Exploring the psychological impact of cancer surgery: a review

This review provides a comprehensive analysis of phase-specific management strategies for type 2 diabetes (T2D) in patients undergoing gastric cancer (GC) surgery, encompassing the preoperative, intraoperative and postoperative phases within the context of oncodiabetology. In the preoperative phase, predicting T2D remission and evaluating antidiabetic medications while considering their adverse event profiles are important. These medications include metformin and sodium-glucose cotransporter 2 inhibitors, which may help prevent both T2D progression and GC advancement. Regarding surgical approaches, Roux-en-Y reconstructions are associated with better T2D remission rates than Billroth I/II reconstructions, likely because of enhanced glucose metabolism. The considerable effects of gastrectomy and reconstruction on glucose levels have led to the development of a new surgical approach, known as oncometabolic surgery. This approach integrates oncologic treatment with metabolic benefits and has gained attention as a promising strategy for managing T2D in patients undergoing GC surgery. In the postoperative phase, glucose monitoring, individualized medication adjustments, weight management, and patient education are essential for maintaining remission and preventing relapse. A comprehensive, stage-specific approach to glycemic care is crucial for improving both metabolic and oncologic outcomes in patients with GC.

Background: Enhanced Recovery After Surgery (ERAS) protocols are comprehensive, evidence-based pathways designed to optimize perioperative care and improve patient outcomes by minimizing surgical stress, maintaining physiological stability, and expediting functional recovery. These protocols span preoperative, intraoperative, and postoperative phases, integrating strategies such as multimodal analgesia, goal-directed fluid therapy (GDFT), and early ambulation. The anesthesiologist plays a pivotal role in ensuring the successful implementation of ERAS protocols, contributing to effective pain management, hemodynamic stability, and reduced postoperative complications. Objective: This narrative review aims to critically analyze the evolving role of anesthesiologists within ERAS protocols, highlighting their contributions to optimizing perioperative care and improving surgical outcomes. Methods: A comprehensive review of key references on ERAS protocols was conducted, synthesizing data from peer-reviewed articles, clinical studies, and ERAS guidelines. The extracted information was organized according to a structured outline, focusing on the preoperative, intraoperative, and postoperative phases of anesthetic care within ERAS pathways. Findings: Anesthesiologists contribute significantly to each phase of ERAS implementation. In the preoperative phase, they lead patient education, prehabilitation, and anesthetic planning. During surgery, they implement multimodal analgesia, regional anesthesia, and GDFT to minimize opioid use and maintain euvolemia. Postoperatively, anesthesiologists support early ambulation, non-opioid pain control, and prevention of postoperative nausea and vomiting (PONV). Innovations such as point-of-care ultrasound (POCUS), artificial intelligence (AI)-driven decision support, and novel anesthetic agents are enhancing the efficacy of ERAS protocols. However, challenges remain, including institutional barriers, resistance to opioid-sparing techniques, and the need for improved multidisciplinary collaboration. Conclusion: The anesthesiologist’s role in ERAS extends beyond intraoperative management to encompass leadership in multidisciplinary care and patient-centered recovery. By addressing barriers to ERAS implementation and embracing technological advancements, anesthesiologists can drive innovation and enhance perioperative outcomes. Continued research, education, and collaboration are essential to further standardize ERAS protocols and promote global adoption, ensuring optimal surgical care and improved patient experiences.

Appendicitis is an acute inflammatory condition of the appendix that requires prompt surgical intervention and comprehensive perioperative nursing care to prevent complications. This study aims to describe the application of perioperative pain management in a patient with appendicitis at UPT RSUD Labuang Baji Makassar. A descriptive case study design is employed using a perioperative nursing care approach covering preoperative, intraoperative, and postoperative phases. The subject is a 44-year-old male patient diagnosed with appendicitis who undergoes appendectomy. Data are collected through interviews, observation, physical examination, and documentation, with pain assessed using the Numeric Rating Scale. Nursing interventions focus on non-pharmacological pain management, including deep breathing relaxation in the preoperative phase and Benson relaxation therapy in the postoperative phase. The results show a decrease in pain intensity and anxiety before surgery, effective control of intraoperative bleeding, and gradual reduction of postoperative pain accompanied by improved tissue integrity and patient knowledge. This case study demonstrates that appropriate non-pharmacological nursing interventions effectively support perioperative pain management and enhance patient recovery in appendicitis cases.

