Publisher: Association for Perioperative Practice   (Total: 1 journals)   [Sort by number of followers]

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Journal of Perioperative Practice
Journal Prestige (SJR): 0.13
Number of Followers: 6  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1750-4589 - ISSN (Online) 2515-7949
Published by Association for Perioperative Practice Homepage  [1 journal]
  • Summer time

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      Authors: Julie Quick
      Pages: 171 - 171
      Abstract: Journal of Perioperative Practice, Volume 32, Issue 7-8, Page 171-171, July/August 2022.

      Citation: Journal of Perioperative Practice
      PubDate: 2022-06-28T08:17:57Z
      DOI: 10.1177/17504589221099717
      Issue No: Vol. 32, No. 7-8 (2022)
       
  • Ligation of the common carotid artery

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      Authors: Harold Ellis
      Pages: 202 - 203
      Abstract: Journal of Perioperative Practice, Volume 32, Issue 7-8, Page 202-203, July/August 2022.

      Citation: Journal of Perioperative Practice
      PubDate: 2022-06-28T08:17:57Z
      DOI: 10.1177/17504589211057431
      Issue No: Vol. 32, No. 7-8 (2022)
       
  • Perioperative group and save testing are not routinely indicated for
           emergency laparoscopic appendicectomy and laparoscopic hernia repairs: A
           North West London retrospective study

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      Authors: Jasim Al-Musawi, Ieuan Reece, Jun Yu Chen, Clemency Britton, Ealaff Shakweh, Kritchai Vutipongsatorn, Clarissa Ng, Shreeya Kotecha, Michael Lawler, Garima Daga, Noman Zafar
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      Introduction:Two valid group and saves are commonly required for patients undergoing laparoscopic appendicectomy and laparoscopic hernia repairs preoperatively; however, perioperative blood transfusions are seldom required. This is financially burdensome and frequently leads to delays in theatre lists. We performed a retrospective analysis to investigate blood transfusions performed perioperatively and within 28 days of these procedures.Method:We used our electronic records to collect data of all laparoscopic appendectomies and laparoscopic hernia repairs between March 2017 and March 2021. Patients of any age undergoing these operations were included. Patients requiring concomitant intra-abdominal surgery or who had incomplete medical records were excluded.Results:A total of 1891 patients were included, of which 1462 (77.3%) had a laparoscopic appendicectomy versus 429 (22.7%) who had a laparoscopic hernia repair. In all, 3507 group and saves were taken costing £47,398.50. One patient (0.068%) required emergency blood transfusion (4 units of red cells) secondary to major haemorrhage.Conclusion:Our findings demonstrate that the incidence of perioperative blood transfusions for laparoscopic appendicectomy and laparoscopic hernia repairs is low, challenging the indication for routine preoperative group and saves.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-08-08T11:02:10Z
      DOI: 10.1177/17504589221110333
       
  • Preoperative echocardiography for patients with hip fractures undergoing
           surgery in a low-resource setting: Asset or obstacle'

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      Authors: Marlon M Mencia, Rondell Skeete, Pedro Pablo Hernandez Cruz, Shamir O Cawich
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      The aim of this study was to determine the rate of preoperative transthoracic echocardiography in hip fracture patients and to evaluate its effects on time to surgery and length of stay. We conducted a retrospective review of all patients with hip fractures treated at a tertiary referral hospital. Data examined included age, sex, comorbidities, time to surgery, length of stay, fracture type and transthoracic echocardiography findings. Forty-eight patients with hip fractures underwent surgery (men 41.7%; mean age 77.2 (49–95)). Nine patients (18.7%) had a preoperative transthoracic echocardiography. Preoperative transthoracic echocardiography was associated with a significantly longer time to surgery an abbreviation for days e.g dys should be added after the values to indicate what time frame is being measured (14.7 versus 6.8, p = 0.0051) and length of stay (23.6 versus 10.4, p = 0.0002). This study demonstrates a high rate of preoperative transthoracic echocardiography in hip fracture patients. The role of transthoracic echocardiography should be reassessed in view of its association with significant surgical delays.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-07-29T09:03:04Z
      DOI: 10.1177/17504589221110332
       
  • John Hunter, excision of a massive parotid tumour

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      Authors: Harold Ellis
      Abstract: Journal of Perioperative Practice, Ahead of Print.

