Natriuretic peptide-directed medical therapy: a systematic review
AbstractNatriuretic peptides (NP) are strongly associated with perioperative cardiovascular events. However, in patients with raised NP, it remains unknown whether treatment to reduce NP levels prior to surgery results in better perioperative outcomes. In this systematic review and meta-analysis, we investigate NP-directed medical therapy in non-surgical patients to provide guidance for NP-directed medical therapy in surgical patients. The protocol was registered with PROSPERO (CRD42017051468). The database search included MEDLINE (PubMed), CINAHL (EBSCO host), EMBASE (EBSCO host), ProQuest, Web of Science, and Cochrane da...
Source: Perioperative Medicine - February 18, 2020 Category: Surgery Source Type: research

The value of teachable moments in surgical patient care and the supportive role of digital technologies
AbstractEvidence strongly supports improved outcomes following surgery when patients are more physically active, have better dietary intake, or are generally fitter prior to surgery. Having an operation is a major life event for patients, and many are not educated around what they can do as individuals to aid a speedier and more successful recovery following their operation. What if there was a time point before surgery where clinicians could inspire patients to adjust their lifestyles for the better, in order to see fewer complications after surgery? This is where the concept of teachable moments comes into play.This comm...
Source: Perioperative Medicine - February 4, 2020 Category: Surgery Source Type: research

Waardenburg-Shah syndrome (WS type IV): a rare case from Pakistan
AbstractWaardenburg-Shah syndrome is a rare autosomal recessive [AR] inherited disorder characterized by the presence of Hirschsprung ’s disease with a high likelihood of aganglionic megacolon, due to which the mortality is high. The management of the condition involves surgical intervention for the removal of the aganglionic segment of the colon. Here, we report a neonate that presented with a white forelock, white eyelashes, i ris hypopigmentation, and sensorineural deafness associated with bilious vomiting, refusal to feed, and failure to pass meconium indicating intestinal obstruction. (Source: Perioperative Medicine)
Source: Perioperative Medicine - January 24, 2020 Category: Surgery Source Type: research

The emerging specialty of perioperative medicine: a UK survey of the attitudes and behaviours of anaesthetists
ConclusionsDespite evidence of emerging services, this survey describes barriers to ongoing development of perioperative medicine. Facilitators may include increased clinical exposure, targeted education and training and collaborative working with other specialties. (Source: Perioperative Medicine)
Source: Perioperative Medicine - January 21, 2020 Category: Surgery Source Type: research

Technical and clinical evaluation of a closed loop TIVA system with SEDLine TM spectral density monitoring: Multicentric prospective cohort study
ConclusionsThe closed loop total intravenous anesthesia system with SEDLine developed by the authors was used without major complication and appear to be feasible its use in clinical performance. (Source: Perioperative Medicine)
Source: Perioperative Medicine - January 9, 2020 Category: Surgery Source Type: research

A significant proportion of venous thromboembolism events in general surgical patients occurs after discharge: analysis of the ACS-NSQIP Essentials database
ConclusionThis is the first paper to report on this high post-discharge incidence of VTE in general surgical patients and to recommend continuation of VTE prophylaxis in the post-discharge period. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 13, 2019 Category: Surgery Source Type: research

Cannabis-based medicines and the perioperative physician
We present a summary of the pharmacology of cannabis-based medicines including anaesthetic interactions and implications, to assist colleagues encountering these medicines in clinical practice. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 6, 2019 Category: Surgery Source Type: research

Compliance, adherence and effectiveness of a community-based pre-operative exercise programme: a pilot study
ConclusionThis community-based pre-operative  exercise programme showed acceptable compliance and adherence rates, and significantly increased upper and lower body strength and HRQoL. Pre-operative exercise training should be considered as early as possible in the surgical-oncology pathway and respected within patient scheduling. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 2, 2019 Category: Surgery Source Type: research

