Journal of perioperative practice最新文献

{"title":"Ultrasound-guided bilateral anterior quadratus lumborum block at the lateral supra-arcuate ligament in patients undergoing laparoscopic radical gastrectomy: A randomised controlled study.","authors":"Liangqing Lin, Yaohua Yu, Pinhui Ke, Lili Liu, Qinghua Wu, Qingshui Lin","doi":"10.1177/17504589241242341","DOIUrl":"https://doi.org/10.1177/17504589241242341","url":null,"abstract":"<p><strong>Objective: </strong>Ultrasound-guided bilateral anterior quadratus lumborum block at the lateral supra-arcuate ligament has recently been proposed as an effective analgesia for abdominal surgery. To test the hypothesis that this novel technique was a viable alternative approach of conventional thoracic epidural analgesia for laparoscopic radical gastrectomy.</p><p><strong>Methods: </strong>Three hundred patients scheduled for laparoscopic radical gastrectomy were randomised 1:1 into the anterior quadratus lumborum block group: receiving the novel regional analgesia, and the thoracic epidural analgesia group: receiving thoracic epidural anaesthesia. The primary endpoint was intraoperative consumption of propofol and remifentanil. Intention-to-treat analysis was performed for all variables.</p><p><strong>Results: </strong>At five and ten minutes after block, anterior quadratus lumborum block group achieved more dermatomes coverage of the sensory block with both p < 0.001. Intraoperative consumption of propofol and remifentanil was comparable between two groups (1116.21 ± 199.76 versus 1166.45 ± 125.31µg, p = 0.245 and remifentanil 1.83 ± 0.41 versus 1.81 ± 0.37ng, p = 0.988). However, anterior quadratus lumborum block group was associated with less intraoperative consumption of norepinephrine and atropine, shorter time to urinary catheter removal and out-of-bed activity than the thoracic epidural anaesthesia group. No significant difference in extubation time, pain scores at rest and exercising at all time points following surgery was observed between the two groups.</p><p><strong>Conclusions: </strong>Compared with conventional thoracic epidural anaesthesia, the novel technique was an equivalent effective component of multimodal analgesic protocol for laparoscopic radical gastrectomy. There were some advantages, including shorter procedure time, more reliable dermatomal coverage, shorter duration of urinary catheterisation and earlier time of out-of-bed activity to enhance recovery after surgery.</p><p><strong>Trial registration: </strong>The study was registered in the Chinese Clinical Trial Registry on 2 November 2022 (ChiCTR2200065325).</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":"35 3","pages":"77-87"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484254","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}

{"title":"Ultrasound-based Accuro system versus traditional palpation technique for neuraxial anaesthesia: A systematic review and meta-analysis of randomised controlled trials.","authors":"Mahfouz Sharapi, Eslam Afifi, Aya Mustafa Al Mawla, Mazen Negmeldin Aly Yassin, Sara Adel Awwad, Mohamed El-Samahy","doi":"10.1177/17504589231215927","DOIUrl":"10.1177/17504589231215927","url":null,"abstract":"<p><strong>Introduction: </strong>This review evaluates the efficacy and safety of Accuro, a handheld ultrasound device, compared to the palpation technique for neuraxial anaesthesia. Accuro provides real-time imaging guidance, potentially improving accuracy and efficiency.</p><p><strong>Methods: </strong>A comprehensive search across six electronic databases identified randomised clinical trials comparing Accuro with palpation for neuraxial anaesthesia. Risk ratios or mean differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Bias risk was evaluated using the Cochrane Risk of Bias tool.</p><p><strong>Results: </strong>Five studies (n=369) met the inclusion criteria. Accuro showed a favourable risk ratio for first insertion success (1.44 [95% CI [1.01, 2.05], p=0.05]). It significantly reduced needle skin passes (MD -0.63; 95% CI [-1.05, -0.21]; p<0.01), but not needle redirection (MD -1.31; 95% CI [-2.71, 0.11]; p=0.07). Procedure time was shorter in palpation (MD 127.82; 95% CI [8.68, -246.97]; p=0.04). Four studies had a low risk of bias; one had some concerns.</p><p><strong>Conclusion: </strong>Accuro can potentially improve success rates and reduce skin passes in neuraxial anaesthesia. Further trials with larger samples are needed, especially in patients with anticipated difficulties.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"60-69"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139040585","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}

