Articles

Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care

Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously...

Authors: Federico Piccioni, Andrea Droghetti, Alessandro Bertani, Cecilia Coccia, Antonio Corcione, Angelo Guido Corsico, Roberto Crisci, Carlo Curcio, Carlo Del Naja, Paolo Feltracco, Diego Fontana, Alessandro Gonfiotti, Camillo Lopez, Domenico Massullo, Mario Nosotti, Riccardo Ragazzi…

Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications

Perioperative goal-directed haemodynamic therapy (GDHT), defined as the administration of fluids with or without inotropes or vasoactive agents against explicit measured goals to augment blood flow, has been e...

Authors: Ahilanandan Dushianthan, Martin Knight, Peter Russell and Michael PW Grocott

Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery

Small randomized trials of early postoperative oral nutritional supplementation (ONS) suggest various health benefits following colorectal surgery (CRS). However, real-world evidence of the impact of early ONS...

Authors: David G. A. Williams, Tetsu Ohnuma, Vijay Krishnamoorthy, Karthik Raghunathan, Suela Sulo, Bridget A. Cassady, Refaat Hegazi and Paul E. Wischmeyer

Documentation of individualized preoperative risk assessment: a multi-center study

Individual surgical risk assessment (ISRA) enhances patient care experience and outcomes by informing shared decision-making, strengthening the consent process, and supporting clinical management. Neither the ...

Authors: Joshua A. Bloomstone, Benjamin T. Houseman, Evora Vicents Sande, Ann Brantley, Jessica Curran, Gerald A. Maccioli, Tania Haddad, James Steinshouer, David Walker and Ramani Moonesinghe

Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice

Multicomponent peri-operative interventions offer to accelerate patient recovery and improve cost-effectiveness. The recent National Institute of Health Research-commissioned evidence synthesis review by Nunns...

Authors: Michael Nunns, Joseph B. John, John S. McGrath, Liz Shaw, Simon Briscoe, Jo Thompson Coon, Anthony Hemsley, Christopher J. Lovegrove, David Thomas, Michael G. Mythen and Rob Anderson

The need for post-operative vasopressor infusions after major gynae-oncologic surgery within an ERAS (Enhanced Recovery After Surgery) pathway

Hypotension following major abdominal surgery is common, and once hypovolaemia has been optimally treated, is often due to vasodilation which can be treated with vasopressor infusions. There is unpredictabilit...

Authors: Michèle Bossy, Molly Nyman, Thumuluru Kavitha Madhuri, Anil Tailor, Jayanta Chatterjee, Simon Butler-Manuel, Patricia Ellis, Aarne Feldheiser and Ben Creagh-Brown

Pain and haemorrhage are the most common reasons for emergency department use and hospital admission in adults following ambulatory surgery: results of a population-based cohort study

Advances in healthcare delivery have allowed for the increase in the number of ambulatory surgery procedures performed in Canada. Despite these advances, patients return to hospital following discharge. Howeve...

Authors: Monakshi Sawhney, David H. Goldstein, Xuejiao Wei, Genevieve C. Pare, Louie Wang and Elizabeth G. VanDenKerkhof

Preoperative communication between anaesthetists and patients with obesity regarding perioperative risks and weight management: a structured narrative review

Individuals with obesity frequently present for anaesthesia and surgery. Good communication during the preoperative consultation can optimise the provision of relevant health information and guide improvement ...

Authors: Anthony Hodsdon, Natalie Anne Smith and David A. Story

Development of a preoperative risk score on admission in surgical intermediate care unit in gastrointestinal cancer surgery

Gastrointestinal cancer surgery continues to be a significant cause of postoperative complications and mortality in high-risk patients. It is crucial to identify these patients. Our study aimed to evaluate the...

Authors: Antero Fernandes, Jéssica Rodrigues, Luís Antunes, Patrícia Lages, Carla Salomé Santos, Daniel Moreira-Gonçalves, Rafael S. Costa, Joaquim Abreu Sousa, Mário Dinis-Ribeiro and Lúcio Lara Santos

Postoperative visits by dedicated anesthesiologists in patients with elevated troponin: a retrospective cohort study evaluating postoperative care utility and early detection of complications

An elevated cardiac troponin level after noncardiac surgery is associated with both morbidity and mortality. Guidelines suggest routine troponin monitoring in high-risk patients. We implemented a dedicated ane...

Authors: Annemarie Akkermans, Lisette M. Vernooij, Wilton A. van Klei and Judith A. van Waes

Using provider-focused education toolkits can aid enhanced recovery programs to further reduce patient exposure to opioids

Evidence-based perioperative analgesia is an important tactic for reducing patient exposure to opioids in the perioperative period and potentially preventing new persistent opioid use.

