Journal of perioperative practice最新文献

{"title":"Prediction of difficult laryngoscopy and/or intubation among morbidly obese patients: Upper lip bite test versus modified Mallampati classification.","authors":"Freda Richa, Christine El-Hage, Viviane Chalhoub, Patricia Yazbeck","doi":"10.1177/17504589231206903","DOIUrl":"10.1177/17504589231206903","url":null,"abstract":"<p><strong>Introduction: </strong>We aim to compare the upper lip bite test with the modified Mallampati test as predictors of difficult laryngoscopy and/or difficult intubation among morbidly obese patients.</p><p><strong>Methods: </strong>A total of 500 morbidly obese patients (body mass index > 40 kg/m²) undergoing general anaesthesia with tracheal intubation are included in this prospective single-blinded observational clinical study. The preoperative airway assessment is obtained by the modified Mallampati test and upper lip bite test. The difficulty of laryngoscopy is assessed by an experienced anaesthetist in patients adequately anaesthetised and fully relaxed. The view is classified according to Cormack and Lehane's classification. Modified Mallampati test III or IV and upper lip bite test III are considered positive tests. Difficult laryngoscopy is defined as Cormack and Lehane's classification III and IV, whereas difficult endotracheal intubation is defined as an intubation difficulty scale ⩾ 5.</p><p><strong>Results: </strong>The incidences of Cormack and Lehane's classification III and IV and intubation difficulty scale ⩾ 5 are 9.4% and 11.8% respectively. The specificity, positive predictive value and accuracy are higher with the upper lip bite test. The combination of the upper lip bite test and the modified Mallampati test improved these measures. The likelihood ratio + was significantly higher for the upper lip bite test (6.35 and 9.47) than for the modified Mallampati test (3.21 and 3.16).</p><p><strong>Conclusion: </strong>The upper lip bite test is a test with high sensitivity, specificity, negative predictive value and accuracy making it a favourable test for identifying easy and difficult intubations and laryngoscopies in morbidly obese patients.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"347-356"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811399","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":"Early versus late removal of the I-Gel in paediatric patients with mild upper respiratory tract symptoms undergoing ambulatory ilioinguinal surgery: A prospective observational study.","authors":"Anouar Jarraya, Manel Kammoun, Hasna Bouchaira, Khadija Ben Ayed, Hend Ketata","doi":"10.1177/17504589231211445","DOIUrl":"10.1177/17504589231211445","url":null,"abstract":"<p><p>The optimal timing of I-Gel removal in children with mild respiratory symptoms remains controversial. Consequently, we tried to assess the impact of early versus late I-Gel removal on the incidence of perioperative respiratory adverse events among children aged one to five years undergoing ambulatory surgery under general anaesthesia with I-Gel airway ventilation. The anaesthesia protocol was the same for all patients. Children were divided into two groups according to the approach of I-Gel removal (early versus late). The incidence of perioperative respiratory adverse events after the I-Gel removal was the main outcome, and a multivariable regression was performed to investigate the implication of the I-Gel removal in perioperative respiratory adverse events. According to our study, the incidence of perioperative respiratory adverse events was not correlated to the timing of I-Gel removal. However, prolonged postoperative oxygen support can be seen when the I-Gel is removed in anaesthetized children.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"357-362"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811395","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":"Effect of increased systemic oxygen delivery on postoperative outcomes and quality of life in elderly undergoing major abdominal surgery: A randomised controlled trial.","authors":"Kishore Kumar Madhangopal, Ajay Kumar Jha, Sandeep Kumar Mishra, Suman Lata, Sri Ram Anant Nagabhushnam Padala","doi":"10.1177/17504589241287661","DOIUrl":"https://doi.org/10.1177/17504589241287661","url":null,"abstract":"<p><p>Studies comparing the intentional increase in oxygen delivery and normal oxygen delivery during general anaesthesia in elderly patients undergoing major abdominal surgery are limited and have reported contradictory findings. Therefore, the study aimed to evaluate the effect of intraoperative increase in systemic oxygen delivery on postoperative outcomes and quality of life in elderly patients undergoing major abdominal surgery. This randomised, blinded, parallel-arm, pragmatic clinical trial included elderly patients of >60 years of age undergoing major abdominal surgery. The patients in the intervention arm received noradrenaline or increased fractional inspiration of oxygen to augment central venous oxygen saturation ⩾75%. The primary outcome measure