Pre‐habilitation (i): aggregation of marginal gains

IntroductionEnhanced Recovery After Surgery (ERAS) protocols are evidence-based perioperative management pathways designed to optimize surgical outcomes. The American Society of Craniofacial Surgeons (ASCFS) Presidential Task Force has developed a series of ERAS protocols for patients with cleft and craniofacial anomalies. We outline an ERAS protocol for secondary alveolar bone grafting using cancellous bone graft from the iliac crest for patients with cleft lip and palate.Design and settingThe authors extracted information from existing peer-reviewed literature and our institutional experience at a large, tertiary pediatric hospital through retrospective chart review to guide surgeons in the pre-hospitalization, preoperative, intraoperative, and postoperative phases of care of alveolar bone grafting.ResultsIn the pre-hospitalization phase, our ERAS protocol emphasizes family education and expectation management, as well as minimization of preoperative fasting. In the preoperative phase, oral midazolam is recommended to reduce patient anxiety. In the intraoperative phase, we emphasize multimodal pain control with regional nerve blocks, bupivacaine-soaked absorbable sponge in the iliac crest, and ketorolac to minimize postoperative narcotic use. To prevent postoperative nausea and vomiting, we emphasize the use of an oropharyngeal pack prior to incision and nasogastric tube evacuation of the gastric contents at the completion of surgery, as well as a combination of ondansetron with dexamethasone intraoperatively. In the postoperative phase, we recommend dexmedetomidine, early postoperative oral feeding and hydration, and early ambulation with Physical Therapy consultation.ConclusionsThe present study sought to outline an ERAS protocol for secondary alveolar bone grafting in pediatric patients with cleft lip and/or palate to optimize surgical outcomes.

Acute liver failure (ALF) is a life-threatening condition characterized by rapid liver function deterioration, necessitating a multidisciplinary approach for optimal perioperative care. This comprehensive review focuses on the critical role of the anaesthesiologist throughout the preoperative, intraoperative, and postoperative phases, addressing the unique challenges posed by ALF. The article begins with an exploration of ALF, underlining the urgency of timely referral to specialized hepatology centres. Liver transplantation emerges as a life-saving intervention, and the complex decision-making process is discussed, emphasizing the need for a multidisciplinary team to assess transplantation candidacy based on established prognostic criteria. In the preoperative phase, the review stresses the importance of early engagement with tertiary liver centres for timely referrals and identifies patients suitable for transplantation. Safe transport protocols are detailed, highlighting the meticulous planning required for the secure transfer of ALF patients between healthcare facilities. The intraoperative management section delves into the anaesthesiologist's key concerns, including neurological status, sepsis, acute kidney injury, body mass index, and preoperative fasting. Hemodynamic stability, fluid management, and coagulation balance during surgery are emphasized, with insights into anaesthesia techniques, vascular access, monitoring, and hemodynamic management tailored to the challenges posed by ALF patients. The postoperative care is thoroughly examined covering neurological, hemodynamic, metabolic, renal, and nutritional aspects. Management of ALF involves multidisciplinary team, including nephrology for continuous renal replacement therapy, transfusion medicine for plasma exchange, critical care for overall patient care, nutritionists for ensuring adequate nutrition, and hepatologists as the primary guides. In conclusion, the review recognizes the anaesthesiologist as a linchpin in the perioperative care of ALF patients. The integration of safe transport protocols and multidisciplinary approach is deemed crucial for navigating complexities of ALF, contributing to improved patient outcomes. This article serves as an invaluable resource for gastroenterologist and intensivists, enhancing their understanding of the anaesthesiologist's indispensable role in the holistic care of ALF patients in an ever-evolving healthcare landscape.