      Citation: Journal of Perioperative Practice
      PubDate: 2022-07-21T01:25:43Z
      DOI: 10.1177/17504589221095967
       
  • A qualitative study of nurse-perceived barriers to body temperature
           management in postoperative patients

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      Authors: Norihiro Kameda
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      Although evidence-based practices exist for preventing hypothermia in patients during surgery, few studies have focused on this concern in postoperative patients. The aim of this qualitative study was to explore the most challenging issues experienced by surgical ward nurses while managing the body temperature of adult surgical patients. To address this research gap, this study used a qualitative descriptive design to document barriers to body temperature management as reported by a sample of 16 perioperative nurses. The semi-structured, face-to-face interviews were digitally recorded, transcribed verbatim and analysed using inductive content analysis. The main barriers fell into three categories: professional nursing ability limitations, unfavourable working conditions and management of human resources. The eight subcategories were disadvantageous professional views, professional knowledge limitations, low motivation to provide nursing care, non-standard treatment environment, inadequate equipment and care protocols, heavy nursing care loads, inadequate staff training and ineffective staff supervision. These findings highlighted the importance of adequate resources, proper education and evidence-based care protocols in the effective delivery of body temperature management to postoperative patients.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-07-05T10:15:57Z
      DOI: 10.1177/17504589221107235
       
  • Patient Controlled Analgesia and its effect on postoperative outcomes in
           an older cohort of patients undergoing orthopaedic procedures: A
           retrospective observational study

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      Authors: Mayura Thilanka Iddagoda, Andrew Nienaber, Carina Pretorius, Leon Flicker
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      Background:Patient Controlled Analgesia is a popular technique used to manage postoperative pain. The suitability of Patient Controlled Analgesia in older patients after surgical procedures and its effect on postoperative outcomes are not clear.Method:The records of 305 older patients undergoing orthopaedic surgeries in a single tertiary centre were reviewed. Postoperative outcomes were compared between those given Patient Controlled Analgesia and those who were not, using multinomial logistic regression adjusted by propensity scores.Results:Physical function on day 3 after surgery is worse, and risk of requiring personal assistance is higher if the patient had Patient Controlled Analgesia (p = 0.01). Length of stay in patients using patient-controlled analgesia was longer than patients not using patient-controlled analgesia (p = 0.002), and patients given Patient Controlled Analgesia had higher odds of needing support on discharge (p = 0.01). Surprisingly, pain control is poor in the Patient Controlled Analgesia group (p = 0.009).Conclusion:In this review, Patient Controlled Analgesia use was common (40% of our sample), and postoperative outcomes such as physical function on day 3, length of stay and discharge destination were unfavourable in patients who had Patient Controlled Analgesia.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-07-05T10:09:58Z
      DOI: 10.1177/17504589221101437
       
  • Optimising the use of cell salvage in revision hip arthroplasty

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      Authors: Lucy C Walker, Emma Halliwell, Stephen W Veitch
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      Background:Intraoperative cell salvage is an established method to reduce the requirement for and the volume of allogenic blood transfusion but adds to the financial cost of performing surgery.Aims:The primary aim of this study was to determine which patients and what type of revision hip surgery benefit most from intraoperative cell salvage.Methods:This observational study included patients who underwent revision hip surgery performed by the senior author at a single orthopaedic unit. The cohort was divided into single and two-component revision groups; then, the transfusion requirement combined with analysis of patient factors was used to create a decision-making protocol.Findings:The two-component group had a significantly higher number of cases using cell salvage and a higher total transfusion volume. Patients who required postoperative allogenic blood transfusions had a higher mean age, were less likely to have received tranexamic acid and had a lower preoperative haemoglobin level.Conclusion:Based on these results, a decision-making protocol was developed for when to use cell salvage in revision hip surgery.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-06-02T07:31:39Z
      DOI: 10.1177/17504589221099832
       
  • The role of the bedside assistant in robot-assisted surgery: A critical
           synthesis