was composite of in-hospital mortality and major organ complications. The secondary outcome measure included comparison of quality of life. A total of 160 patients were assessed for eligibility, and 146 were randomised in the study groups. The mean arterial and central venous oxygen saturation increased and were significantly higher in the intervention arm. The composite primary outcome occurred in 49.31% in the intervention arm and 57.53% in the usual care arm (relative risk; 95% confidence interval: 0.85; 0.63-1.16; absolute risk reduction; 8.22%; p = 0.32). Furthermore, quality of life at the end of three months was similar (0.658 ± 0.19 versus 0.647 ± 0.19; p = 0.771). In conclusion, central venous oxygen saturation-guided increase in systemic oxygen delivery during the intraoperative period of major abdominal surgery in elderly patients did not reduce predefined composite outcome of in-hospital mortality or organ-specific complications.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589241287661"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559002","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":"Add dexmedetomidine to levobupivacaine for transversus abdominis plane block in elderly patients undergoing inguinal hernia repair: Could it make a difference? A randomised trial.","authors":"Ghada Mohammad Abo Elfadl, Wesam Nashat Ali, Fatma Nabil Ahmed, Nessren M Abd El-Rady, Ahmed Mohammed Ali, Marwa Mahmoud Abdel Rady","doi":"10.1177/17504589231196653","DOIUrl":"10.1177/17504589231196653","url":null,"abstract":"<p><strong>Background: </strong>Transversus abdominis plane block is becoming more common as part of multimodal analgesia for post-abdominal operation pain relief. This study compared the analgesic effects of adding dexmedetomidine to levobupivacaine (transversus abdominis plane) block in elderly patients undergoing inguinal hernia surgery to adding fentanyl.</p><p><strong>Methods: </strong>Overall, 90 elderly patients with a simple inguinal hernia repair were randomly assigned to one of three groups. After spinal anaesthesia, an ultrasound-guided transversus abdominis plane block was performed. Transversus abdominis plane block was accomplished with 0.25% levobupivacaine + 0.9% normal saline in Group L (n = 30) (20mL). Transversus abdominis plane block was accomplished with 0.25% levobupivacaine + 1 µg/kg dexmedetomidine in Group D (n = 30) (20mL). Transversus abdominis plane block was obtained with 0.25% levobupivacaine + 1 µg/kg fentanyl in Group F (n = 30) (20mL). The primary outcome was the first analgesic request, and the secondary outcomes were the visual analog scale, postoperative analgesic requirements, sedation, hemodynamic stability, and related complications 24 hours postoperatively. 1gm paracetamol intravenously was provided as rescue analgesia.</p><p><strong>Results: </strong>The time to first analgesic request in the dexmedetomidine group was substantially more prolonged than in the fentanyl and control groups (516.5±27.8, 451.2±11.1, and 403.9±10.5min, respectively; p < 0.05). Postoperative analgesic requirements were significantly decreased in dexmedetomidine 1(1-2) than control 2(1-3) and fentanyl 1.5(1-2) respectively (P<0.01). VAS was significantly lower in Group D and Group F than in Group L postoperatively. No significant difference in side effects was noted between the groups.</p><p><strong>Conclusion: </strong>The transversus abdominis plane block is the best multimodal analgesia choice for inguinal hernia repair in older patients. Combining dexmedetomidine with levobupivacaine in the transversus abdominis plane block can improve the quality of postoperative analgesia while avoiding significant side effects.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"339-346"},"PeriodicalIF":1.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41151221","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 randomised comparison of transverse abdominal plane block versus thoracic epidural analgesia on postoperative opioid consumption for colorectal enhanced recovery after surgery programme (OPIATE study).","authors":"Reshma Ambulkar, Sohan Lal Solanki, Bindiya Salunke, Pavithra Ps, Supriya Gholap, Ashwin L Desouza, Sumitra G Bakshi, Vandana Agarwal","doi":"10.1177/17504589241288670","DOIUrl":"https://doi.org/10.1177/17504589241288670","url":null,"abstract":"<p><strong>Background: </strong>The transverse abdominis plane block is increasingly being used as a less-invasive alternative to thoracic epidural analgesia for effective pain management. This study aimed to compare transverse abdominis plane block with opioid-based thoracic epidural analgesia in terms of postoperative opioid consumption.</p><p><strong>Methods: </strong>Patients in the thoracic epidural analgesia group received a continuous infusion of 0.1% levobupivacaine with 2mcg/ml of fentanyl, while those in the transverse abdominis plane group received 6-hourly boluses of 0.4ml/kg of 0.25% levobupivacaine. The primary objective was to compare the average fentanyl consumption, measured as intravenous fentanyl equivalents, over 72 hours.