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Deutsches Arzteblatt International Jan 2015
Topics: Cardiovascular Diseases; Humans; Medical History Taking; Physical Examination; Postoperative Complications; Preoperative Care
PubMed: 25686386
DOI: 10.3238/arztebl.2015.0070a -
British Journal of Anaesthesia Jun 2024The changing ethical and legal landscape in the UK means that anaesthetists should routinely be discussing the risk of death during the consent process. To do this...
The changing ethical and legal landscape in the UK means that anaesthetists should routinely be discussing the risk of death during the consent process. To do this effectively means expanding anaesthetic preassessment services for children and young people, something that has been recognised as a priority, but which still needs investment and an appreciation of its value at the trust level.
Topics: Humans; Child; Informed Consent; Preoperative Care; Adolescent; United Kingdom; Anesthesia
PubMed: 38729742
DOI: 10.1016/j.bja.2024.03.005 -
Journal of Perianesthesia Nursing :... Dec 2019
Topics: Bariatrics; Humans; Obesity; Preoperative Care
PubMed: 31801661
DOI: 10.1016/j.jopan.2019.09.001 -
European Urology Focus Jan 2024The aim of prehabilitation is to improve the physical and emotional health of patients before upcoming surgery or therapies. This mini-review focuses on current advances... (Review)
Review
The aim of prehabilitation is to improve the physical and emotional health of patients before upcoming surgery or therapies. This mini-review focuses on current advances in urological prehabilitation and how it can be used together with enhanced recovery after surgery and conventional rehabilitation protocols. Urological prehabilitation has primarily focused on improving urinary continence, erectile function, bone density, and lean body mass, with some promising results for all of these outcomes. Although all cancer patients should be considered for prehabilitation, older or medically frail individuals may derive the greatest benefit. PATIENT SUMMARY: This mini-review discusses prehabilitation as part of the care for cancer patients. Although the research on prehabilitation is evolving, current studies generally demonstrate that it may help to enhance a patient's strength and endurance before upcoming surgery or other treatments.
Topics: Male; Humans; Preoperative Care; Preoperative Exercise; Cancer Survivors; Neoplasms; Research
PubMed: 37996272
DOI: 10.1016/j.euf.2023.11.006 -
Anesthesiology Clinics Dec 2018Pharmacogenomics (PGx) is the study of how individuals' personal genotypes may affect their responses to various pharmacologic agents. The application of PGx principles... (Review)
Review
Pharmacogenomics (PGx) is the study of how individuals' personal genotypes may affect their responses to various pharmacologic agents. The application of PGx principles in perioperative medicine is fairly novel. Challenges in executing PGx programs into health care systems include physician buy-in and integration into usual clinical workflow, including the electronic health record. This article discusses the current evidence highlighting the potential of PGx with various drug categories (including opioids, nonopioid analgesics, sedatives, β-blockers, antiemetics, and anticoagulants) used in the perioperative process and the challenges of integrating PGx into a health care system and relevant workflows.
Topics: Genomics; Humans; Precision Medicine; Preoperative Care
PubMed: 30390784
DOI: 10.1016/j.anclin.2018.07.014 -
Journal of Clinical Nursing Apr 2017The aims of this integrative literature review are to define the role of a preoperative nurse and to describe the main components and hypothetical outcomes of a... (Review)
Review
AIMS AND OBJECTIVES
The aims of this integrative literature review are to define the role of a preoperative nurse and to describe the main components and hypothetical outcomes of a preoperative nursing care structure before a surgical patient arrives to an elective procedure.
BACKGROUND
The development of medical care has impacted surgical processes, and patients are now spending less time in hospital settings. Patients often enter the hospital on the day of a procedure and are discharged as soon as it is medically safe, creating challenges for nursing care. Preoperative clinics have been opened, and the importance of preoperative nursing care has been widely understood. Previous literature has provided descriptions about the roles, tasks and outcomes of preoperative nurses; however, the terminology is heterogeneous, and the optimal model remains unknown.
DESIGN
A systematic procedure for searching, selecting, and evaluating the literature was followed. The data were collected from PubMed and CINAHL between 1 January 2004 and 20 September 2014. In total, 41 articles were included in the study and were analysed by qualitative inductive content analysis.
RESULTS
The data provided seven main tasks of a preoperative nurse, tools to support preoperative nursing and outcomes of structured preoperative nursing care.
CONCLUSION
A preoperative nurse is a specialised coordinator of patient care, and the main purposes of this role are to meet the patient's and the family's needs individually and to prepare them for the scheduled procedure and postoperative recovery. By following the structure of the seven main tasks and using different supportive tools, preoperative nursing can positively impact patient and provider satisfaction, patient safety, quality of care and cost savings.
RELEVANCE TO CLINICAL PRACTICE
A preoperative nursing care structure should be implemented in clinical practice and then evaluated to measure whether the hypothetical outcomes reported in this literature review can be achieved.
Topics: Clinical Competence; Humans; Patient Care; Practice Patterns, Nurses'; Preoperative Care
PubMed: 27325370
DOI: 10.1111/jocn.13448 -
British Journal of Anaesthesia Jul 2021In the general adult population, lymphopaenia is associated with an increased risk for hospitalisation with infection and infection-related death. The quality of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In the general adult population, lymphopaenia is associated with an increased risk for hospitalisation with infection and infection-related death. The quality of evidence and strength of association between perioperative lymphopaenia across different surgical procedures and mortality/morbidity has not been examined by systematic review or meta-analysis.
