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Lakartidningen Feb 2019International guidelines for paediatric elective preoperative fasting currently recommend a 2 hour limit for clear fluids. Recent reports on gastric emptying time,...
International guidelines for paediatric elective preoperative fasting currently recommend a 2 hour limit for clear fluids. Recent reports on gastric emptying time, pulmonary aspiration incidence and the negative effects of fasting have led to a new consensus statement by the European Society of Paediatric Anaesthesia, recommending a 1-hour limit for clear fluids. A multicentre audit of the incidence of aspiration with the new fasting regimens is still needed.
Topics: Adolescent; Anesthesiology; Child; Child, Preschool; Drinking; Europe; Fasting; Humans; Infant; Infant, Newborn; Practice Guidelines as Topic; Preoperative Care; Time Factors
PubMed: 31192375
DOI: No ID Found -
Anaesthesia Nov 2018
Topics: Aged; Aged, 80 and over; Frail Elderly; Geriatric Assessment; Humans; Preoperative Care; Risk Factors
PubMed: 29934994
DOI: 10.1111/anae.14356 -
Minerva Anestesiologica May 2018In the era of perioperative medicine, important advances have been made in the perioperative care of patients, usually within those known as enhanced recovery after... (Review)
Review
In the era of perioperative medicine, important advances have been made in the perioperative care of patients, usually within those known as enhanced recovery after surgery (ERAS) protocols. These have led to a decrease in postoperative complications and the duration of hospital stays; however, there is still a lack of preoperative care, which could make perioperative medicine more prominent. Elderly patients, malnourished, anemic and ones with a low physical function before surgery are likely to have sub-optimal recovery from surgery. More importantly, a low functional reserve, together with the inherent physiological stress of surgery, reduces the functional capacity of patients in the postoperative period, meaning that they will not reach their preoperative functional capacity. It is well established that both preoperative malnutrition and anemia worsen surgical results, however, for various reasons, their preoperative optimization is complex. Additionally, both are related to the functional capacity of patients. During the last years, prehabilitation has been incorporated into ERAS protocols. Prehabilitation consists of exercise training and nutritional and psychological support, which increases the physiological reserve before surgical stress. The integration of exercise, adequate nutrition, anemia correction and psycho-social components, with multi-modal optimization in the preoperative period leads to an improvement in the functional capacity of the patients undergoing surgery, with the consequent improvement in terms of outcomes. The present article discusses specific aspects of preoperative care which are not well defined in the ERAS protocols and which represent fundamental shifts in surgical practice, including preoperative nutrition, management of preoperative anemia and prehabilitation.
Topics: Algorithms; Anemia; Exercise; Humans; Nutrition Assessment; Postoperative Complications; Practice Guidelines as Topic; Preoperative Care
PubMed: 29444561
DOI: 10.23736/S0375-9393.18.12286-3 -
British Journal of Anaesthesia Dec 2017There is a consistent relationship between physical activity, physical fitness, and health across almost all clinical contexts, including the perioperative setting.... (Review)
Review
There is a consistent relationship between physical activity, physical fitness, and health across almost all clinical contexts, including the perioperative setting. Physiological measurements obtained during physical exercise may be used to infer the risk of adverse outcome after major surgery. In particular, data obtained from perioperative cardiopulmonary exercise testing have an expanding role in perioperative care. Such information may be used to inform a variety of changes in clinical practice, including interventions that may reduce the risk of perioperative adverse events. Specifically, for patients undergoing major cancer surgery there is a complex interplay between different cancer treatments, including neoadjuvant therapies (chemo- and chemo- plus radiotherapy), surgery, and physical fitness, and the modulation of these relationships by perioperative exercise interventions. Preoperative cardiopulmonary exercise testing provides an objective evaluation of physical fitness and has been used to provide an individualized risk profile in order to guide collaborative decision-making, inform the consent process, characterize and optimize co-morbidities, and to triage patients to perioperative care. Furthermore, studies evaluating exercise interventions aimed at increasing preoperative exercise capacity have established that training improves physical fitness. However, to date, this literature is largely composed of feasibility and pilot studies with small sample sizes, which are in general underpowered to assess clinical outcomes. Adequately powered prospective multicentre studies are needed to characterize the most effective means of improving patient fitness before surgery and to evaluate the impact of such improvements on surgical and disease-specific (e.g. cancer) outcomes.