Focused cardiac ultrasound in preoperative assessment: the perioperative provider ’s new stethoscope?
AbstractFocused cardiac ultrasound (FoCUS) —a simplified, qualitative version of echocardiography—is a well-established tool in the armamentarium of critical care and emergency medicine. This review explores the extent to which FoCUS could also be used to enhance the preoperative physical examination to better utilise resources and ident ify those who would benefit most from detailed echocardiography prior to surgery. Among the range of pathologies that FoCUS can screen for, the conditions it provides the most utility in the preoperative setting are left ventricular systolic dysfunction (LVSD) and, in certain c...
Source: Perioperative Medicine - November 22, 2019 Category: Surgery Source Type: research

Standard coagulation assays alone are not sufficient to exclude surgically relevant rivaroxaban plasma concentrations
AbstractBackgroundWhile mainly larger hospitals have introduced routine anti-Xa assays for rivaroxaban (RXA), these are not readily available to smaller hospitals often relying on routine coagulation tests such as prothrombin time (PT) and activated partial thromboplastin time (aPTT).The aim of our study was to investigate the effect of RXA plasma concentration on the standard coagulation tests PT (Quick test and INR) and aPTT in a large group of real-life patients. We further assessed whether normal results of these standard coagulation assays are sufficient to exclude surgically relevant RXA plasma concentration, defined...
Source: Perioperative Medicine - November 20, 2019 Category: Surgery Source Type: research

The role of cardiac rehabilitation using exercise to decrease natriuretic peptide levels in non-surgical patients: a systematic review
AbstractExercise is recommended in patients with cardiac failure. In the perioperative patient, exercise is also gaining popularity as a form of prehabilitation. In this meta-analysis, we examine if exercise is able to reduce natriuretic peptide levels. Natriuretic peptide (NP) has strong prognostic ability in identifying patients who will develop adverse postoperative cardiovascular outcomes. The protocol was registered with PROSPERO (CRD42017051468). The database search included MEDLINE (PubMed), CINAHL (EBSCO host), EMBASE (EBSCO host), ProQuest, Web of Science, and Cochrane database. The primary outcomes were to determ...
Source: Perioperative Medicine - November 18, 2019 Category: Surgery Source Type: research

Large volume infusions of hydroxyethyl starch during cardiothoracic surgery may be associated with postoperative kidney injury: propensity-matched analysis
AbstractBackgroundThe safety of intraoperative administration of hydroxyethyl starch (HES) has been debated. We hypothesized that intraoperative use of HES is associated with postoperative acute kidney injury (AKI) following cardiopulmonary bypass (CPB).Materials and methodsPatients who underwent cardiothoracic surgery using CPB between 2007 and 2014 were retrospectively reviewed. The incidence of AKI within 7  days after surgery, defined by the Kidney Disease Improving Global Outcome criteria, was compared for patients who did or did not receive 6% (70/0.5) or 6% (130/0.4) HES for anesthesia management before or afte...
Source: Perioperative Medicine - October 31, 2019 Category: Surgery Source Type: research

Correction to: Perioperative antibiotic prescribing in surgery departments of two private sector hospitals in Madhya Pradesh, India
Following publication of the original article (Machowska et al. 2019), the authors provided new footnotes for Table 1 and Table 2. The complete tables and updated footnotes are supplied below. (Source: Perioperative Medicine)
Source: Perioperative Medicine - October 28, 2019 Category: Surgery Source Type: research

Primer on adult patient satisfaction in perioperative settings
AbstractThe topic of patient satisfaction has gained increasing importance over the past decade. Due to the impact of patient satisfaction on health care quality, understanding factors that predict satisfaction is vital. The purpose of this review is to examine the literature and identify factors related to patient perioperative satisfaction as well as predictive variables that, if modified, can enhance satisfaction scores of patients undergoing surgery. Our review reports that patient satisfaction scores are affected by modifiable factors such as clinician-patient communication, information provision to patients, and oper...
Source: Perioperative Medicine - September 19, 2019 Category: Surgery Source Type: research

Perioperative antibiotic prescribing in surgery departments of two private sector hospitals in Madhya Pradesh, India
AbstractBackgroundSingle-dose perioperative antibiotic prophylaxis (PAP) is recommended for clean, non-infectious surgeries to prevent surgical site infections. However, the common practice of unindicated use and prolonged use of antibiotics contributes to the development and spread of antibiotic resistance (ABR). The present study explores the perioperative use of antibiotics among inpatients with surgical indications at surgery departments of a teaching (TH) and a non-teaching (NTH) tertiary care hospital in Madhya Pradesh, India.MethodsData was collected manually for all inpatients for 3  years (April 2008–...
Source: Perioperative Medicine - September 10, 2019 Category: Surgery Source Type: research

