Pre-assessment and management of long COVID patients requiring elective surgery: challenges and guidance
AbstractWhilst most patients infected with COVID-19 make a full recovery, around 1 in 33 patients in the UK report ongoing symptoms post-infection, termed ‘long COVID’. Studies have demonstrated that infection with early COVID-19 variants increases postoperative mortality and pulmonary complications for around 7 weeks after acute infection. Furthermore, this increased risk persists for those with ongoing symptoms beyond 7 weeks. Patients with lo ng COVID may therefore also be at increased postoperative risk, and despite the significant prevalence of long COVID, there are minimal guidelines on how best to assess and m...
Source: Perioperative Medicine - June 5, 2023 Category: Surgery Source Type: research
The prevalence of hyperglycemia and its association with perioperative outcomes in gynecologic surgery: a retrospective cohort study
ConclusionIn our study cohort, the prevalence of hyperglycemia was low and was not associated with higher risk of composite or wound-specific complications. However, adherence to diabetes screening guidelines was poor. Future studies should aim to develop a preoperative blood glucose testing strategy that balances the low utility of universal glucose screening with the benefit of diagnosing impaired glucose metabolism in at-risk individuals. (Source: Perioperative Medicine)
Source: Perioperative Medicine - June 2, 2023 Category: Surgery Source Type: research
Comparison of 6-min walk test distance vs. estimated maximum oxygen consumption for predicting postoperative pulmonary complications in patients undergoing upper abdominal surgery: a prospective cohort study
ConclusionThe results suggested that e\(\dot{V}\)O2max calculated from the 6MWT is a better predictor of PPCs than 6MWD in patients undergoing upper abdominal surgery and can be used as a tool to screen patients at risk of PPCs. (Source: Perioperative Medicine)
Source: Perioperative Medicine - May 23, 2023 Category: Surgery Source Type: research
Association of intraoperative hypotension and postoperative acute kidney injury after adrenalectomy for pheochromocytoma: a retrospective cohort analysis
ConclusionsWe found a significant association between hypotension and postoperative AKI in patients with pheochromocytoma undergoing adrenalectomy in the period after tumor resection. Optimizing hemodynamics, especially blood pressure after the adrenal vessel ligation and tumor is resected, is crucial for the prevention of postoperative AKI in patient with pheochromocytoma, which could be different from general populations. (Source: Perioperative Medicine)
Source: Perioperative Medicine - May 16, 2023 Category: Surgery Source Type: research
Intraoperative pleth variability index-based fluid management therapy and gastrointestinal surgical outcomes in elderly patients: a randomised controlled trial
ConclusionsAmong elderly patients undergoing GI surgery, intraoperative GDFT based on the simple and non-invasive PVI did not reduce the occurrence of composite postoperative complications but was associated with a lower cardiopulmonary complication rate than usual fluid management.Trial registrationThis trial was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC-17012220) on 1 August 2017. (Source: Perioperative Medicine)
Source: Perioperative Medicine - May 12, 2023 Category: Surgery Source Type: research
Prehabilitation for patients with colorectal cancer: a snapshot of current daily practice in Dutch hospitals
ConclusionsWhereas preoperative screening is sufficiently incorporated in Dutch hospitals, standardised enhancement of the patient ’s condition in the context of multimodal prehabilitation seems to be challenging. This study presents an overview of current clinical practice in the Netherlands. Uniform clinical prehabilitation guidelines are vital to diminish heterogeneity in programmes and to produce useful data to enable a n ationwide implementation of an evidence-based prehabilitation programme. (Source: Perioperative Medicine)
Source: Perioperative Medicine - May 8, 2023 Category: Surgery Source Type: research
Acupuncture-related techniques for postoperative cognitive complications: a systemic review and meta-analysis
ConclusionsAcupuncture-related techniques, including needle techniques and electrical techniques, are associated with fewer postoperative cognitive complications, suggesting that acupuncture could be considered a potential option in the perioperative setting. Additional research is needed to develop higher-quality evidence and optimal regimens.Trial registrationPROSPERO (CRD42021258378). (Source: Perioperative Medicine)
Source: Perioperative Medicine - May 3, 2023 Category: Surgery Source Type: research
Perioperative glycemic management in adults presenting for elective cardiac and non-cardiac surgery
