risk of hypotension (27 studies, OR: 0.26, 95 % CI: 0.21–0.33; P < 0.00001). Additionally, remimazolam was associated with lower rates of respiratory depression (OR: 0.33; P < 0.00001) and bradycardia (OR: 0.36; P < 0.00001), and reduced injection site pain (OR: 0.09; P < 0.00001. There was no significant difference in the sedation success rate for remimazolam and propofol (13 studies, OR: 0.44, 95 % CI: 0.28–0.69; P = 0.0004; I² 0 %). Moreover, patients reported higher satisfaction with remimazolam (8 studies; MD: 0.43, 95 % CI: 0.16–0.70; P < 0.00001).</div></div><div><h3>Conclusion</h3><div>Our systematic review and meta-analysis demonstrated that remimazolam is clinically comparable to propofol for sedation in gastrointestinal endoscopy, offering superior hemodynamic stability, greater safety, and higher patient satisfaction. However, caution is advised in interpreting these findings.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100569"},"PeriodicalIF":1.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-02DOI: 10.1016/j.pcorm.2025.100570
Chayanika Kutum , Prashant Lakhe
Pediatric neurosurgery encompasses a wide range of conditions, including congenital anomalies, brain tumors, hydrocephalus, trauma, and epilepsy, that often require complex surgical interventions tailored to the child’s developmental stage. Postoperative care in this population is uniquely challenging due to age-related physiological variations, neurodevelopmental considerations, and disease-specific risks. The immediate postoperative period is particularly critical, necessitating vigilant monitoring and a multidisciplinary approach to prevent complications and ensure optimal recovery. This review provides a comprehensive overview of postoperative care in pediatric neurosurgery, focusing on key aspects such as airway management, hemodynamic and respiratory stability, neurological monitoring, pain control, fluid and electrolyte balance, and complication surveillance. Criteria for postoperative disposition—whether to ward, PACU, or neuro ICU—are discussed based on procedure type and perioperative risk. Systemic and neuromonitoring protocols and strategies for managing common issues like pain, nausea, temperature instability, glycemic fluctuations, and nutrition are outlined. Postoperative complications, including intracranial hemorrhage, raised intracranial pressure, seizures, meningitis, and cranial nerve deficits, are addressed, with emphasis on early recognition and intervention. Procedure-specific considerations are also highlighted, including tailored care following surgeries for brain tumors, craniovertebral junction anomalies, vascular malformations, neural tube defects, and CSF diversion procedures. Effective postoperative management in pediatric neurosurgery requires individualized care plans, age-appropriate interventions, and collaboration among neurosurgeons, anesthesiologists, intensivists, and nursing teams. Standardization of care pathways and further research are essential to improve outcomes and reduce variability across institutions.
{"title":"Postoperative care in pediatric neurosurgery: An overview","authors":"Chayanika Kutum , Prashant Lakhe","doi":"10.1016/j.pcorm.2025.100570","DOIUrl":"10.1016/j.pcorm.2025.100570","url":null,"abstract":"<div><div>Pediatric neurosurgery encompasses a wide range of conditions, including congenital anomalies, brain tumors, hydrocephalus, trauma, and epilepsy, that often require complex surgical interventions tailored to the child’s developmental stage. Postoperative care in this population is uniquely challenging due to age-related physiological variations, neurodevelopmental considerations, and disease-specific risks. The immediate postoperative period is particularly critical, necessitating vigilant monitoring and a multidisciplinary approach to prevent complications and ensure optimal recovery. This review provides a comprehensive overview of postoperative care in pediatric neurosurgery, focusing on key aspects such as airway management, hemodynamic and respiratory stability, neurological monitoring, pain control, fluid and electrolyte balance, and complication surveillance. Criteria for postoperative disposition—whether to ward, PACU, or neuro ICU—are discussed based on procedure type and perioperative risk. Systemic and neuromonitoring protocols and strategies for managing common issues like pain, nausea, temperature instability, glycemic fluctuations, and nutrition are outlined. Postoperative complications, including intracranial hemorrhage, raised intracranial pressure, seizures, meningitis, and cranial nerve deficits, are addressed, with emphasis on early recognition and intervention. Procedure-specific considerations are also highlighted, including tailored care following surgeries for brain tumors, craniovertebral junction anomalies, vascular malformations, neural tube defects, and CSF diversion procedures. Effective postoperative management in pediatric neurosurgery requires individualized care plans, age-appropriate interventions, and collaboration among neurosurgeons, anesthesiologists, intensivists, and nursing teams. Standardization of care pathways and further research are essential to improve outcomes and reduce variability across institutions.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100570"},"PeriodicalIF":1.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.pcorm.2025.100566
Yonah Joffe , Juliana S. Burt , Kara Eversole , David Estores , David J. Libon , Franchesca Arias , Christoph N. Seubert , Benjamin A. Chapin , Cynthia Wilson Garvan , Catherine C. Price
Introduction
Cognitive function, literacy, and education may affect adherence to colonoscopy bowel preparation and predict clinical outcomes. The two case studies presented include preoperative cognitive and educational information rarely captured for routine colonoscopies. Using a novel clinical service, we highlight the relationship between specific preoperative variables and failed colonoscopy bowel preparation.