Authors: Ankit Sarin, Elizabeth Lancaster, Lee-lynn Chen, Sima Porten, Lee-may Chen, Jeanette Lager and Elizabeth Wick

The association between low pre-operative step count and adverse post-operative outcomes in older patients undergoing colorectal cancer surgery

Multiple tools exist estimating perioperative risk. With an ageing surgical demographic, frailty is becoming an increasingly important concept in perioperative medicine due to its association with adverse post...

Authors: Simon J. G. Richards, Pippa M. Jerram, Christian Brett, Michelle Falloon and Frank A. Frizelle

Opioid-free anesthesia—caution for a one-size-fits-all approach

Post-operative pain management should ideally be optimized to ensure patient’s mobilization and ability to partake in effective pulmonary exercises for patient’s early recovery. Opioids have traditionally been...

Authors: Sushan Gupta, Avani Mohta and Vijaya Gottumukkala

The impact of preoperative systemic inflammation on the efficacy of intravenous iron infusion to correct anaemia prior to surgery for colorectal cancer

Intravenous iron is increasingly used prior to surgery for colorectal cancer (CRC) to correct iron deficiency anaemia and reduce blood transfusion. Its utility in functional iron deficiency (FID) or anaemia of...

Authors: Stephen T. McSorley, John H. Anderson, Thomas Whittle, Campbell S. Roxburgh, Paul G. Horgan, Donald C. McMillan and Colin W. Steele

Why women are not small men: sex-related differences in perioperative cardiopulmonary exercise testing

The use of preoperative cardiopulmonary exercise testing (CPET) to evaluate the risk of adverse perioperative outcomes is increasingly prevalent. CPET-derived information enables personalised perioperative car...

Authors: G. Thomas, M. A. West, M. Browning, G. Minto, M. Swart, K. Richardson, L. McGarrity, S. Jack, M. P. W. Grocott and D. Z. H. Levett

Correction to: Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?

An amendment to this paper has been published and can be accessed via the original article.

Authors: Jean-Francois Bonnet, Eleanor Buggy, Barbara Cusack, Aislinn Sherwin, Tom Wall, Maria Fitzgibbon and Donal J. Buggy

Patient experience of health and care when undergoing colorectal surgery within the ERAS program

Several studies show that the enhanced recovery after surgery (ERAS) program reduces complications postoperatively and leads to faster recovery and shorter hospital stays. However, little is known about patien...

Authors: Berith Wennström, Anna Johansson, Sabina Kalabic, Anna-Lena E-son Loft, Stefan Skullman and Ingrid Bergh

Feasibility of setting up a pre-operative optimisation ‘pre-hab’ service for lung cancer surgery in the UK

Pre-operative optimisation ‘pre-hab’ is a growing area in peri-operative medicine. This is usually undertaken with the aim of reducing post-operative complications. In the case of early-stage lung cancer, surg...

Authors: William M. Ricketts, Karen Bollard, Emma Streets, Kristi Hutton, Catherine Hornby and Kelvin Lau

Functional performance and 30-day postoperative mortality after emergency laparotomy—a retrospective, multicenter, observational cohort study of 1084 patients

Despite the importance of predicting adverse postoperative outcomes, functional performance status as a proxy for frailty has not been systematically evaluated in emergency abdominal surgery. Our aim was to ev...

Authors: Mirjana Cihoric, Line Toft Tengberg, Nicolai Bang Foss, Ismail Gögenur, Mai-Britt Tolstrup and Morten Bay-Nielsen

Perioperative Quality Initiative (POQI) consensus statement on fundamental concepts in perioperative fluid management: fluid responsiveness and venous capacitance

Optimal fluid therapy in the perioperative and critical care settings depends on understanding the underlying cardiovascular physiology and individualizing assessment of the dynamic patient state.

Authors: Greg S. Martin, David A. Kaufman, Paul E. Marik, Nathan I. Shapiro, Denny Z. H. Levett, John Whittle, David B. MacLeod, Desiree Chappell, Jonathan Lacey, Tom Woodcock, Kay Mitchell, Manu L. N. G. Malbrain, Tom M. Woodcock, Daniel Martin, Chris H. E. Imray, Michael W. Manning…

Optimising remote site airway management kit dump using the SCRAM bag—a randomised controlled trial

Emergency airway management may be required at any hospital location. Remote site management is associated with increased airway morbidity and mortality. Poor planning and interrupted workflow are significant ...

Authors: Barry M. Schyma, Andrew E. Wood, Saranga Sothisrihari and Paul Swinton

Assessing needs of patients and families during the perioperative period at King Abdullah Medical City

This paper explores elective surgery patients’ and family members’ needs during the perioperative period, in a specialized hospital in Saudi Arabia. Needs are influenced by context and could differ from a sett...