Impact of an enhanced recovery pathway on length of stay and complications in elective radical cystectomy: a before and after cohort study
AbstractBackgroundEnhanced recovery after surgery (ERAS) pathways aim to standardize and integrate perioperative care, incorporating the best available evidence-based practice throughout the perioperative period targeted at attenuating the surgical stress response while optimizing physiologic function, with the goal of facilitating recovery. Radical cystectomy is associated with significant postoperative morbidity, but comprehensive ERAS pathways have not been well studied in this population.MethodsThis is a before and after cohort study of an ERAS pathway for radical cystectomy at a large academic medical center. Followin...
Source: Perioperative Medicine - August 22, 2019 Category: Surgery Source Type: research

A randomised trial of non-invasive cardiac output monitoring to guide haemodynamic optimisation in high risk patients undergoing urgent surgical repair of proximal femoral fractures (ClearNOF trial NCT02382185)
ConclusionsHaemodynamic optimisation including blood pressure management in high-risk patients undergoing repair of a hip fracture did not result in a statistically significant reduction in complications; however, a potential reduction in length of stay was seen.Trial registrationA randomised trial of non-invasive cardiac output monitoring to guide haemodynamic optimisation in high risk patients undergoing urgent surgical repair of proximal femoral fractures (ClearNOF trialNCT02382185). (Source: Perioperative Medicine)
Source: Perioperative Medicine - August 8, 2019 Category: Surgery Source Type: research

Perioperative fluid management: moving toward more answers than questions —a commentary on the RELIEF study
AbstractPerioperative fluid and hemodynamic management have been much-debated topics over the last few years. Recently, a number of large trials have been published to help inform this debate. The Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery (RELIEF) study is the largest trial to date of perioperative fluid management. The 3000-patient trial comparing 2 different fluid regimes showed that a restrictive fluid regimen during and up to 24  h after surgery was associated with an increase in acute kidney injury (AKI). This result is at odds with a recent trend to a more restrictive fluid approach ...
Source: Perioperative Medicine - July 15, 2019 Category: Surgery Source Type: research

Data integrity issues: catalyst for a more robust approach to research on perioperative oxygen therapy?
(Source: Perioperative Medicine)
Source: Perioperative Medicine - July 4, 2019 Category: Surgery Source Type: research

A retrospective evaluation of the impact of patient ethnicity on the use of epidural analgesia or blood transfusions in children undergoing major oncologic surgery
In this study of children who had undergone open abdominal or pelvic surgery for tumor resection, we sought to compare the use of epidural analgesia or intraoperative blood transfusions between Caucasian and non-Caucasian children.MethodsA retrospective study of 139 children was performed. Logistic regression models were used to evaluate the association between the specified perioperative factors and patient ethnicity.ResultsThe average age (standard deviation) was 11  years (± 5), 50% were female, and 58% were Caucasian. Compared to Caucasian children, non-Caucasian children were younger (difference i...
Source: Perioperative Medicine - June 20, 2019 Category: Surgery Source Type: research

The effect of virtual reality technology on preoperative anxiety in children: a Solomon four-group randomized clinical trial
AbstractBackgroundPreoperative anxiety correlates positively with the amount of postoperative pain, analgesic use, and length of hospital stay. The purpose of this study was to investigate the effect of virtual reality technology on pre-operative anxiety in children.MethodsThe study utilized Solomon four-group design intervention and a randomized clinical trial. A total of 40 candidates undergoing abdominal surgery were randomly divided into two groups. The pre-operative anxiety scale was assessed by a checklist containing a standardized Yale Preoperative Anxiety Scale questionnaire. The interventional group had a 5-min ex...
Source: Perioperative Medicine - June 4, 2019 Category: Surgery Source Type: research