{"title":"A rare presentation of bone cement implantation syndrome as hypertensive anaphylaxis: A diagnostic and management dilemma.","authors":"Vishal Kumar Neeradi, Sandeep Kund Reddy Aluka, Chander Katroth, Hemalatha Bora, Tarannum Sultana, Krishna Rao Maremanda","doi":"10.1177/17504589241264399","DOIUrl":"10.1177/17504589241264399","url":null,"abstract":"<p><strong>Background: </strong>Bone cement implantation syndrome characteristically involves acute alterations in the function of respiratory and cardiovascular systems. We present a case report of cement reaction with unusual presentation, that is, hypoxia, hypertension and tachycardia. A 74-year-old hypertensive male on regular medications sustained a slip and fall, presented with a right intertrochanteric neck of femur fracture, now posted for cemented hemiarthroplasty. Intraoperatively, after applying bone cement, the patient developed sweating, dyspnoea, bilateral wheezing and tachypnoea and desaturation of up to 80%-84%. Respiratory symptoms were associated with tachycardia (140-160 bpm) and hypertension (220/110 mm Hg). The surgeon was alerted about the event, the patient was reassured, and respiration was assisted with positive pressure ventilation with supplementation of 100% oxygen.</p><p><strong>Discussion: </strong>Several mechanisms have been proposed, such as the toxic effect of systemically absorbed methyl methacrylate, exothermic reaction, fat and marrow embolism, high marrow pressure during cementing and anaphylactic reaction. The administration of adrenaline, which can worsen the clinical picture, is the mainstay in managing anaphylaxis.</p><p><strong>Conclusion: </strong>The association of hypertension and tachycardia with bone cement implantation syndrome, previously not reported, can have distinct pathomechanisms and cause a diagnostic and management dilemma.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"88-92"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976753","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}

{"title":"Association of polypharmacy and perioperative outcomes: Systematic review and meta-analysis.","authors":"Yixuan Lee, Yixin Liew, Mui Hian Sim, Xiu Ling Jacqueline Sim","doi":"10.1177/17504589251320818","DOIUrl":"https://doi.org/10.1177/17504589251320818","url":null,"abstract":"<p><p>Polypharmacy is becoming more prevalent due to an ageing population. As more patients are undergoing surgical procedures, it is important to determine which group of patients are at higher risk of poorer outcomes. This review aimed to provide a summary of existing literature and to determine if polypharmacy is associated with poorer perioperative outcomes and to identify any gaps in the literature. This systematic review was conducted using electronic databases PubMed, Embase and Web of Science from their inception to December 2024. Statistical analysis was performed using generic inverse variance method. We identified 45 eligible studies from different countries and different surgical populations. Thirty-two studies (71.11%) defined polypharmacy as the use of five or more medications. Polypharmacy is significantly associated with postoperative delirium (odds ratio = 1.62, 95% confidence interval = 1.32-1.98, <i>I</i>² = 0%). Although polypharmacy is found to be significantly associated with postoperative delirium, the relationship between polypharmacy and postoperative delirium remains complex.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589251320818"},"PeriodicalIF":1.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516847","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}

{"title":"Effects of inhaled anaesthetic agents on the oxygen dissociation curve: An updated discussion.","authors":"Amarjeet Kumar, Manjunath N","doi":"10.1177/17504589251320809","DOIUrl":"https://doi.org/10.1177/17504589251320809","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589251320809"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484212","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}

{"title":"What are the lived career experiences of senior operating department practitioners? An interpretative phenomenological analysis.","authors":"Lee Rollason","doi":"10.1177/17504589251319967","DOIUrl":"https://doi.org/10.1177/17504589251319967","url":null,"abstract":"<p><p>Operating department practitioners are registered health care practitioners who provide specialist care to patients across the perioperative environment in the disciplines of anaesthetics, surgery and post-anaesthetic care. There is a significant knowledge gap that surrounds the profession in terms of their career experiences. Using a methodology of interpretative phenomenological analysis, the lived career experiences of six senior operating department practitioners were investigated. Seven themes were identified across the experiences of participants addressing a wide range of topics including issues such as professional development, relationships with other health care professionals, sexual safety, student experiences and visibility. Recommendations based on this study include further investigation of operating department practitioner experiences across a wider demographic, an immediate review of how job adverts are constructed to be more inclusive and a call for increased professional visibility of operating department practitioners. Long-term recommendations include a resolution around the use of Patient Group Directives, workplace culture reviews and a review of theatre-attire appropriateness in relation to sexual safety in the perioperative environment.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589251319967"},"PeriodicalIF":1.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484251","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}

{"title":"Perioperative management of the patient on cannabis and cannabinoids: A review.","authors":"Maria Scheuermann, Guy Hans, Davina Wildemeersch","doi":"10.1177/17504589251320804","DOIUrl":"https://doi.org/10.1177/17504589251320804","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>This review aims to summarise this literature on perioperative care for patients with long-term cannabis consumption or cannabis use disorder.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589251320804"},"PeriodicalIF":1.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477102","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}

