{"title":"Fluid management","authors":"Andrew Pedder, James Sylvester, Steven Lobaz","doi":"10.1016/j.mpsur.2025.02.003","DOIUrl":"10.1016/j.mpsur.2025.02.003","url":null,"abstract":"<div><div>Intravenous fluids are one of the most prescribed medical therapies, with widespread effects on patient outcome, morbidity and mortality. They are often poorly understood and their prescription is overseen by the most junior members of the healthcare team. Better knowledge of the appropriate choice, rate and volume of fluid, alongside the consequences of any prescription, can therefore have a significant impact on patient care. This article reviews some of the basic concepts underpinning the use of fluid therapy, associated physiology, clinical application and evidence base in the perioperative setting.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 4","pages":"Pages 181-189"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821416","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 principles and conduct of anaesthesia","authors":"Anurag Vats, Monalisa J Marbaniang","doi":"10.1016/j.mpsur.2025.02.004","DOIUrl":"10.1016/j.mpsur.2025.02.004","url":null,"abstract":"<div><div>Anaesthesia is one of the younger specialities of medicine and has made immense advancement since its inception. Modern anaesthesia techniques, drugs, and monitoring methods have facilitated the development and advancement of surgical practice, which benefits patients. This article provides an overview of the pharmacology and the conduct of a general anaesthetic. Regional anaesthesia has always been an integral part of the practice of anaesthesia and surgery. We discuss the essential components of the practice of neuraxial anaesthesia and peripheral nerve blocks. It is known that many surgical trainees are deficient in the knowledge of the safe administration of local anaesthetics, which we have tried to address in this article and present the latest in the prevention and management of local anaesthetic systemic toxicity.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 4","pages":"Pages 222-231"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821349","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 and concomitant medicines management","authors":"Mark ZY Tan, Noamaan Wilson-Baig","doi":"10.1016/j.mpsur.2025.03.001","DOIUrl":"10.1016/j.mpsur.2025.03.001","url":null,"abstract":"<div><div>Perioperative medicines management remains an important part of surgical and perioperative care. This article provides practical guidance for clinicians on managing medicines during the perioperative period. It aims to summarize the biochemical pathways underpinning common drugs, provide succinct overviews of the considerations around perioperative medicines management, and signpost readers to key recommendations. The paper is structured according to body systems, and subsections on each key category of medicines. In each section, there will be a succinct narrative overview, usually accompanied by a diagram of drug pathways, and a table containing key information. Each overview provides an approach to consider the corresponding category of medicines, and key considerations or recommendations. Each diagram will contain the contextual physiology and drug targets. Each table will include key information about drugs, including mechanism of action, perioperative recommendations, and specific considerations. By taking a systematic approach and developing a thorough understanding of pharmacology, the surgeon can effectively contribute within a multidisciplinary team and provide the best possible care for patients throughout their journey.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 4","pages":"Pages 203-221"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821348","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}
Eid Hussien, Diaaeldin Aboelnile, Ahmed Aboelnile, Leigh Kelly
{"title":"Management of acute pain","authors":"Eid Hussien, Diaaeldin Aboelnile, Ahmed Aboelnile, Leigh Kelly","doi":"10.1016/j.mpsur.2025.01.011","DOIUrl":"10.1016/j.mpsur.2025.01.011","url":null,"abstract":"<div><div>Acute pain relief remains suboptimal for many patients. Effective postoperative analgesic strategies require a holistic approach, promoting timely recovery and integration with other pathways like physiotherapy and nutrition. Poor acute postoperative pain management can limit mobility, leading to complications that increase morbidity and mortality. Thus, timely and effective acute pain management is essential. Acute Pain Service (APSs) play a role in managing complex cases and specific invasive analgesic methods. However, initial pain management usually falls to the admitting surgical doctor. This article reviews key considerations for safe, effective acute pain management and highlights recent updates in consensus guidelines and evidence from the past three years.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 4","pages":"Pages 240-248"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821351","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":"Anaemia and blood transfusion incorporating patient blood management","authors":"Sean R Bennett, Sam Fosker","doi":"10.1016/j.mpsur.2025.01.010","DOIUrl":"10.1016/j.mpsur.2025.01.010","url":null,"abstract":"<div><div>Chronic anaemia in the stable patient carries a small risk in non-haemorrhagic surgery. Where bleeding is anticipated, the risk increases. Management of anaemia preoperatively with haematinics may mitigate the risk but preoperative transfusion of even 1 unit of packed red blood cells (RBCs) increases the risk. The goal is to avoid perioperative blood transfusion. Preoperative oral iron from eight to three weeks before surgery remains the preferred option. Intravenous (IV) iron with or without erythropoiesis stimulating agents (ESAs) should be considered when oral iron fails or in specific patient groups. Bleeding causes acute anaemia requiring maintenance of blood volume and only transfusion to keep the haematocrit (Hct) >21% and haemoglobin (Hb) >74 g/L in low-risk patients without coronary artery disease (CAD) and Hct 24%–27% or Hb >80 g/L in high-risk patients. Both anaemia and transfusion increase the morbidity and mortality associated with surgery. The most significant impact on adverse outcomes is major bleeding (MB). Therefore medical, surgical and anaesthetic management should focus on correcting anaemia and minimizing blood loss to prevent adverse patient outcomes.