Enhanced recovery after surgery (ERAS) program for lumbar spine fusion
ConclusionsImplementing an  ERAS bundle for 1–2-level lumbar fusion had minimal effect in decreasing length of stay, but a significant decrease in postoperative opioid and rescue antiemetic use. This ERAS bundle showed mixed results likely secondary to poor ERAS protocol compliance. Going forward, this QI project will look to improve post-operative ERAS implementation to improve patient outcomes. (Source: Perioperative Medicine)
Source: Perioperative Medicine - May 28, 2019 Category: Surgery Source Type: research

Factors influencing day surgery patients ’ quality of postoperative recovery and satisfaction with recovery: a narrative review
The objective of this paper is to discuss and reflect on factors that can affect patients’ quality of postoperative recovery and satisfaction with recovery after day surg ery. Involving patients in shared decision-making (SDM) and providing sufficient preoperative and postoperative information can improve their satisfaction. It is important to assess whether patients experience poor recovery, which can be both distressing and dissatisfying. We suggest that patients’ age, sex, mental health status, and health literacy (HL) skills should be assessed preoperatively, since these factors seem to have a negative impa...
Source: Perioperative Medicine - May 22, 2019 Category: Surgery Source Type: research

Intravenous lidocaine infusion as a component of multimodal analgesia for colorectal surgery —measurement of plasma levels
ConclusionsWhilst there were no signs or symptoms of lidocaine toxicity in our patients, there was a wide range of plasma concentrations including some over 10  μg ml−1; a level above which symptoms of toxicity may be expected. We have changed our dosing protocol to using ideal rather than actual body weight based on these results. (Source: Perioperative Medicine)
Source: Perioperative Medicine - February 26, 2019 Category: Surgery Source Type: research

Anesthetic consideration for airway management of patients undergoing endoscopic fibrin glue treatment of tracheobronchial rupture: a case series of three patients
AbstractTracheobronchial ruptures are very severe and life-threatening injuries. The origin of such airway damage is trauma or an iatrogenic event. Last year, we operated on three different cases of tracheal ruptures using endobronchial suture with three different airway management. We exposed the description of three different techniques to manage the airway during an endoscopic suture of tracheobronchial rupture with fibrin glue (laryngeal mask, orotracheal tube positioned distally the lesion, one lung ventilation with a small size single tube). Using this kind of technique, we have obtained a protective ventilation on t...
Source: Perioperative Medicine - December 17, 2018 Category: Surgery Source Type: research

Acute kidney injury in postoperative shock: is hyperoncotic albumin administration an unrecognized resuscitation risk factor?
ConclusionsEarly exposure to hyperoncotic albumin in postoperative shock appeared to be associated with acute kidney injury. There did not appear to be any association with hepatic injury, mortality, or ICU days. The clinical and economic implications of this finding warrant further investigation. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 14, 2018 Category: Surgery Source Type: research

Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures: a Cochrane systematic review
ConclusionsSmall effect sizes for biochemical outcomes and lack of correlated clinical follow-up data mean that robust conclusions on major morbidity and mortality associated with buffered versus non-buffered perioperative fluid choices are still lacking. Buffered fluid may have biochemical benefits, including a significant reduction in postoperative hyperchloraemia and metabolic acidosis. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 13, 2018 Category: Surgery Source Type: research

What is the effect of perioperative intravenous iron therapy in patients undergoing non-elective surgery? A systematic review with meta-analysis and trial sequential analysis
ConclusionWe found no conclusive evidence of an effect of IV iron on clinically important outcomes in patients undergoing non-elective surgery. Further adequately powered trials to evaluate its benefit in emergency surgical specialties with a high burden of anaemia are warranted.Trial registrationThis systematic review was registered on PROSPERO (CRD42018096288) (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 12, 2018 Category: Surgery Source Type: research

Characterizing post-extubation negative pressure pulmonary edema in the operating room —a retrospective matched case-control study
This study investigated the incidence and associated risk factors for post-extubation NPPE during emergence.MethodsThis retrospective, matched case-control study was conducted by reviewing the post-anesthesia records in Tzu Chi General Hospital, Taiwan. Patients reported of having acute hypoxemia (SpO2
Source: Perioperative Medicine - December 6, 2018 Category: Surgery Source Type: research