{"title":"Comparative assessment of 5-factor modified frailty index and American Society of Anesthesiologists classification for morbidity and mortality prediction in arthroplasty: A prospective observational study.","authors":"Soumya Sarkar, Deepak Gautam, Rahul Kumar Anand, Devansh Goyal, Sahil Batra, Rajesh Malhotra, Puneet Khanna, Dalim Kumar Baidya","doi":"10.1177/17504589251315706","DOIUrl":"https://doi.org/10.1177/17504589251315706","url":null,"abstract":"<p><strong>Background: </strong>Identifying early predictors of postoperative complications is paramount in frail patients. While the American Society of Anaesthesiologists classification is subjective, the 5-factor modified frailty index is simpler and associated with promising results in predicting morbidity and mortality in various surgical specialities.</p><p><strong>Methods: </strong>This prospective observational study assessed the comparative utility of 5-factor modified frailty index and American Society of Anaesthesiologists classification in predicting intensive care unit admission and revision surgery in 220 patients following arthroplasty with standardised anaesthesia techniques under the same group of surgeons. The 5-factor modified frailty index and American Society of Anaesthesiologists class were assessed 1 day before surgery, and postoperatively, all the patients were followed up for 30 days.</p><p><strong>Results: </strong>American Society of Anaesthesiologists and 5-factor modified frailty index had a significant association with postoperative intensive care unit requirements (odds ratio = 7.5, 95% confidence interval 1.3 to 42.4 and odds ratio = 8.3, 95% confidence interval 1.6 to 17.6, respectively). Only the 5-factor modified frailty index was significantly associated (odds ratio = 5.3, 95% confidence interval 1.3 to 9.7) with revision surgery. Patients with the 5-factor modified frailty index value of 3 had the best predictive odds for postoperative intensive care unit admission (odds ratio = 73.6, 95% confidence interval 7.5 to 718.8) and revision of surgery, particularly during total hip replacement (odds ratio = 54, 95% confidence interval 3.3).</p><p><strong>Conclusion: </strong>The 5-factor modified frailty index exhibited a more robust predictive capacity for postoperative intensive care unit requirements and the likelihood of revision surgery, particularly a 5-factor modified frailty index score of 3 in total hip replacement procedures.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589251315706"},"PeriodicalIF":1.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469012","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}

{"title":"To assess the usefulness of 6-min walk test for determining autonomic dysfunction in diabetic patients compared with non-diabetic patients during preoperative evaluation: A prospective observational controlled study.","authors":"Naqiya Noorain, Mohammed Ismail Nizami, Shibani Padhy, Kavitha Jayaram","doi":"10.1177/17504589251318229","DOIUrl":"https://doi.org/10.1177/17504589251318229","url":null,"abstract":"<p><strong>Background: </strong>The incidence of perioperative cardiovascular morbidity and mortality in diabetic patients is due to impaired cardiovascular response to exercise caused by impairment in peripheral blood flow and oxygen diffusion to the exercising muscle. Preoperative bedside testing by 6-min walk for autonomic dysfunction in diabetic patients might reduce haemodynamic instability and cardiovascular complications.</p><p><strong>Methods and materials: </strong>Sixty patients with American Society of Anaesthesiologists grade 1 classification and 60 diabetic patients (total of 120) of age 30-60 years, of either sex, undergoing elective surgery under general anaesthesia were recruited. A 6-min walk test, breath-holding time and five clinical bedside tests for autonomic dysfunction were performed. Based on that, patients were classified into non-diabetic patients (group C), diabetic patients without autonomic dysfunction (group D) and diabetic patients with autonomic dysfunction (group A).</p><p><strong>Results: </strong>The incidence of autonomic dysfunction was 31.7%. Among all the parameters, breath-holding time, steps and distance covered by 6-min walk test was significantly less in group A. The incidence of intraoperative tachycardia and hypotension was significantly higher (78.9% and 57.9%, respectively) in group A.</p><p><strong>Conclusion: </strong>The 6-min walk test can be used as one of the preliminary tests for detection of cardiac autonomic neuropathy in diabetes since it had association with distance covered and intraoperative haemodynamic disturbances.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589251318229"},"PeriodicalIF":1.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441929","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}

{"title":"How anaesthetic drugs are selected to account for patient and surgical factors: A case report.","authors":"Bevan Michael Scott","doi":"10.1177/17504589251320317","DOIUrl":"https://doi.org/10.1177/17504589251320317","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589251320317"},"PeriodicalIF":1.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441926","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}