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 4","pages":"Pages 190-197"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821417","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 future of surgical training – what would the ideal postgraduate surgical training programme look like in 2035?","authors":"Kathryn Bell","doi":"10.1016/j.mpsur.2025.01.009","DOIUrl":"10.1016/j.mpsur.2025.01.009","url":null,"abstract":"<div><div>This essay explores the evolving landscape of surgical training and practice, anticipating changes in healthcare over the next decade. This proposes a forward-looking curriculum for postgraduate surgical training in 2035, considering societal shifts, technological advancements, and the growing complexity of patient care. The training program should align with the Social Efficiency ideology, ensuring it meets the needs of patients, healthcare stakeholders, and future surgeons. Key updates in curriculum content are predicted to include clinical complexity, the integration of emerging technologies such as genomics, bioengineering, and non-invasive surgery, and a focus on sustainable practice. The increasing burden of chronic diseases, disability, and an ageing population will necessitate the development of surgeons equipped to handle complex cases. Additionally, the rise of artificial intelligence (AI), virtual training (VT), and innovative technologies will reshape training methodologies, offering new opportunities for skill development and assessment. Challenges to traditional workplace-based learning, including increased clinical responsibilities and case diversity, suggest a shift to trainee-centered, outcomes-based models. Ultimately, the 2035 surgical training programme should adapt to societal needs, technological progress, and evolving patient expectations, ensuring that future surgeons are well-prepared for a dynamic and complex healthcare environment.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 4","pages":"Pages 264-266"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821354","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}
Naresh Rajasekar, Kiran K Koneti, Vikram Rajasekar
{"title":"Chronic pain management after surgery","authors":"Naresh Rajasekar, Kiran K Koneti, Vikram Rajasekar","doi":"10.1016/j.mpsur.2025.02.002","DOIUrl":"10.1016/j.mpsur.2025.02.002","url":null,"abstract":"<div><div>Chronic post-surgical pain is a common problem affecting between 2% and 10% of adults after surgery and is a significant health burden. The development of chronic post-surgical pain involves multiple mechanisms including peripheral and central sensitization and nerve injury. There are many risk factors including preoperative pain, chemotherapy/radiotherapy, surgical, psychological and genetic factors. The prevention of chronic post-surgical pain is challenging but progress is being made in identifying at-risk groups, improved surgical technique and preventative analgesia including regional analgesia. Accurate diagnosis is essential for prompt management, including identification of neuropathic pain. Management involves identifying any surgically or medically treatable cause, followed by pharmacological, psychological, physical and interventional management. It is essential for all clinicians involved in the care of surgical patients to have an awareness of chronic post-surgical pain, its prevention, diagnosis and treatment.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 4","pages":"Pages 249-254"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821352","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}
Naresh Rajasekar, Kiran K Koneti, Bijay Mallikarjuna
{"title":"Surgical management for chronic pain","authors":"Naresh Rajasekar, Kiran K Koneti, Bijay Mallikarjuna","doi":"10.1016/j.mpsur.2025.01.007","DOIUrl":"10.1016/j.mpsur.2025.01.007","url":null,"abstract":"<div><div>Chronic pain in the UK affects up to 43% of the population. The consequences include physical and psychological distress, loss of function, employment, family and social strain, and increased utilization of healthcare services. Modern pain management services operate across primary, secondary and tertiary care and incorporate general practitioners, psychologists, physiotherapists, pharmacists, specialist nurses, pain physicians and surgeons. This allows for a coordinated approach to chronic pain, engaging the patient in a structured pathway from conservative measures, through to surgery if necessary. Surgical interventions have been utilized effectively throughout the 20th century for the treatment of a variety of conditions, some of which are now effectively managed with improved pharmacological approaches or novel neuromodulation techniques. Ablative procedures that aim to permanently interrupt the pain pathway still represent the final solution for some conditions, particularly those with cancer-associated pain; however, the search for less invasive, less risky measures continues. This is stimulated by an increased understanding of the neurobiology of pain transmission and the physiological changes which occur in persistent pain.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 4","pages":"Pages 255-261"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821353","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":"Consent: risk assessment, risk communication and shared decision making","authors":"Catherine Rimmer","doi":"10.1016/j.mpsur.2025.01.008","DOIUrl":"10.1016/j.mpsur.2025.01.008","url":null,"abstract":"<div><div>The consent process is the foundation of the modern doctor–patient relationship, and can present a significant challenge to doctors. The consent process can be complex, and often involves the interaction of many different factors, including ethical and legal considerations. A shared decision-making process allows for full consideration of the treatment options available, and takes into account individual patients' values and preferences. Ensuring that the patient is fully informed requires a thorough understanding of the risks of an intervention for that particular patient; therefore, individualized risk assessment is of fundamental importance. Using a combination of individual patient information, formal investigations and population data gives the most complete assessment of risk. Communicating that risk information to patients is key, and the doctor should always use clear language and avoid bias. The use of visual aids and information leaflets and the avoidance of vague language and complex statistical terms will all help the patient to develop a more complete understanding of the risks they face.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 4","pages":"Pages 198-202"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821418","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":"Test yourself: MCQ and single best answer","authors":"Adrian Ben Cresswell","doi":"10.1016/j.mpsur.2025.02.005","DOIUrl":"10.1016/j.mpsur.2025.02.005","url":null,"abstract":"","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 4","pages":"Pages 262-263"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822380","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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