Topics: Exercise Test; Exercise Therapy; Humans; Physical Fitness; Preoperative Care
PubMed: 29161402
DOI: 10.1093/bja/aex393 -
British Journal of Anaesthesia Feb 2015
Topics: Exercise Therapy; Humans; Physical Fitness; Preoperative Care
PubMed: 25300655
DOI: 10.1093/bja/aeu348 -
Minerva Anestesiologica May 2022Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide. Head injured patients may frequently require emergency neurosurgery. The... (Review)
Review
Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide. Head injured patients may frequently require emergency neurosurgery. The perioperative TBI period is very important as many interventions done in this stage can have a profound effect on the long-term neurological outcome. This practical concise narrative review focused mainly on: 1) the management of severe TBI patients with neurosurgical lesions admitted to a spoke center (i.e. hospital without neurosurgery) and therefore needing a transfer to the hub center (i.e. hospital with neurosurgery); 2) the management of severe TBI patients with intracranial hypertension/brain herniation awaiting for neurosurgery; and 3) the neuromonitoring-oriented management in the immediate post-operative period. The proposals presented in this review mainly apply to severe TBI patients admitted to high-income countries.
Topics: Brain; Brain Injuries, Traumatic; Emergencies; Humans; Intracranial Hypertension; Neurosurgery; Postoperative Care; Preoperative Care
PubMed: 34636222
DOI: 10.23736/S0375-9393.21.15927-9 -
BMC Health Services Research Nov 2019Requesting blood prior to a surgical procedure for perioperative transfusion is a common practice in surgical patients. More unit of blood is requested than used by... (Review)
Review
BACKGROUND
Requesting blood prior to a surgical procedure for perioperative transfusion is a common practice in surgical patients. More unit of blood is requested than used by anticipating the patient will be transfused to provide a safety margin in an event of unexpected haemorrhage. Over requesting with minimal utilization results in significant wastage of blood, reagents and human resource. This study was conducted to assess blood utilization practice of the largest tertiary hospital in Ethiopia.
METHODS
A cross-sectional prospective study method was used. Data was collected using a Proforma questionnaire by perusal of each individual patient's records from December 1, 2017 to February 28, 2018.patient age, sex, department requesting the blood, level of operating surgeon, hemodynamic status, number of unit requested, number of unit crossed matched and number of unit transfused were collected. Efficiency of blood utilization was calculated with three indices: Crossmatch to transfusion ratio, transfusion probability, and transfusion index indices.
RESULTS
Blood was requested for 406 patients and a total of 898 units were crossmatched for this patients. Overall Crossmatch to transfusion ration, transfusion probability and transfusion index were 7.6, 15.3% and 0.29 respectively. Results showed insignificant blood usage. Among different departments and units, better blood utilization was seen in neurosurgical unit with C/T ratio, TP and TI of 4.9, 24.4 and 0.6% respectively, while worst indices were from obstetrics unit with C/T ratio, TP and TI of 31.0, 6.5% and 0.06.
CONCLUSION
Using all the three parameters for evaluation of efficiency of blood utilization, the practice in our hospital shows ineffective blood utilization in elective surgical procedure. Blood requesting physician should order the minimum blood anticipated to be used as much as possible.
Topics: Blood Grouping and Crossmatching; Blood Transfusion; Cost-Benefit Analysis; Cross-Sectional Studies; Elective Surgical Procedures; Humans; Practice Guidelines as Topic; Preoperative Care; Prospective Studies
PubMed: 31694644
DOI: 10.1186/s12913-019-4584-1 -
La Tunisie MedicaleThe prescription of preoperative complementary tests aims to decrease morbidity and mortality associated to the perioperative period.