Introduction: Robotic surgery systems have been introduced to deal with the basic disadvantages of laparoscopic surgery. However, working with these systems may lead to time loss due to additional robot-specific tasks, such as set-up of equipment and sterile draping of the system. To evaluate loss of time in robot-assisted surgery, we compared 10 robot-assisted cholecystectomies to 10 standard laparoscopic cholecystectomies.Materials and Methods: The robot-assisted procedures were performed with the da Vinci telemanipulation system. The total time in the operating room (OR) was scored and divided into preoperative, operative, and postoperative phases. These phases were further divided into smaller timeframes to precisely define moments of time loss.Results: The most significant difference between the two groups was found in the preoperative phase. Robot-related tasks led to time loss in all time-frames of this phase. In the operative phase, the trocar entry time-frame was longer in robot-assisted cases than in standard procedures. Additionally, postoperative OR clearing was longer in the robot-assisted cases. Total operating time did not differ significantly between the two procedures.Conclusion: Robot-assisted surgery leads to time loss during preparation of routine laparoscopic procedures.

Objective: estimate the prevalence of anxiety in laryngectomy patients in the pre andpostoperative periods and its relation with the self-care level. Method: observational research of 40 patients with stage IV laryngeal cancer. Threeobservations took place: in the preoperative phase, at seven and at 14 days afterthe surgery; between June 2010 and December 2012. Two self-care levels weredefined: self-sufficient and needing help for activities of daily living andtreatment-related activities. To assess the anxiety levels, Zigmond's hospitalanxiety scale (1983) was used. Results: in the preoperative and postoperative phases, the patients presented high levelsof anxiety. Concerning self-care, on average, self-sufficient patients presentedlower levels of anxiety than patients who needed help to accomplish activities ofdaily living and activities deriving from the surgery, without significantdifferences. Conclusion: anxiety is present at all times in laryngectomy patients and the reduction of theself-care deficit seems to decrease it, without putting a permanent end to it.

A Method to Evaluate Cardiac Surgery Mortality: Phase of Care Mortality Analysis

Anesthesia Literature Review

To evaluate nurse practitioner (NP) roles during the peri-operative period and their association with healthcare outcomes, including length of stay (LOS), post-operative emergency department (ED) visits and 30-day readmissions. A prospective observational study. This study, conducted at an Israeli tertiary care centre between 2022 and 2023, included 188 patients from Paediatric Orthopaedics, General Surgery and Breast and Stoma Services. Data on patient demographics, clinical details and outcomes, including LOS, post-operative ED visits and 30-day readmissions, were extracted from medical records. NPs documented interventions they performed across the pre-operative, in-hospital and post-hospital phases. Associations between NP interventions and patient outcomes were analysed using multivariate regression models. NPs performed an average of 6.7 interventions per patient across the peri-operative phases. A moderate-to-high number of interventions performed during the pre-operative phase was significantly associated with a shorter LOS. Performing a moderate-to-high number of interventions during the post-hospital phase was correlated with fewer ED visits and lower rates of 30-day readmission. Interventions performed by NPs during the pre-operative and post-hospital phases were significantly linked to better patient outcomes, notably shorter hospitalizations and fewer post-discharge complications. Recognising the role of NPs in peri-operative care may guide healthcare systems in optimising post-surgical care pathways, ultimately minimising preventable emergency visits, reducing hospital LOS and lowering readmission rates. This study underscores the value of NPs as integral providers in peri-operative surgical care. Their involvement in pre-operative preparation and post-discharge coordination contributes meaningfully to patient recovery trajectories. The findings support expanding their role within surgical teams to enhance care continuity and promote better recovery outcomes. The EQUATOR guidelines were used with the STROBE checklist for reporting this study. No patient or public contribution.