</p><p><strong>Results: </strong>Data of 35 patients were analysed. Fentanyl consumption at the end of 72 hours was significantly lower in the transverse abdominis plane group (median [interquartile range] 495 mcg (255, 750), and mean (95% confidence interval) 717.35mcg (403.54-1031.16)) compared to the thoracic epidural analgesia group (median [interquartile range] 760mcg (750, 760), and mean (95% confidence interval) 787mcg (746.81-827.19)) with a p value of 0.010. Pain scores at rest and during movement were comparable between the groups (<i>p</i> > 0.05). However, the median pain scores during movement were significantly lower in the thoracic epidural analgesia group at 60 and 72 hours (<i>p</i> ⩽ 0.05).</p><p><strong>Conclusion: </strong>Multimodal analgesia with transverse abdominis plane resulted in lower opioid consumption over 72 hours compared to thoracic epidural analgesia.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589241288670"},"PeriodicalIF":1.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509510","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":"Comparison of intrathecal fentanyl as an adjunct in spinal anaesthesia to ultrasound-guided quadratus lumborum block as an effective postoperative analgesia for Caesarean section surgery.","authors":"Subhasish Patnaik, Shalendra Singh, Lalita Kumar Dash, Arunav Sharma, Anand Naveen Chandran, Priya Taank","doi":"10.1177/17504589241286707","DOIUrl":"10.1177/17504589241286707","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain in patients, if dealt with inadequately, has been a significant cause of morbidity. The present study compared the postoperative analgesic efficacy of intrathecal fentanyl and ultrasound-guided quadratus lumborum block following Caesarean surgery.</p><p><strong>Methods: </strong>A prospective randomised controlled study was planned for parturients who underwent Caesarean surgery under spinal anaesthesia. Patients received bupivacaine (10mg) and 25µg of intrathecal fentanyl in the spinal anaesthesia (group intrathecal fentanyl, n = 30) or 20mL of 0.375% ropivacaine bilateral quadratus lumborum block (group quadratus lumborum; n = 30) after surgery. The visual analogue scale score, quality of recovery-15 score and incidence of ill effects were recorded.</p><p><strong>Results: </strong>The postoperative haemodynamic parameters were comparable between the two groups. The visual analogue scale score at different time intervals decreased after the quadratus lumborum block (p < 0.05). The mean global quality of recovery score was better in the quadratus lumborum group (p < 0.001). In the quadratus lumborum group, the mean time to first ambulation was lower than that in the intrathecal fentanyl group (p < 0.05). The requirement for first-rescue analgesia was earlier in the intrathecal fentanyl group (4.67 ± 0.72) than in the quadratus lumborum group (4.92 ± 0.88).</p><p><strong>Conclusion: </strong>Intrathecal fentanyl and quadratus lumborum block had effective postoperative analgesic effects on Caesarean surgery patients. However, the quadratus lumborum block group exhibited better analgesia and early ambulation than the intrathecal fentanyl group, with an improved quality of recovery.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589241286707"},"PeriodicalIF":1.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476537","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":"Does the experience of the endoscopic vein harvester matter to the quality of the vein conduit: A critical thematic literature review.","authors":"Michael Kay, Youssef Abouelela, Sam Raaj, Bhuvaneswari Krishnamoorthy","doi":"10.1177/17504589241288512","DOIUrl":"10.1177/17504589241288512","url":null,"abstract":"<p><p>Coronary artery bypass graft surgery remains the golden standard surgical option for multiple vessel disease. Harvesting the long saphenous vein using endoscopic vein harvesting requires advanced surgical skills dexterity, but the lack of a national standardised training programme allows for variance in the learning curve and the quality of the vein during the learning cycle is unknown. A search of bibliographic databases: CINHAL Plus, Embase, Pubmed and the Cochrane register for randomised controlled trials identified 11 articles eligible for review. The themes emerging were learning curve-associated injuries to the long saphenous vein, intimal wall remodelling of the long saphenous vein and incidence of graft patency rates. Harvesting practitioners with less than 100 cases of experience inflict more conduit injuries leading to endothelial remodelling and narrowed vein grafts at the six-month point resulting in lumen loss. Practitioners with more than 100 cases demonstrated reduced learning curve-related injuries on the conduit. Adopting a formalised structured training programme such as the Manchester Endoscopic Learning Tool has shown to reduce endothelial injury to the long saphenous vein minimising early vein graft failure during the learning cycle.