Authors: Wid Alsabban, Ahmed Alhadithi, Faisal Salem Alhumaidi, Abdullah Mutlaq Al Khudhair, Saeed Altheeb and Ahmed Saad Badri

Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?

Postoperative morbidity occurs in 10–15% of patients undergoing major noncardiac surgery. Predicting patients at higher risk of morbidity may help to optimize perioperative prevention. Preoperative haemodynami...

Authors: Jean-Francois Bonnet, Eleanor Buggy, Barbara Cusack, Aislinn Sherwin, Tom Wall, Maria Fitzgibbon and Donal J. Buggy

Prioritisation of quality indicators for elective perioperative care: a Delphi consensus

A systematic review of the peer-reviewed and grey literature previously identified over 1200 perioperative structure and process quality indicators. We undertook a Delphi consensus process with the aim of crea...

Authors: D. Gilhooly, M. Chazapis and S. R. Moonesinghe

Extended versus inpatient thromboprophylaxis with heparins following major open abdominopelvic surgery for malignancy: a systematic review of efficacy and safety

Patients undergoing open abdominopelvic procedures for malignancy are at high risk of postoperative venous thromboembolism (VTE). This risk can be mitigated with prophylaxis; however, optimum duration in this ...

Authors: B. Heijkoop, S. Nadi, D. Spernat and G. Kiroff

Adherence to recommended practices for perioperative anesthesia care for older adults among US anesthesiologists: results from the ASA Committee on Geriatric Anesthesia-Perioperative Brain Health Initiative ASA member survey

While specific practices for perioperative care of older adults have been recommended, little is known regarding adherence by US physician anesthesiologists to such practices. To address this gap in knowledge,...

Authors: Stacie Deiner, Lee A. Fleisher, Jacqueline M. Leung, Carol Peden, Thomas Miller and Mark D. Neuman

Natriuretic peptide-directed medical therapy: a systematic review

Natriuretic 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 result...

Authors: Christella S. Alphonsus, Pooveshnie Govender, Reitze N. Rodseth and Bruce M. Biccard

The value of teachable moments in surgical patient care and the supportive role of digital technologies

Evidence 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 lif...

Authors: Anna Robinson, Robert Slight, Andrew Husband and Sarah Slight

Waardenburg-Shah syndrome (WS type IV): a rare case from Pakistan

Waardenburg-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 mortali...

Authors: Taimoor Ashraf Khan, C. Aqeel Safdar, Shehryar Zameer and Arshad Khushdil

The emerging specialty of perioperative medicine: a UK survey of the attitudes and behaviours of anaesthetists

In 2014, the Royal College of Anaesthetists (RCoA) launched the Perioperative Medicine Programme to facilitate the delivery of best preoperative, intraoperative and postoperative care through implementation of...

Authors: J. S. L. Partridge, A. Rogerson, A. L. Joughin, D. Walker, J. Simon, M. Swart and J. K. Dhesi

Technical and clinical evaluation of a closed loop TIVA system with SEDLine^TM spectral density monitoring: Multicentric prospective cohort study

Closed loop total intravenous anesthesia is a technique in which the patient’s hemodynamic and anesthetic depth variables are monitored, and based on this information, a computer controls the infusion rate of ...

Authors: Claudia Castellanos Peñaranda, Fabián D. Casas Arroyave, Francisco J. Gómez, Paola A. Pinzón Corredor, Juan M. Fernández, Marcela Velez Botero, Juan D. Bohórquez Bedoya and Carlos Marulanda Toro

A significant proportion of venous thromboembolism events in general surgical patients occurs after discharge: analysis of the ACS-NSQIP Essentials database

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in general surgical patients.

Authors: Abdelghaffar K. Salous, Ashraf Reyad, Karen Sweeney and Arun Mavanur

Cannabis-based medicines and the perioperative physician

The increasing availability of cannabis for both recreational and medicinal purposes means that anaesthetists will encounter an increasing number of patients taking cannabis-based medications. The existing evi...

Authors: Patrick Tapley and Suzanne Kellett

Compliance, adherence and effectiveness of a community-based pre-operative exercise programme: a pilot study

Pre-operative exercise training improves HR components of fitness and HRQoL following hospital-based programmes.

Authors: Lisa Loughney, Ronan Cahill, Kiaran O’Malley, Noel McCaffrey and Brona Furlong

Focused cardiac ultrasound in preoperative assessment: the perioperative provider’s new stethoscope?

Focused 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...