BACKGROUND: Resilience is the ability of patients to adapt effectively when given a diagnosis of an illness. While awaiting brain tumor surgery, patients often experience uncertainty from brain tumor-related symptoms resulting in inducing depressive symptoms, having physical disability, and reducing quality of life. Resilience studies have been widely conducted in the postoperative phase with a limited knowledge on the preoperative phase. This study aimed to identify predictors of resilience while awaiting brain tumor surgery. METHODS: This cross-sectional predictive study includes 100 participants 18 years and older, with diagnosis of brain tumors, and waiting for brain tumor surgery at the outpatient department of 1 tertiary hospital in Bangkok between August 2022 and February 2023. Multiple linear regression was used to examine the predictors of resilience. RESULTS: Most of the sample (77%) were female with a mean age of 52.71 (13.17) years. The most common type of brain tumor was meningioma (38%). The median waiting time since brain tumor diagnosis until the date of preadmission for operation was 18 (3-1464) days. Symptom severity, social support, and treatment plan were able to explain 37.3% of the variance of resilience in patients awaiting brain tumor surgery ( F = 19.077, P < .01, R2 = 0.373, adjusted R2 = 0.354). CONCLUSION: Resilience is an important skill for patients with brain tumor to manage uncertainty events that occur in their lives. The preoperation phase needs to assess both physical and mental tumor-related symptoms, and include caregivers as part of the care, to promote resilience skill for patients awaiting brain tumor surgery.

Coronary surgery in women: How can we improve outcomes.

Perioperative hyperglycemia in people with diabetes is associated with increased morbidity, mortality, and health care costs. Despite guideline recommendations to institute interventions to reduce hyperglycemia, standardized protocols that integrate into clinical workflows are lacking. In this article, we evaluate the efficacy of a digitally embedded, glycemic management protocol in people with diabetes undergoing surgery. We conducted a retrospective analysis of a quality improvement study conducted at a tertiary-care academic hospital. Adults with diabetes undergoing noncardiac surgery with more than two hours of procedure time were included. A multidisciplinary protocol was implemented guiding insulin administration and glucose monitoring across preoperative, intraoperative, and post-anesthesia care unit (PACU) phases. People undergoing surgery during one year before protocol implementation were compared with those in the year after. The primary outcome was the proportion of intraoperative glucose readings within 70 to 180 mg/dL. Secondary outcomes included glucose control in other perioperative phases, hypoglycemia incidence, and 30-day postoperative complications. Among 1254 adults (634 pre-intervention, 620 post-intervention), the mean proportion of intraoperative glucose values in the target range of 70 to 180 mg/dL showed a modest yet statistically significant improvement after protocol implementation (0.65 vs 0.72, P = .021). We found a reduced risk of hypoglycemia in the preoperative phase (3.7% vs 1.3%, P = .007) and no increased risk of hypoglycemia in the intraoperative or PACU phases. An increase in glucose monitoring and intravenous insulin use was noted across all phases of care (P < .001). Implementation of a digitally embedded perioperative glycemic management protocol improved glucose monitoring and intraoperative glucose control without increasing hypoglycemia. These findings support the safe and effective use of the protocol across surgical specialties and case urgencies, supporting the value of integrating decision support tools into clinical workflows.

An institutional policy was previously established for patients with diabetes on insulin pump therapy undergoing elective surgical procedures. Electronic medical records were reviewed to assess documentation of insulin pump status and glucose monitoring during preoperative, intraoperative, and postanesthesia care unit (PACU) phases of care. Twenty patients with insulin pumps underwent 23 procedures from March 1 to December 31, 2011. Mean (standard deviation) age was 58 (13) years, mean diabetes duration was 28 (17) years, and mean duration of insulin pump therapy was 7 (6) years. Nearly all cases (86%) during the preoperative phase had the presence of the device documented--an improvement over the 64% noted in data collected before the policy. Intraoperatively, 13 cases (61%) had the presence of the pump documented, which was higher than the 28% before implementation of the policy. However, documentation of pump status was found in only 38% in the PACU and was actually less than the 60% documented previously. Over 90% of cases had glucose checked in the preoperative area and the PACU, and only 60% had it checked intraoperatively, which was nearly identical to the percentages seen before policy implementation. No adverse events occurred when insulin pump therapy was continued. Although some processes still require improvement, preliminary data suggest that the policy for perioperative management of insulin pumps has provided useful structure for care of these cases. The data thus far indicate that insulin pump therapy can be continued safely during the perioperative period.