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      Authors: Carolina Relvas Britton, Indu Francis, Li June Tay, Bhuvaneswari Krishnamoothy
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      Introduction:Robot-assisted surgery has grown exponentially since its inception and first approval in the United States in the year 2000. The surgeon operating with the assistance of the robot sits remotely to the patient and another practitioner assists at the bedside. The role of the bedside assistant and the training that is required to undertake this role are understudied topics.Aim:To explore the functions, training and professional development of the bedside assistant in robot-assisted surgery and propose the necessary foundations for the safe enactment of the role in the United Kingdom.Methods:Through critical interpretative synthesis, relevant literature was systematically searched and analysed to inform integration of evidence.Results:Seventy-three studies were retrieved from the literature, across several health care disciplines and surgical specialities. These were critically analysed to inform a theoretically sound account grounded on evidence.Conclusion:The role, functions and skills of the bedside assistant in robot-assisted surgery vary across contexts. These were analysed and critically synthetised to produce several keys to the success of bedside assistants in robot-assisted surgery in the context of the United Kingdom and of its national regulations.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-05-20T07:15:06Z
      DOI: 10.1177/17504589221094136
       
  • Reasons for day of surgery cancellation of orthopaedic cases following a
           major earthquake in Trinidad and Tobago

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      Authors: Shanta Bidaisee, Pedro Pablo Hernandez Cruz, Marlon M Mencia
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      An earthquake in 2018 resulted in irreparable damage to the Port of Spain General Hospital, Trinidad and Tobago, and severely affected orthopaedic services. This study investigates the rate and reasons for cancellation on the day of surgery of orthopaedic cases during the post-earthquake period. We prospectively collected data on all cases scheduled to undergo surgery during the study period. Information was gathered on patient demographics, the number and reasons for cancellation. Data were analysed using Analyse-it for Microsoft Excel 5.40 (Analyse-it Software Ltd). Our results show that 43 patients were cancelled, resulting in a 44.3% cancellation rate. Patients who had their surgery cancelled were older, with a higher American Society of Anesthesiologists class compared with patients whose surgery was not cancelled. Hospital-related factors were found to be responsible for the majority of cancellations. Placed in context, our findings suggest that limited operating time due to the earthquake-induced hospital damage was the principal reason for the high rate of surgery cancellations.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-05-15T04:29:31Z
      DOI: 10.1177/17504589211045228
       
  • Port-site hernias in patients undergoing laparoscopic and/or robotic
           surgery: Can they be prevented'

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      Authors: Yvonne Richards
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      As laparoscopic surgery advances into robotic surgery, there still remains the occurrence of port-site hernias. This can have severe consequences for the patient, including needing further surgery such as bowel resection. This has an impact on both patient and the National Health Service as the stay in hospital is prolonged, increasing the demand on staff and creating more expense to the National Health Service. This literature review explores the prevalence of port-site hernias and discovers the recommendations in preventive measures. Findings include the benefit of using non-bladed trocars and further studies need to be conducted into the association between smaller or larger ports and port-site hernias.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-05-12T11:23:18Z
      DOI: 10.1177/17504589221094135
       
  • Clinical outcome of patients undergoing preoperative chest physiotherapy
           in elective upper abdominal surgeries

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      Authors: Vikram Singh, Sreekar Agumbe Pai, Vijaykumar Hosmath
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      Upper abdominal surgeries are associated with postoperative pulmonary complications. This study aimed to evaluate the effectiveness of preoperative chest physiotherapy on the clinical outcome in upper abdominal surgery patients. Fifty patients were equally randomised into control (general care) and intervention (preoperative chest physiotherapy) groups. Forced vital capacity, forced expiratory volume, incidence of postoperative pulmonary complications, duration of surgery and days spent in intensive unit care were recorded. The intergroup difference in the spirometric values was significant post-surgery. A total of 11 patients experienced postoperative pulmonary complications. Significant difference in the mean duration of surgery and duration of stay in the intensive care unit in both the study groups was observed. Incidence of postoperative pulmonary complications was significantly associated with number of days spent in the intensive care unit. Significant increase in the spirometric values post-surgery in the intervention group implies the importance of preoperative chest physiotherapy in reducing postoperative complications.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-05-05T11:06:36Z
      DOI: 10.1177/17504589211045225
       
  • ‘A pain in the buttock’: A case report of gluteal compartment syndrome
           after robotic partial nephrectomy

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      Authors: Stephen Su Yang, Maurice Anidjar, Milène A Azzam
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      Acute compartment syndrome is a surgical emergency that, if unrecognised, leads to tissue and muscle ischaemia, necrosis, multi-organ failure and even death. Gluteal compartment syndrome is a rare type of compartment syndrome that typically occurs as a sequela of trauma, and its presentation may be difficult to recognise. We describe a case of a patient who developed gluteal compartment syndrome following a prolonged renal surgery in lateral decubitus position. Our case report aims to raise clinicians’ awareness to consideration of this rare syndrome in patients presenting with lower extremity or back pain after prolonged surgery.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-04-29T11:35:31Z
      DOI: 10.1177/17504589221092563
       