Case presentations
Case CR is a 69-year-old White non-Hispanic male who showed symptoms of amnestic mild cognitive impairment upon preoperative evaluation. CR's at-home bowel preparation was inadequate due to poor instruction adherence and ultimately led to an incomplete colonoscopy. Case JR is an 85-year-old Black non-Hispanic male with 4 years of education, 3rd grade reading level, and memory deficits. JR misunderstood the pre-procedure instructions, causing him to complete the bowel preparation on the wrong day. Subsequently, JR rescheduled the procedure several times, missed his preoperative evaluation for his rescheduled procedure, and ultimately never received his recommended colonoscopy.
Conclusion
Unsuccessful colonoscopy procedures have significant consequences, including missed precancerous polyps and malignant lesions and inefficient allocation of medical and financial resources. Cases highlight the need for interdisciplinary colonoscopy procedure planning for older patients with high-risk neurocognitive and educational profiles.
{"title":"Cognition, literacy, and education in colonoscopy preparation for older adults: Highlights from two clinical case reports","authors":"Yonah Joffe , Juliana S. Burt , Kara Eversole , David Estores , David J. Libon , Franchesca Arias , Christoph N. Seubert , Benjamin A. Chapin , Cynthia Wilson Garvan , Catherine C. Price","doi":"10.1016/j.pcorm.2025.100566","DOIUrl":"10.1016/j.pcorm.2025.100566","url":null,"abstract":"<div><h3>Introduction</h3><div>Cognitive function, literacy, and education may affect adherence to colonoscopy bowel preparation and predict clinical outcomes. The two case studies presented include preoperative cognitive and educational information rarely captured for routine colonoscopies. Using a novel clinical service, we highlight the relationship between specific preoperative variables and failed colonoscopy bowel preparation.</div></div><div><h3>Case presentations</h3><div>Case CR is a 69-year-old White non-Hispanic male who showed symptoms of amnestic mild cognitive impairment upon preoperative evaluation. CR's at-home bowel preparation was inadequate due to poor instruction adherence and ultimately led to an incomplete colonoscopy. Case JR is an 85-year-old Black non-Hispanic male with 4 years of education, 3rd grade reading level, and memory deficits. JR misunderstood the pre-procedure instructions, causing him to complete the bowel preparation on the wrong day. Subsequently, JR rescheduled the procedure several times, missed his preoperative evaluation for his rescheduled procedure, and ultimately never received his recommended colonoscopy.</div></div><div><h3>Conclusion</h3><div>Unsuccessful colonoscopy procedures have significant consequences, including missed precancerous polyps and malignant lesions and inefficient allocation of medical and financial resources. Cases highlight the need for interdisciplinary colonoscopy procedure planning for older patients with high-risk neurocognitive and educational profiles.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100566"},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-30DOI: 10.1016/j.pcorm.2025.100563
Alexander Gomez , Rachna Jayaprakash , Arun Muthukumar
{"title":"Role of perioperative anxiety and stress response in laparoscopic cholecystectomy","authors":"Alexander Gomez , Rachna Jayaprakash , Arun Muthukumar","doi":"10.1016/j.pcorm.2025.100563","DOIUrl":"10.1016/j.pcorm.2025.100563","url":null,"abstract":"","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100563"},"PeriodicalIF":1.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-30DOI: 10.1016/j.pcorm.2025.100565
Joseph AbuRahma , Penny S. Reynolds , Joseph C. Goldstein , Jennifer Bromwell , Thomas Beaver , Yong G. Peng
Background
The Society of Thoracic Surgeons has advocated for enhanced recovery after cardiac surgery and recommends extubation of patients within 6 h following routine coronary artery bypass grafting (CABG). Early extubation has been shown to decrease mortality and postoperative complications. The primary objective of this study was to create a preliminary prediction model that would identify modifiable factors associated with prolonged postoperative mechanical ventilation following isolated CABG at our institution.