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589241288512"},"PeriodicalIF":1.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476538","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":"Clinical implementation of the Validated Intraoperative Bleeding Scale: Perioperative patient management and effective team communication from the nurses' perspective.","authors":"Clare Sewell, Becky L Whiteman, Flavia C Morone Pinto, Steve Leung","doi":"10.1177/17504589241287744","DOIUrl":"10.1177/17504589241287744","url":null,"abstract":"<p><p>Major bleeding represents a critical scenario that can quickly evolve into life threatening, thereby compromising patient safety. A Validated Intraoperative Bleeding Scale called VIBe Scale was introduced and studied as part of a quality improvement initiative. This study evaluated the clinical implementation of the VIBe Scale in perioperative patient management and team communication from the nurses' perspectives. A descriptive study was undertaken, incorporating introductory lecture, simulation of major bleeding event and post-lecture questionnaire with 33 operating room nurses. Despite many participants not previously having experience of the VIBe Scale in practice, over two-thirds reported the scale could improve situational awareness. Furthermore, nearly two-thirds reported they could see the utility of the VIBe Scale as a tool to improve communication. Our study shows that the VIBe Scale is an easily understood concept, has the potential to increase situational awareness and can support team communication around intraoperative bleeding events.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589241287744"},"PeriodicalIF":1.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476536","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":"The effects of anaesthesia on the cardiovascular, respiratory and nervous systems during inhalational anaesthesia: A case report.","authors":"Bevan Michael Scott","doi":"10.1177/17504589241276652","DOIUrl":"https://doi.org/10.1177/17504589241276652","url":null,"abstract":"<p><p>Our understanding of the effects of anaesthesia is incomplete. Anaesthesia works primarily by causing widespread depression of the central nervous system. This article will consider the anaesthesia provided for a patient undergoing a hysteroscopy, endometrial ablation and biopsy for abnormal uterine bleeding. The relationship between physiology and the effects of anaesthesia is discussed. Several effects of anaesthesia are observed during the case. Relating to the respiratory system, preoxygenation increased end tidal oxygen by 39%, delaying desaturation during apnoea. Propofol had a profound effect on the patient's respiratory rate by inhibiting the ventilatory drive, resulting in apnoea. The cardiovascular system was affected by tracheal intubation. Stimulation of the sympathetic nervous system caused a 96% increase in heart rate. Induction of anaesthesia resulted in hypotension, treated with the administration of ephedrine, causing vasoconstriction. Modified rapid sequence induction required an increased dose of rocuronium, resulting in an increased duration of action at the neuromuscular junction. The prolonging muscle paralysis required sugammadex as a reversal agent. This case demonstrated the effects of anaesthesia on the respiratory, cardiovascular and nervous systems.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589241276652"},"PeriodicalIF":1.2,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476541","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":"Implementation of research, education and leadership placements into Operating Department Practitioner training: A 4-pillar practice-based learning approach.","authors":"Victoria Cadman, Helen Batty, Jennifer Law","doi":"10.1177/17504589241276743","DOIUrl":"https://doi.org/10.1177/17504589241276743","url":null,"abstract":"<p><p>Practice-based learning has traditionally focused on clinical practice in pre-registration courses. However, recent national strategies emphasise the importance of incorporation of all four pillars, clinical, education, leadership and research, into practice-based learning (placements). This article details the introduction of practice-based learning in research, education and leadership alongside clinical placements for BSc Operating Department Practice students at Sheffield Hallam University. It provides insights into the benefits of this approach, outlines the components of each placement with examples of completed projects, shares feedback from students and practice partners and addresses challenges. The authors advocate for adoption of this approach across all pre-registration Operating Department Practice courses, to ensure a workforce capable of meeting evolving health care needs and driving the Operating Department Practice profession forwards.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589241276743"},"PeriodicalIF":1.2,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476540","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}