  • The management of cataract surgery in diabetic patients

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      Authors: Yu Xia
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      A cataract in the eye is a major cause of vision loss in diabetic patients, which occurs earlier and develops faster than non-diabetic patients, and often requires surgery for treatment. However, diabetic patients undergoing cataract surgery have a higher risk of intraoperative and postoperative complications than non-diabetic patients. For diabetic patients undergoing any surgery, careful perioperative assessment and management are required to reduce postoperative complications and improve surgical outcomes. Better understanding of their needs may guide perioperative practitioners to manage their care appropriately. This article presents recent evidence and guidance associated with the preoperative, intraoperative and postoperative management of diabetic patients undergoing cataract surgery and to inform perioperative practitioners of the challenges and potential complications to provide the best care and improve sight.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-04-21T11:36:49Z
      DOI: 10.1177/17504589221091063
       
  • Perioperative micronutrients, macroscopic benefits'

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      Authors: Brandon Stretton, Joshua G Kovoor, Andrew Vanlint, Guy Maddern, Campbell H Thompson
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      ‘Micronutrients’ are vitamins and minerals vital for healthy metabolic function, wound healing and disease and infection prevention. Micronutrients may play a role in significantly improving postoperative recovery and indices of patient comfort; however, minimal research exists for surgical patients. Furthermore, current guidelines on perioperative nutrition have a macronutrient focus which may fail to guide detection and treatment of the subclinical micronutrient deficiency in a patient who is not obviously malnourished. Limited research into supplementation of some micronutrient deficiencies shows favourable results; however, given the financial implications of wound care, the prevalence of micronutrient deficiency and possible benefits from attention to micronutrition for postoperative recovery, further research into this area is urgently warranted. Interventions to guide optimal future clinical practice are suggested.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-04-21T11:33:48Z
      DOI: 10.1177/17504589221091058
       
  • The first open cardiac operation

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      Authors: Harold Ellis
      Abstract: Journal of Perioperative Practice, Ahead of Print.

      Citation: Journal of Perioperative Practice
      PubDate: 2022-04-21T11:32:10Z
      DOI: 10.1177/17504589221089913
       
  • Predictive factors of postoperative acute pain in laparoscopic inguinal
           hernia repair in men: A single-centre retrospective study in Japan

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      Authors: Masashi Nishikawa, Taeko Fukuda, Masaya Okazaki
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      IntroductionLaparoscopic inguinal hernia repair has significantly reduced the incidence of postoperative acute and chronic pain compared to open repair, but it remains problematic. This study’s purpose was to retrospectively identify predictive factors of acute pain after laparoscopic inguinal hernia repair.MethodsWe reviewed the medical records of 193 patients. After excluding atypical cases and female patients, 156 patients were analysed. Factors affecting rescue analgesic requirements were investigated via multivariable logistic regression analysis. Independent variables included age, body mass index, analgesics used during surgery and surgical factors (unilateral/bilateral, primary/recurrent). The degree of postoperative pain and the hospital stay duration after surgery were also investigated.ResultsOf the 156 patients, 40 (25.6%) required rescue analgesics. Patients under 60 years of age were about seven times more likely to need rescue analgesics than patients over 80 years of age. Primary surgery patients were about 5.5 times more likely to need rescue analgesics than recurrent surgery patients. The maximum verbal rating scale score was less than 3 in 89% of patients. All patients were discharged by two days postoperatively.ConclusionLaparoscopic inguinal hernia repair results in less postoperative acute pain. However, analgesia management should be considered prudently for younger patients and primary surgery patients.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-24T11:50:02Z
      DOI: 10.1177/17504589211054371
       
  • Adopting the day surgery default in the provision of lumbar discectomy and
           decompressive surgery