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.
AbstractBackgroundPrescription opioid use at high doses or over extended periods of time is associated with adverse outcomes, including dependency and abuse. The aim of this study was to identify mediating variables that predict chronic opioid use, defined as three or more prescriptions after orthopedic surgery.MethodsIndividuals were ages between 18 and 50  years and undergoing arthroscopic hip surgery between 2004 and 2013. Two categories of chronic opioid use were calculated based on individuals (1) having three or more unique opioid prescriptions within 2 years and (2) still receiving opioid prescriptions>...
Source: Perioperative Medicine - November 22, 2018 Category: Surgery Source Type: research

A prospective case series evaluating use of an in-line air detection and purging system to reduce air burden during major surgery
AbstractBackgroundIntravascular air embolism (AE) is a preventable but potentially catastrophic complication caused by intravenous tubing, trauma, and diagnostic and surgical procedures. The potentially fatal risks of arterial AE are well-known, and emerging evidence demonstrates impact of venous AEs on inflammatory response and coagulation factors. A novel FDA-approved in-line air detection and purging system was used to detect and remove air caused by administering a rapid fluid bolus during surgery.MethodsA prospective, randomized, case series was conducted. Subjects were observed using standard monitors, including tran...
Source: Perioperative Medicine - November 8, 2018 Category: Surgery Source Type: research

Pulmonary artery catheter use in adult patients undergoing cardiac surgery: a retrospective, cohort study
AbstractBackgroundThe utility of pulmonary artery catheters (PACs) and their measurements depend on a variety of factors including data interpretation and personnel training. This US multi-center, retrospective electronic health record (EHR) database analysis was performed to identify associations between PAC use in adult cardiac surgeries and effects on subsequent clinical outcomes.MethodsThis cohort analysis utilized the Cerner Health Facts database to examine patients undergoing isolated coronary artery bypass graft (CABG), isolated valve surgery, aortic surgery, other complex non-valvular and multi-cardiac procedures, ...
Source: Perioperative Medicine - October 25, 2018 Category: Surgery Source Type: research

Correction to: Intraoperative oxygenation in adult patients undergoing surgery (iOPS): a retrospective observational study across 29 UK hospitals
Following publication of the original article (Morkane et al., 2018), it was noticed that the second collaborating group ‘South Coast Perioperative Audit and Research Collaboration (SPARC)’ was not displayed on the HTML online version due to an error by the Publisher. (Source: Perioperative Medicine)
Source: Perioperative Medicine - October 24, 2018 Category: Surgery Source Type: research

Clinical and economic impact of goal-directed fluid therapy during elective gastrointestinal surgery
ConclusionIn patients undergoing gastrointestinal surgery, the implementation of a GDFT protocol was associated with a reduction in postoperative morbidity without increasing costs.Trial registrationclinicaltrials.gov,NCT02507557. Registered 13 July 2015. (Source: Perioperative Medicine)
Source: Perioperative Medicine - October 4, 2018 Category: Surgery Source Type: research

Relationship between endotoxin core, staphylococcal and varicella antibody levels and outcome following aortic valve replacement surgery: a prospective observational study
ConclusionsThis study again suggests the inverse relationship between endotoxin core antibody levels and outcome following aortic valve surgery as well as suggesting a similar relationship with antibodies to staphylococcus. There is no such relationship for antibody levels against an organism not providing a peri-operative threat. Understanding this relationship may enable therapeutic manipulation of immune status, re-evaluation of risk and further investigation of the low immune state.Trial registrationThe patients in this study are a sub-group of the RELIEF AS study.ClinicalTrials.gov identifierNCT02174471. (Source: Perioperative Medicine)
Source: Perioperative Medicine - September 20, 2018 Category: Surgery Source Type: research

Comparison of dextran and albumin on blood coagulation in patients undergoing major gynaecological surgery
ConclusionsStandard plasma-based coagulation tests, platelet count and whole blood viscoelastic clot structure are affected by 6% dextran-70 to a greater extent than by 5% albumin, but platelet aggregation is not. Future studies should use more advanced haemodynamic monitoring to assess isovolemic plasma volume expansion with dextran and whether this affects haemostasis to a lesser degree. (Source: Perioperative Medicine)
Source: Perioperative Medicine - September 6, 2018 Category: Surgery Source Type: research