BACKGROUND
The prescription of preoperative complementary tests aims to decrease morbidity and mortality associated to the perioperative period.
AIM
To assess the practice and the financial cost of the systematic prescription of preoperative tests.
METHODS
This was a retrospective study including all patients older than three years, scheduled for elective surgery from November 2018 to January 2019. Two attendings analyzed the data collected during the pre-anesthetic assessment and evaluated the usefulness of the ordered preoperative tests. The overall cost of prescribed preoperative tests and the cost generated by inappropriate prescriptions were also estimated.
RESULTS
This study included 1006 patients. The average age was 46.9 ± 22.05 years old. Five hundred and twenty three of them (51.98%) have no medical history. Among the planned procedures, 6.46% had an intermediate or major bleeding risk. Preoperative prescriptions were ordered by surgeons in 99% of cases. Prescriptions were justifiable in only 9.42% of cases. Abnormal findings were noted in 4.98% of the patients. The total cost was almost 80992 Dinars (≈ 24543 €). Complying the guidelines would save 70245 Dinars (≈ 21286 €) during the three months' study.
CONCLUSION
The routine prescription of preoperative complementary tests results in a significant additional economic cost. Developing national guidelines would change this attitude of unnecessary prescription.
Topics: Humans; Young Adult; Adult; Middle Aged; Aged; Retrospective Studies; Elective Surgical Procedures; Preoperative Care; Prescriptions
PubMed: 36571743
DOI: No ID Found -
Journal of Pediatric Psychology Mar 2016To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery. (Review)
Review
OBJECTIVE
To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery.
METHODS
A systematic review of randomized controlled trials (RCTs) and nonrandomized studies where the primary outcome was children's preoperative anxiety was conducted. Secondary outcomes included postoperative pain, behavioral changes, recovery, induction compliance, satisfaction, and cost-effectiveness. The risk of bias of each study was assessed.
RESULTS
In all, 18 studies were identified. A meta-analytic approach and narrative synthesis of findings were used to summarize the results of the studies.
CONCLUSIONS
This systematic review suggests that AV interventions can be effective in reducing children's preoperative anxiety. Videos, multi-faceted programs, and interactive games appear to be most effective, whereas music therapy and Internet programs are less effective. While AV interventions appear potentially useful, adequately powered RCTs are required to conclusively pinpoint the components and mechanisms of the most effective AV interventions and guide practice.
Topics: Anxiety; Attention; Audiovisual Aids; Child; Child, Preschool; Elective Surgical Procedures; Female; Humans; Internet; Male; Music Therapy; Play and Playthings; Preoperative Care; Preoperative Period; Randomized Controlled Trials as Topic
PubMed: 26476281
DOI: 10.1093/jpepsy/jsv094 -
Archives of Cardiovascular Diseases Feb 2017As preoperative morbi-mortality remains significant, care of newborns with transposition of the great arteries is still challenging. In this review of the literature, we... (Review)
Review
As preoperative morbi-mortality remains significant, care of newborns with transposition of the great arteries is still challenging. In this review of the literature, we discuss the different treatments that could improve the patient's condition into the preoperative period. Instead of a standardized management, we advocate personalized care of these neonates. Considering the deleterious effects of hypoxia, special attention is given to the use of non-invasive technologies to assess oxygenation of the tissues. As a prolonged preoperative time with low cerebral oxygenation is associated with cerebral injuries, distinguishing neonates who should undergo early surgery from those who could wait longer is crucial and requires full expertise in the management of neonatal congenital heart disease. Finally, to treat these newborns as soon as possible, we support a planned delivery policy for foetuses with transposition of the great arteries.
Topics: Disease Management; Humans; Preoperative Care; Transposition of Great Vessels
PubMed: 28024917
DOI: 10.1016/j.acvd.2016.11.002