AbstractPerioperative dysglycemia is associated with adverse outcomes in both cardiac and non-cardiac surgical patients. Hyperglycemia in the perioperative period is associated with an increased risk of postoperative infections, length of stay, and mortality. Hypoglycemia can induce neuronal damage, leading to significant cognitive deficits, as well as death. This review endeavors to summarize existing literature on perioperative dysglycemia and provides updates on pharmacotherapy and management of perioperative hyperglycemia and hypoglycemia in surgical patients. (Source: Perioperative Medicine)
Source: Perioperative Medicine - April 29, 2023 Category: Surgery Source Type: research
Non-intubated deep paralysis: a new anaesthesia strategy for vocal cord polypectomy
ConclusionNIDP can be safely applied to patients and can replace general anaesthesia in vocal cord polypectomy. It can significantly reduce the duration of anaesthesia and postoperative recovery. No anaesthesia complications occurred without intubation, and patients and surgeons were satisfied with NIDP.Trial registrationsThis single-centre, prospective study was registered on clinicaltrial.gov (NCT04247412) on 30th July 2020. (Source: Perioperative Medicine)
Source: Perioperative Medicine - April 19, 2023 Category: Surgery Source Type: research
High-flow nasal oxygen vs. standard oxygen therapy for patients undergoing transcatheter aortic valve replacement with conscious sedation: a randomised controlled trial
ConclusionThis study has demonstrated that high flow, compared with standard oxygen therapy, does not improve arterial oxygenation over the course of the procedure. There are suggestions that it may improve the secondary outcomes studied.Trial registrationInternational Standard Randomised Controlled Trial Number (ISRCTN) 13,804,861. Registered on 15 April 2019.https://doi.org/10.1186/ISRCTN13804861 (Source: Perioperative Medicine)
Source: Perioperative Medicine - April 14, 2023 Category: Surgery Source Type: research
Efficacy of remote ischaemic preconditioning on outcomes following non-cardiac non-vascular surgery: a systematic review and meta-analysis
ConclusionsThis meta-analysis did not show an improvement in the primary outcomes of interest with the use of RIPC. RIPC was associated with a small improvement in certain surrogate parameters of organ function and small reduction in hospital length of stay. Our results should be interpreted with caution due to the limited number of studies addressing individual outcomes and the considerable heterogeneity identified.Trial registrationPROSPERO CRD42019129503. (Source: Perioperative Medicine)
Source: Perioperative Medicine - April 10, 2023 Category: Surgery Source Type: research
Evaluation of fluid responsiveness with dynamic superior vena cava collapsibility index in mechanically ventilated patients
ConclusionsThe SVC-CI and SVV can predict fluid responsiveness effectively in mechanically ventilated patients. And SVC-CI is superior in predicting fluid responsiveness compared with SVV. TheE/e’ ratio and CVP cannot predict FR effectively.Trial registrationChinese clinical trial registry (ChiCTR2000034940). (Source: Perioperative Medicine)
Source: Perioperative Medicine - April 10, 2023 Category: Surgery Source Type: research
The incidence of postoperative vasopressor usage: protocol for a prospective international observational cohort study (SQUEEZE)
DiscussionWhile in cardiac surgery, clinical trials have informed the choice of vasopressors used to treat postoperative vasoplegia; there remains equipoise over the best approach in non-cardiac surgery. Our study will represent the first large-scale assessment of the use of vasopressors after non-cardiac surgery. These data will inform future studies, including trials of different vasopressors and potential management options to improve outcomes and reduce resource use after surgery.Trial registrationClinicalTrials.gov Identifier: NCT03805230, 15 January 2019. (Source: Perioperative Medicine)
Source: Perioperative Medicine - March 24, 2023 Category: Surgery Source Type: research
Knowledge of surgical informed consent and associated factors among patients undergone obstetric and gynecologic surgery at Jimma Medical Center, Jimma, Ethiopia, 2020: an institutional based cross-sectional study
ConclusionThe overall level of knowledge regarding informed consent for surgerywas significantly lower than that of other national and international figures. Patient satisfaction and patientto provider relationships were associated with knowledge of surgical informed consent. Adequate information should provide before surgery to improve patients ’ knowledge regarding surgical informed consent and to improve the consent process to make it better suited to fit the needs of all patients. (Source: Perioperative Medicine)
Source: Perioperative Medicine - March 16, 2023 Category: Surgery Source Type: research
Sex differences in myocardial injury after non-cardiac surgery and postoperative mortality
ConclusionThe incidence of MINS was lower in women than in men. In patients with MINS, female sex may be associated with a survival benefit. Further studies are needed to confirm these findings. (Source: Perioperative Medicine)
Source: Perioperative Medicine - March 16, 2023 Category: Surgery Source Type: research