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      Authors: Anthony J Paluch, Alexander H Matthews, Sophie Mullins, Ross J Vanstone, Timothy Woodacre
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      IntroductionProvision of day case spinal procedures in the UK is below expected standards and there is a need for the creation of guidance and patient pathways to address this. Here we present a day case lumbar discectomy protocol and evaluate its impact at our institution.MethodsA new pathway (incorporating defined selection criteria, patient education, anaesthetic protocol and discharge prescriptions) was implemented for all suitable patients within a single surgeon’s cohort. Day case rates for lumbar discectomy were compared before and after implementation. Patient feedback was collated using a patient-reported experience measure.ResultsEighteen of 23 patients selected as suitable via the pathway successfully underwent day surgery, leading to an increase in lumbar discectomy day case rates from 25% to 69% at our institution. Nearly all patients were satisfied with their experience, although a significant proportion felt provision of postoperative analgesia could be improved.ConclusionWe present a day surgery pathway for lumbar discectomy that is safe and effective. This could be more widely implemented to increase day case rates.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-24T11:40:38Z
      DOI: 10.1177/17504589211054360
       
  • Single-dose premedication enhances multimodal analgesia after knee
           arthroplasty

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      Authors: Kenneth Kardash, Eric Harvey, Stacey Payne, Stephen Su Yang
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      BackgroundWith the current trend to reduce postoperative opioid use to enhance recovery and address perioperative opioid addiction concerns, the challenge of managing pain after total knee arthroplasty has increased. This study examined the effect of adding a preoperative medication regime to a multimodal postoperative analgesia protocol that included regional anaesthesia.Materials and methodsSixty patients undergoing elective first-time unilateral knee arthroplasty received celecoxib 100mg, gabapentin 600mg and dexamethasone 10mg po one hour before skin incision. They were compared to a sequential retrospective cohort of 49 patients. All patients routinely received acetaminophen 650mg po q6h, ibuprofen 400mg po q8h, patient-controlled opioid analgesia and continuous adductor canal blocks postoperatively. Pain scores and opioid consumption were recorded at 4, 8, 12, 24 and 48h.ResultsPain scores and cumulative opioid use were statistically and clinically significantly reduced at all time points up to 48h.ConclusionsCombining preoperative oral celecoxib, gabapentin and dexamethasone had a clinically significantly effect in reducing pain scores and opioid use for at least 48h. Most of this effect is probably due to dexamethasone.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-24T11:38:32Z
      DOI: 10.1177/17504589211049292
       
  • Effect of positive end expiratory pressure on atelectasis in patients
           undergoing major upper abdominal surgery under general anaesthesia: A lung
           ultrasonography study

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      Authors: Parvathy Ramachandran Nair, Rashmi Ramachandran, Anjan Trikha, Rahul Kumar Anand, Vimi Rewari
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      Postoperative pulmonary complications vary in major upper abdominal surgery. The objective of this study was to assess the effect of positive end expiratory pressure on the incidence of atelectasis in patients undergoing major upper abdominal surgery under general anaesthesia using lung ultrasound. The patients were randomised into receiving either no positive end expiratory pressure (Group I) or positive end expiratory pressure of 5cm H2O (Group II). Lung ultrasound was performed at various time points – baseline, 10 minutes, 2 hours after induction, during closure of skin and 30 minutes post extubation. The lung aeration as assessed by Total Modified Lung Ultrasound Score was worse in the Group I as compared to the Group II at 2 hours post induction. Driving pressure in Group II was significantly reduced compared to Group I. Application of positive end expiratory pressure, as minimal as 5cm H2O, as a single intervention, helps in significantly reducing the Total Modified Lung Ultrasound Score after a duration of more than 2 hours and also attaining low driving pressures during intraoperative mechanical ventilation.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-24T11:36:47Z
      DOI: 10.1177/17504589211045218
       
  • Unusual presentation of atraumatic insufficiency pelvic fractures
           unmasking pregnancy-related osteoporosis: A case report

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      Authors: George JM Hourston, Andrea Bardos, Kuldeep Stohr
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      We describe the case of a young 27-year-old Caucasian female who presented in the third trimester of her first pregnancy with sudden and severe suprapubic and left-sided hip pain without history of trauma. She was eventually diagnosed with two insufficiency fractures of the pelvis. The underlying diagnosis was pregnancy-related osteoporosis. Her baby was delivered successfully at term, with an elective caesarean section. The diagnosis was eventually made using a magnetic resonance imaging scan. Pregnancy-related osteoporosis is relatively rare, and cases of patients presenting with insufficiency fractures of this condition are rarer still. Our case raises the importance of considering this diagnosis in females in the later stages of pregnancy, with severe sudden hip or pelvis pain. The patient gave informed written consent for the publication of this case.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-24T11:34:17Z
      DOI: 10.1177/17504589211034295
       