Patient-reported outcomes 6  months after enhanced recovery after colorectal surgery
ConclusionsLong-term benefits of an ERAS program were mostly confirmed. Longer procedure time and patients with cancer correlated with an increased likelihood of hospital 6-month readmission, suggesting that perioperative outcomes in complex cancer patients need to be evaluated over a longer time frame. In addition, invasiveness of procedure continues to have a significant effect on pain scores even 6  months later. (Source: Perioperative Medicine)
Source: Perioperative Medicine - August 23, 2018 Category: Surgery Source Type: research

Recruitment of sublingual microcirculation using handheld incident dark field imaging as a routine measurement tool during the postoperative de-escalation phase —a pilot study in post ICU cardiac surgery patients
ConclusionsCytocam-IDF imaging to monitor microcirculation as a daily parameter is feasible and could become a valuable tool to non-invasively assess the tissue oxygenation at the bedside. An increase in TVD and PVD (functional capillary density) indicated the recruitment of the sublingual microcirculation in patients with diuretic therapy. Future research is needed to prove the correlation between the recruitment of the sublingual microcirculation and the de-escalation phase of the fluid management. (Source: Perioperative Medicine)
Source: Perioperative Medicine - August 9, 2018 Category: Surgery Source Type: research

Intraoperative oxygenation in adult patients undergoing surgery (iOPS): a retrospective observational study across 29 UK hospitals
AbstractBackgroundConsiderable controversy remains about how much oxygen patients should receive during surgery. The 2016 World Health Organization (WHO) guidelines recommend that intubated patients receive a fractional inspired oxygen concentration (FIO2) of 0.8 throughout abdominal surgery to reduce the risk of surgical site infection. However, this recommendation has been widely criticised by anaesthetists and evidence from other clinical contexts has suggested that giving a high concentration of oxygen might worsen patient outcomes. This retrospective multi-centre observational study aimed to ascertain intraoperative o...
Source: Perioperative Medicine - July 24, 2018 Category: Surgery Source Type: research

The rising tide of opioid use and abuse: the role of the anesthesiologist
AbstractOpioid use has risen dramatically in the past three decades. In the USA, opioid overdose has become a leading cause of unintentional death, surpassing motor vehicle accidents. A patient ’s first exposure to opioids may be during the perioperative period, a time where anesthesiologists have a significant role in pain management. Almost all patients in the USA receive opioids during a surgical encounter. Opioids have many undesirable side effects, including potential for misuse, or opioid use disorder. Anesthesiologists and surgeons employ several methods to decrease unnecessary opioid use, opioid-related adver...
Source: Perioperative Medicine - July 3, 2018 Category: Surgery Source Type: research

Comparing the experience of enhanced recovery programme for gynaecological patients undergoing laparoscopic versus open gynaecological surgery: a prospective study
AbstractBackgroundEnhanced recovery has been shown to improve patients ’ experience after surgery. There are no previous studies comparing patients’ experience between those undergoing laparoscopic and open gynaecological surgery. Therefore, the aim of this prospective study is to compare patients’ functional recovery based on milestones set by the enhanced recov ery programme and patients’ satisfaction between the two groups.MethodsAll eligible patients undergoing gynaecological surgery within an enhanced recovery after surgery (ERAS) programme from March to August 2014 were involved in this study....
Source: Perioperative Medicine - June 27, 2018 Category: Surgery Source Type: research

Anesthesiologists as perioperative hospitalists and outcomes in patients undergoing major urologic surgery: a historical prospective, comparative effectiveness study
AbstractBackgroundPerioperative care has been identified as an area of wide variability in quality, with conflicting models, and involving multiple specialties. In 2014, the Loma Linda University Departments of Anesthesiology and Urology implemented a perioperative hospitalist service (PHS), consisting of anesthesiology-trained physicians, to co-manage patients for the entirety of their perioperative period. We hypothesized that implementation of this PHS model would result in an improvement in patient recovery.MethodsAs a quality improvement (QI) initiative, the PHS service was formed of selected anesthesiologists who rec...
Source: Perioperative Medicine - June 19, 2018 Category: Surgery Source Type: research