Methods
This was a single-center retrospective observational records review study. Case records for 85 patients who had undergone an isolated, elective CABG between January 2021 and December 2022 were evaluated. A multivariable logistic regression model with backwards selection was used to estimate probability of prolonged postoperative mechanical ventilation (>6 h). Predictor variables were based on readily available clinical information on patient demographics, comorbidities, and factors related to operative management (time on bypass, opioid use, patient acid-base status, core temperature). Models were internally validated by bootstrapping, and model performance was evaluated by optimism-corrected c-statistics.
Results
Twenty-six of 85 patients (31 %) were intubated for >6 h. Base deficit, age, core temperature, and history of chronic obstructive pulmonary disease (COPD) were the strongest and most consistent predictors of prolonged intubation. Model discrimination and calibration were satisfactory (c-statistics > 0.75). A simple probability chart was constructed from the final model to estimate patient risk of prolonged intubation.
Conclusions
Older (>75 years), increased base deficit (base deficit ≤ -6 mmol/L), and hypothermic (<36 °C) patients with history of COPD had the highest estimated probability of prolonged intubation (>90 %) following isolated CABG. Future validation studies will require a larger cohort. Nevertheless, findings from this study have led to proactive changes in patient management at our institution to identify high-risk patients and prevent or partially reverse base deficit and hypothermia before patient arrival to the intensive care unit.
{"title":"Identifying factors associated with prolonged mechanical ventilation following isolated coronary artery bypass grafting: a retrospective observational study","authors":"Joseph AbuRahma , Penny S. Reynolds , Joseph C. Goldstein , Jennifer Bromwell , Thomas Beaver , Yong G. Peng","doi":"10.1016/j.pcorm.2025.100565","DOIUrl":"10.1016/j.pcorm.2025.100565","url":null,"abstract":"<div><h3>Background</h3><div>The Society of Thoracic Surgeons has advocated for enhanced recovery after cardiac surgery and recommends extubation of patients within 6 h following routine coronary artery bypass grafting (CABG). Early extubation has been shown to decrease mortality and postoperative complications. The primary objective of this study was to create a preliminary prediction model that would identify modifiable factors associated with prolonged postoperative mechanical ventilation following isolated CABG at our institution.</div></div><div><h3>Methods</h3><div>This was a single-center retrospective observational records review study. Case records for 85 patients who had undergone an isolated, elective CABG between January 2021 and December 2022 were evaluated. A multivariable logistic regression model with backwards selection was used to estimate probability of prolonged postoperative mechanical ventilation (>6 h). Predictor variables were based on readily available clinical information on patient demographics, comorbidities, and factors related to operative management (time on bypass, opioid use, patient acid-base status, core temperature). Models were internally validated by bootstrapping, and model performance was evaluated by optimism-corrected c-statistics.</div></div><div><h3>Results</h3><div>Twenty-six of 85 patients (31 %) were intubated for >6 h. Base deficit, age, core temperature, and history of chronic obstructive pulmonary disease (COPD) were the strongest and most consistent predictors of prolonged intubation. Model discrimination and calibration were satisfactory (c-statistics > 0.75). A simple probability chart was constructed from the final model to estimate patient risk of prolonged intubation.</div></div><div><h3>Conclusions</h3><div>Older (>75 years), increased base deficit (base deficit ≤ -6 mmol/L), and hypothermic (<36 °C) patients with history of COPD had the highest estimated probability of prolonged intubation (>90 %) following isolated CABG. Future validation studies will require a larger cohort. Nevertheless, findings from this study have led to proactive changes in patient management at our institution to identify high-risk patients and prevent or partially reverse base deficit and hypothermia before patient arrival to the intensive care unit.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100565"},"PeriodicalIF":1.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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