  • Impact of the COVID-19 pandemic on the management and outcomes of
           emergency surgical patients: A retrospective cohort study

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      Authors: Pierre Montauban, Charannya Balakumar, Jaideep Rait, Prizzi Zarsadias, Faisal Shahzad, Nnenna Ogbuagu, Sara Iqbal, Ashim Chowdhury, Anang Pangeni, Ankur Shah, Mohammad R Imtiaz
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      IntroductionThe COVID-19 pandemic has led to drastic measures being implemented for the management of surgical patients across all health services worldwide, including the National Health Service in the United Kingdom. It is suspected that the virus has had a detrimental effect on perioperative morbidity and mortality. Therefore, the aim of this study was to assess the impact of the COVID-19 pandemic on these outcomes in emergency general surgical patients.MethodsEmergency general surgical admissions were included in this retrospective cohort study in one of the COVID-19 hotspots in the South East of England. The primary outcome was the 30-day mortality rate. Secondary outcomes included the length of stay in hospital, complication rate and severity grade and admission rates to the ITU.ResultsOf 123 patients, COVID-19 was detected in 12.2%. Testing was not carried out in 26%. When comparing COVID-positive to COVID-negative patients, the mean age was 71.8 + 8.8 vs. 50.7 + 5.7, respectively, and female patients accounted for 40.0 vs. 52.6%. The 30-day mortality rate was 26.7 vs. 3.9 (OR 6.49, p = 0.02), respectively. The length of stay in hospital was 20.5 + 22.2 vs. 7.7 + 9.8 (p 
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-24T11:31:57Z
      DOI: 10.1177/17504589211032625
       
  • Establishing a COVID-secure site for elective surgery during the COVID
           pandemic: An observational study

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      Authors: Liam Phelan, Holly Digne-Malcolm, Dominic Hassett, David N Naumann, Mark P Dilworth, Douglas M Bowley
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      IntroductionMaintaining timely and safe delivery of major elective surgery during the COVID-19 pandemic is essential to manage cancer and time-critical surgical conditions. Our NHS Trust established a COVID-secure elective site with a level 2 Post Anaesthetic Care Unit (PACU) facility. Patients requiring level 3 Intensive Care Unit admission were transferred to a non-COVID-secure site. We investigated the relationship between perioperative anaesthetic care and outcomes.Materials and methodsAll consecutive patients undergoing major surgery at the COVID-secure site between June and November 2020 were included. Patient demographics, operative interventions and 30-day outcomes were recorded. Multivariate logistic regression was used to determine the odds ratio of outcomes according to PACU length of stay and the use of spinal or epidural anaesthesia, with age, sex, malignancy status and American Society of Anesthesiologists grade as independent co-variables.ResultsThere were 280 patients. PACU length of stay>23h was associated with increased 30-day complications. Epidural anaesthesia was associated with PACU length of stay>23h, increased total length of stay, increase hospital transfer and 30-day complications. Two patients acquired nosocomial COVID-19 following hospital transfer.DiscussionEstablishing a separate COVID-secure site has facilitated delivery of major elective surgery during the COVID-19 pandemic. Choice of perioperative anaesthesia and utilisation of PACU appear likely to affect the risk of adverse outcomes.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-24T11:25:49Z
      DOI: 10.1177/17504589211031083
       
  • An anti-inflammatory bundle may help avoid opioids for low-risk outpatient
           procedures

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      Authors: Rachel Dbeis, Khadij Assani, Negin Fadaee, Desmond Huynh, Ali Khader, Shirin Towfigh
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      BackgroundCurrently, over half of drug overdose deaths are due to opioids. Opioid alternatives may be prescribed to help curb the opioid epidemic. However, little is known about their efficacy for acute postoperative pain.MethodsWe studied patients who underwent low-risk outpatient surgery. Perioperatively, all patients were started on an anti-inflammatory bundle consisting of multimodal pain remedies. Opioids were available to the patients postoperatively. Pain scores and opioid use were recorded.ResultsOver 18 months, 120 patients underwent low-risk outpatient surgery and all used the anti-inflammatory bundle. All patients had a significant decrease in postoperative pain scores (p = 0.001). There was no significant difference in postoperative pain scores between those who followed the anti-inflammatory bundle alone and those who also used opioids (mean 2.2 vs 3.1/10). Twenty-five (21%) patients were using opioids preoperatively and 50 (42%) postoperatively. Of those using opioids preoperatively, six (24%) patients used the anti-inflammatory bundle alone and avoided opioids postoperatively.ConclusionsFor 58% of our patients, an anti-inflammatory bundle alone provided adequate pain control after a low-risk outpatient operation, such as hernia repair. Our practice uses the anti-inflammatory bundle for all patients. Our goal is to reduce both the need for opioids and the surgeon’s contribution to the opioid epidemic.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-24T11:23:17Z
      DOI: 10.1177/17504589211031069
       