Authors: Tara Lenk, John Whittle, Timothy E. Miller, David G. A. Williams and Yuriy S. Bronshteyn

Standard coagulation assays alone are not sufficient to exclude surgically relevant rivaroxaban plasma concentrations

While 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 t...

Authors: Alexander Kaserer, Andreas Schedler, Burkhardt Seifert, Donat R. Spahn, Jan-Dirk Studt and Philipp Stein

The role of cardiac rehabilitation using exercise to decrease natriuretic peptide levels in non-surgical patients: a systematic review

Exercise 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 t...

Authors: Christella S. Alphonsus, Pooveshni Govender, Reitze N. Rodseth and Bruce M. Biccard

Large volume infusions of hydroxyethyl starch during cardiothoracic surgery may be associated with postoperative kidney injury: propensity-matched analysis

The 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 ca...

Authors: Wataru Matsunaga, Masamitsu Sanui, Yusuke Sasabuchi, Yasuma Kobayashi, Asuka Kitajima, Fumitaka Yanase, Yutaka Takisawa and Alan Kawarai Lefor

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.

Authors: Anna Machowska, Jonatan Sparrentoft, Shyam Kumar Dhakaita, Cecilia StålsbyLundborg and Megha Sharma

Primer on adult patient satisfaction in perioperative settings

The 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 vit...

Authors: Lily N. Trinh, Michelle A. Fortier and Zeev N. Kain

Perioperative antibiotic prescribing in surgery departments of two private sector hospitals in Madhya Pradesh, India

Single-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 ...

Authors: Anna Machowska, Jonatan Sparrentoft, Shyam Kumar Dhakaita, Cecilia StålsbyLundborg and Megha Sharma

Impact of an enhanced recovery pathway on length of stay and complications in elective radical cystectomy: a before and after cohort study

Enhanced 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 att...

Authors: W. Jonathan Dunkman, Michael W. Manning, John Whittle, John Hunting, Edward N. Rampersaud, Brant A. Inman, Julie K. Thacker and Timothy E. Miller

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)

Hip fracture is a procedure with high mortality and complication rates, and there exists a group especially at risk of these outcomes identified by their Nottingham Hip Fracture Score (NHFS). Meta-analysis sug...

Authors: S. J. Davies, D. R. Yates, R. J. T. Wilson, Z. Murphy, A. Gibson, V. Allgar and T. Collyer

Perioperative fluid management: moving toward more answers than questions—a commentary on the RELIEF study

Perioperative 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 L...

Authors: Timothy E. Miller and Rupert M. Pearse

Data integrity issues: catalyst for a more robust approach to research on perioperative oxygen therapy?

Authors: Alex H. Oldman, Andrew F. Cumpstey, Daniel S. Martin and Michael P. W. Grocott

A retrospective evaluation of the impact of patient ethnicity on the use of epidural analgesia or blood transfusions in children undergoing major oncologic surgery

The impact of patient ethnicity on healthcare delivery is well documented. In this study of children who had undergone open abdominal or pelvic surgery for tumor resection, we sought to compare the use of epid...

Authors: Pascal Owusu-Agyemang, Juan P. Cata, Ravish Kapoor, Antoinette Van Meter, Acsa M. Zavala, Uduak U. Williams, January Y. Tsai, Lei Feng and Andrea Hayes-Jordan

The effect of virtual reality technology on preoperative anxiety in children: a Solomon four-group randomized clinical trial

Preoperative 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 technolo...

Authors: Fateme Dehghan, Rostam Jalali and Hasan Bashiri

Enhanced recovery after surgery (ERAS) program for lumbar spine fusion

There is a paucity of literature regarding the implementation of enhanced recovery after surgery (ERAS) protocols for open lumbar spine fusions. We implemented an ERAS program for 1–2-level lumbar spine fusion...

Authors: Justin Smith, Stephen Probst, Colleen Calandra, Raphael Davis, Kentaro Sugimoto, Lizhou Nie, Tong J. Gan and Elliott Bennett-Guerrero

Factors influencing day surgery patients’ quality of postoperative recovery and satisfaction with recovery: a narrative review

The aim of healthcare services is to provide a high quality of care. One way to ensure that this aim has been fulfilled is to assess patients’ satisfaction with their care. Although satisfaction is a complex c...

Authors: Maria Jaensson, Karuna Dahlberg and Ulrica Nilsson

Intravenous lidocaine infusion as a component of multimodal analgesia for colorectal surgery—measurement of plasma levels

Growing evidence suggests that intravenous lidocaine as a component of multimodal analgesia improves recovery after major colorectal surgery. There is little published data regarding ideal dosing and target pl...

Authors: E. Greenwood, S. Nimmo, H. Paterson, N. Homer and I. Foo