METHODS
We searched MEDLINE, Embase, Web of Science, Google Scholar, and Cochrane databases from their inception to June 29, 2020 for observational studies reporting lymphocyte count and in-hospital mortality rate in adults. We defined preoperative lymphopaenia as a lymphocyte count 1.0-1.5×10 L. Meta-analysis was performed using either fixed or random effects models. Quality was assessed using the Newcastle-Ottawa Scale. The I index was used to quantify heterogeneity. The primary outcome was in-hospital mortality rate and mortality rate at 30 days.
RESULTS
Eight studies met the inclusion criteria for meta-analysis, comprising 4811 patients (age range, 46-91 yr; female, 20-79%). These studies examined preoperative lymphocyte count exclusively. Studies were of moderate to high quality overall, ranking >7 using the Newcastle-Ottawa Scale. Preoperative lymphopaenia was associated with a threefold increase in mortality rate (risk ratio [RR]=3.22; 95% confidence interval [CI], 2.19-4.72; P<0.01, I=0%) and more frequent major postoperative complications (RR=1.33; 95% CI, 1.21-1.45; P<0.01, I=6%), including cardiovascular morbidity (RR=1.77; 95% CI, 1.45-2.15; P<0.01, I=0%), infections (RR=1.45; 95% CI, 1.19-1.76; P<0.01, I=0%), and acute renal dysfunction (RR=2.66; 95% CI, 1.49-4.77; P<0.01, I=1%).
CONCLUSION
Preoperative lymphopaenia is associated with death and complications more frequently, independent of the type of surgery.
PROSPERO REGISTRY NUMBER
CRD42020190702.
Topics: Elective Surgical Procedures; Hospital Mortality; Humans; Lymphopenia; Morbidity; Postoperative Complications; Preoperative Care; Prospective Studies
PubMed: 33795133
DOI: 10.1016/j.bja.2021.02.023 -
The Canadian Journal of Cardiology Jan 2017Heart failure patients who undergo cardiac surgery are exposed to significant perioperative complications and high mortality. We herein review the literature concerning... (Review)
Review
Heart failure patients who undergo cardiac surgery are exposed to significant perioperative complications and high mortality. We herein review the literature concerning preoperative optimization of these patients. Salient findings are that end-organ dysfunction and medication should be optimized before surgery. Specifically: (1) reversible causes of anemia should be treated and a preoperative hemoglobin level of 100 g/L obtained; (2) renal function and volume status should be optimized; (3) liver function must be carefully evaluated; (4) nutritional status should be assessed and cachexia treated to achieve a preoperative albumin level of at least 30 g/L and a body mass index > 20; and (5) medication adjustments performed, such as withholding inhibitors of the renin-angiotensin-aldosterone system before surgery and continuing, but not starting, β-blockers. Levels of natriuretic peptides (brain natriuretic peptide [BNP] and N-terminal proBNP) provide additional prognostic value and therefore should be measured. In addition, individual patient's risk should be objectively assessed using standard formulas such as the EuroSCORE-II or Society of Thoracic Surgeons risk scores, which are simple and validated for various cardiac surgeries, including left ventricular assist device implantation. When patients are identified as high risk, preoperative hemodynamic optimization might be achieved with the insertion of a pulmonary artery catheter and hemodynamic-based tailored therapy. Finally, a prophylactic intra-aortic balloon pump might be considered in certain circumstances to decrease morbidity and even mortality, like in some high risk heart failure patients who undergo cardiac surgery, whereas routine preoperative inotropes are not recommended and should be reserved for patients in shock, except maybe for levosimendan.
Topics: Cardiac Surgical Procedures; Heart Failure; Practice Guidelines as Topic; Preoperative Care
PubMed: 27876563
DOI: 10.1016/j.cjca.2016.08.004 -
The Israel Medical Association Journal... Jun 2016The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We... (Review)
Review
The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We describe here preoperative digitalized programs and the variety of conditions for which those programs can be used to facilitate preparation for surgery. A PubMed search using the keywords "digitalized software programs," "preoperative planning" and "total joint arthroplasty" was performed for all studies regarding preoperative planning of orthopedic procedures that were published from 1989 to 2014 in English. Digitalized software programs are enabled to import and export all picture archiving communication system (PACS) files (i.e., X-rays, computerized tomograms, magnetic resonance images) from either the local working station or from any remote PACS. Two-dimension (2D) and 3D CT scans were found to be reliable tools with a high preoperative predicting accuracy for implants. The short learning curve, user-friendly features, accurate prediction of implant size, decreased implant stocks and low-cost maintenance makes digitalized software programs an attractive tool in preoperative planning of total joint replacement, fracture fixation, limb deformity repair and pediatric skeletal disorders.
Topics: Decision Making, Computer-Assisted; Humans; Orthopedic Procedures; Patient Care Planning; Preoperative Care; Software; Surgery, Computer-Assisted
PubMed: 27468530
DOI: No ID Found -
Anesthesia and Analgesia Mar 2022In this Pro-Con commentary article, we discuss the models, value propositions, and opportunities of preoperative clinics run by anesthesiologists versus hospitalists and...
In this Pro-Con commentary article, we discuss the models, value propositions, and opportunities of preoperative clinics run by anesthesiologists versus hospitalists and their role in perioperative care. The medical and anesthesia evaluation before surgery has pivoted from the model of "clearance" to the model of risk assessment, preparation, and optimization of medical and psychosocial risk factors. Assessment of these risk factors, optimization, and care coordination in the preoperative period has expanded the roles of anesthesiologists and hospitalists as members of the perioperative care team. There is ongoing debate regarding which model of preoperative assessment provides the most optimal preparation for the patient undergoing surgery. This article hopes to shed light on this debate with the data and perspectives on these care models.
Topics: Anesthesiologists; Hospital Administration; Hospitalists; Humans; Perioperative Care; Preoperative Care; Risk Assessment; Surgical Procedures, Operative
PubMed: 35180163
DOI: 10.1213/ANE.0000000000005877