  • Comparison of the effectiveness of thoracic epidural and rectus sheath
           catheter as analgesic modalities following laparotomy: A systematic review
           and meta-analysis

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      Authors: Harry L Claxton, Edward J Nevins, Iain McCallum
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      Background:Rectus sheath catheters are used as an analgesic alternative to thoracic epidural. The aim of this meta-analysis is to compare the analgesic effects and side effects of thoracic epidural and rectus sheath catheter in the setting of emergency or elective laparotomy.Materials and Methods:A systematic review of the Cochrane library, Embase, PubMed and Medline was conducted. Papers that directly compared thoracic epidurals and rectus sheath catheters following laparotomy were identified. Literature published between 2001 and 2021 were included. Data were extracted on the following postoperative outcomes: additional analgesic requirements, pain scores, hypotension and ambulation. A random effects meta-analysis model was used to compare additional opioid requirements between thoracic epidural and rectus sheath catheter.Results:Eight publications were included from five countries. This comprised 484 patients, with 120 patients being extracted from randomised trials. Thoracic epidural reduced the requirement for additional intravenous analgesia compared with rectus sheath catheters (p = 0.004). Despite this, both analgesic techniques were equivalent with regard to reported pain scores. Furthermore, rectus sheath catheters have a lower rate of postoperative hypotension and allow for earlier ambulation compared with thoracic epidural.Conclusions:The literature suggests that rectus sheath catheters provide similar analgesic effect to thoracic epidurals, but rectus sheath catheters have a favourable side effect profile.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-17T12:16:20Z
      DOI: 10.1177/17504589221086130
       
  • Developing guidance for the management of intraoperative anaesthetic
           machine failure

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      Authors: Benjamin Milne, Kate Prior
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      Intraoperative anaesthetic machine failure represents an immediate risk to patient safety, as well as risking long-term harm in the form of accidental awareness under general anaesthesia. Currently, there is no widely accepted consensus guidance for the management of such an event. Based upon institutional experiences of anaesthetic machine failure and the principles of delivering good-quality care under emergency scenarios, we devised a single-sheet guideline for management of this event. This guidance assigns clear roles in the management of the event, identifies the key priorities for immediate care, and makes provisions for ensuring ongoing high-quality care following the event. Discussion is given to the rationale for the key components, and the importance of involving the whole perioperative team in developing such guidance. Further discussion involves the crucial elements of local implementation, making sure that guidance is location and personnel specific. Key future steps in this important patient safety project are also discussed.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-17T12:13:23Z
      DOI: 10.1177/17504589221082851
       
  • Life-threatening complications for diabetic patients taking SGLT2
           inhibitors when undergoing surgery: A poorly recognised problem'

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      Authors: Mark Sohatee, James Holland
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      A knowledge of perioperative problems and complications is an important requirement for surgeons. Diabetic patients are a particular group of patients that are specifically at risk of problems. These risks are not only related to the underlying pathophysiological process associated with the disease, but can also occur secondarily to medications used to manage the condition and require careful monitoring, and is of increased importance in the perioperative period. Although a number of medications have historically been used to manage diabetes, a relatively novel group of diabetic medications ‘SGLT2 inhibitors’ are now being used and have been shown to have many positive attributes, when considering the sequalae of diabetes. However, they have also been associated with significant perioperative problems, which are a consequence of euglycaemic ketoacidosis, a potentially life-threatening condition. Given the significant complications associated with these medications, it is important that practitioners should have an awareness of the problems related to their use. In addition, messages contained in safety releases pertaining to SGLT2 inhibitor use and their risks in patients undergoing surgery, may have been weakened due the timing of their publication in March 2020, during the first UK national lockdown amidst the Coronavirus pandemic.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-16T04:15:08Z
      DOI: 10.1177/17504589211024409
       
  • Cardiovascular effects of hyoscine butylbromide in patients under general
           anaesthesia

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      Authors: Carlos Quintero, Maria F Molano, Sebastian Amaya, Jose J Maya, María J Andrade
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      Background:Cardiovascular effects for drugs such as hyoscine butylbromide are poorly documented in the literature, unlike atropine, which is considered the antimuscarinic of choice in the presence of intraoperative bradycardia.Aim:The aim of the study was to describe the dose-related cardiovascular effect of hyoscine butylbromide in patients between 18 and 65 years of age, with low perioperative risk undergoing elective surgery under general anaesthesia on an outpatient basis or hospitalised at our institution between 1 January and 31 May 2019.Methods:Descriptive, cross-sectional, retrospective study; 28 patients with low perioperative risk who underwent general anaesthesia were selected. Changes in heart rate and blood pressure were analysed during the first 6 minutes after the administration of hyoscine butylbromide. The data obtained was recorded in a Microsoft Excel database and analysed using the Excel analysis tool and IBM SPSS.Results:The average dose of 0.15mg/kg of hyoscine butylbromide achieved an increase in heart rate and mean arterial pressure in 96% and 92.8%, respectively, in the first 6 minutes after the administration. Significant changes in heart rate and blood pressure were obtained during the first 6 minutes at doses between 0.05mg/kg and 0.15mg/kg.Conclusion:Hyoscine butylbromide generates positive effects on the heart rate and blood pressure of patients under general anaesthesia, representing a possible alternative in the management of intraoperative bradycardia.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-03-14T12:18:25Z
      DOI: 10.1177/17504589211072698
       
  • Psychotherapy: A tool to prevent postoperative delirium'

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      Authors: Quirin Zangl, Andreas Kaiser, Bernhard Iglseder
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      The value of psychotherapy in surgical patients suffering from postoperative delirium is unclear. Options for the treatment of established postoperative delirium are few; therapy largely relies on the avoidance of postoperative delirium facilitating factors, like specific drugs and environmental factors in the perioperative setting. Established medical therapies’ efficacy in terms of decreasing incidence of postoperative delirium is very low. The aim of this project is to suggest new therapeutic options in the form of cognitive behavioural therapy as a possible preventive and psychotherapeutic treatment of postoperative delirium. Life expectancy in developed countries increases worldwide and both the need for surgical treatment and the probability of postoperative delirium occurrence increase with age. Due to the necessity of addressing the individual’s negative consequences of postoperative delirium and to optimise socioeconomical needs, new therapeutic options for the treatment of postoperative delirium are desperately needed.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-02-28T01:57:49Z
      DOI: 10.1177/17504589211059333
       
  • John Howship, ruptured aneurysm of the ascending aorta

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      Authors: Harold Ellis
      Abstract: Journal of Perioperative Practice, Ahead of Print.

      Citation: Journal of Perioperative Practice
      PubDate: 2022-02-28T01:56:49Z
      DOI: 10.1177/17504589211072760
       
  • Gunshot wounds of the abdomen in World War One

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      Authors: Harold Ellis
      Abstract: Journal of Perioperative Practice, Ahead of Print.

      Citation: Journal of Perioperative Practice
      PubDate: 2022-02-28T01:55:51Z
      DOI: 10.1177/17504589211072819
       
  • Epidemiology of post-suboccipital craniotomy headache: A multicentre
           retrospective study

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      Authors: Yasushi Shibata, Toru Hatayama, Masahide Matsuda, Tomosato Yamazaki, Yoji Komatsu, Kiyoshi Endo, Hiroyoshi Akutsu
      Abstract: Journal of Perioperative Practice, Ahead of Print.
      The detailed epidemiology and mechanism of post-craniotomy headaches are not well understood. This study aimed to establish the actual clinical incidence and causes of post-craniotomy headaches. Suboccipital craniotomy surgeries performed in six institutions within the five-year study period were included. This study included 311 patients (138 males, 173 female; mean age, 59.3 years old). A total of 145 patients (49%) experienced post-craniotomy headaches. Microvascular decompression surgery, craniectomy and facial spasms were significant risk factors for post-craniotomy headaches. In most cases, the post-craniotomy headaches disappeared within one month; however, some patients suffered from long-term headaches. The craniotomy site and the methods of dura and skull closures should be individually determined for each patient. However, to prevent post-craniotomy headaches, craniotomy, instead of craniectomy, may be considered.
      Citation: Journal of Perioperative Practice
      PubDate: 2022-02-22T11:24:57Z
      DOI: 10.1177/17504589221076368
       
 
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