Intraoperative Care Research Articles

Consensus in ERAS protocols for ventral hernia repair: evidence-based recommendations from the ACHQC QI Committee.

Enhanced recovery after surgery (ERAS) protocols are widely used in the post-operative care of hernia patients. Despite their prevalence, an absence of published consensus guidelines creates significant heterogeneity in practices. The aim of this study was to evaluate elements in ERAS protocols utilized in ventral hernia repair from institutions across the United States and provide consensus recommendations for each identified element. Institutional members of the Abdominal Core Health Quality Collaborative (ACHQC) Quality Improvement (QI) committee submitted current ERAS protocols. Items within each protocol were classified as "elements", then assigned a topic. Any topic with ≥ 2 elements from separate institutions were labeled as a "theme," then grouped by stage in the patient care cycle. A brief review of current evidence was provided in addition to a ACHQC QI committee consensus statement. A total of 295 elements from 6 tertiary referral centers specializing in hernia care were compiled into 24 themes and grouped by four separate stages: Pre-Admission Optimization, Pre-Operative Care, Intra-operative Care, and Post-Operative Management. This article represents a multi-institutional review of ERAS protocols for ventral hernia repair and identifies common themes that may provide the framework for a unified ERAS protocol in hernia surgery. Future work may serve to develop societal guidelines defined specifically for enhanced recovery in ventral hernia repair.

Combined Coronary Artery Bypass Grafting and Orthopedic Fixation in a Patient with Multiple Comorbidities: A Case Report

Background: Coronary artery disease (CAD) is a prevalent cardiovascular condition and leading cause of morbidity and mortality worldwide. The management of orthopedic injuries requiring surgical fixation is particularly complex in patients with comorbidities such as diabetes mellitus (DM) and hypertension (HTN). Coordinating the sequence, timing, and execution of coronary artery bypass grafting (CABG) and orthopedic fixation requires careful consideration of the patient’s overall health, surgical risks, and recovery potential. Case presentation: A 55-year-old male presented with a right distal tibial fracture following a fall. His medical history included HTN, type 2 diabetes mellitus (T2DM), and Kyrle’s skin disease. During his hospital stay, he was diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). Severe multivessel CAD was confirmed by catheterization. After interdisciplinary consultation, simultaneous CABG and open reduction and internal fixation (ORIF) of the tibial fracture were performed. He was discharged in good condition and showed positive recovery during a one-month follow-up. Discussion: This case highlights the complexities of managing patients with multiple comorbidities who require both cardiac and orthopedic surgeries. This simultaneous approach allows for efficient treatment, leading to a shorter hospital stay and recovery period. This report supports the feasibility and benefits of simultaneous surgery in complex clinical scenarios, although further studies are required to establish broader guidelines. Conclusion: Our case emphasizes the importance of a multidisciplinary approach for managing patients with multiple comorbidities who require concurrent surgical intervention. Preoperative planning and specialty coordination ensured optimal outcomes. Further research is needed to develop standardized guidelines for intraoperative care of patients undergoing simultaneous procedures.

Clinical practice guidelines for the care of patients with a chronic subdural haematoma: multidisciplinary recommendations from presentation to recovery

Introduction A chronic subdural haematoma (cSDH) is an encapsulated collection of fluid and blood degradation products in the subdural space. It is increasingly common, affecting older people and those living with frailty. Currently, no guidance exists to define optimal care from onset of symptoms through to recovery. This paper presents the first consensus-built recommendations for best practice in the care of cSDH, co-designed to support each stage of the patient pathway. Methods Guideline development was led by a multidisciplinary Steering Committee with representation from diverse clinical groups, professional associations, patients, and carers. Literature searching to identify relevant evidence was guided by core clinical questions formulated through facilitated discussion with specially convened working groups. A modified Delphi exercise was undertaken to build consensus on draft statements for inclusion in the guideline using survey methodology and an in-person meeting. The proposed guideline was subsequently endorsed by the Society for British Neurological Surgeons, Neuroanaesthesia and Critical Care Society, Association of Anaesthetists, British Association of Neuroscience Nurses, British Geriatric Society, and Centre for Perioperative Care. Results We identified that high quality evidence was generally lacking in the literature, although randomised controlled trial (RCT) data were available to inform specific recommendations on aspects of surgical technique and use of corticosteroids. The final guideline represents the outcome of synthesising available evidence, consensus-built expert opinion and patient involvement. The guideline comprises 67 recommendations across eight major themes, covering: presentation and diagnosis, neurosurgical triage and shared decision-making, non-operative management, perioperative management (including anticoagulation), timing of surgery, intraoperative and postoperative care, rehabilitation and recovery. Conclusions We present the first multidisciplinary guideline for the care of patients with cSDH. The recommendations reflect a paradigm shift in the care of cSDH, recognising and formalising the need for multidisciplinary and collaborative clinical management, communication and decision-making delivered effectively across secondary and tertiary care.

Development of postoperative laryngeal edema in patients undergoing craniotomy for elective intracranial tumor excision: a prospective, observational, preliminary study

BackgroundIntracranial tumor surgeries require different head and surgical positions as well as large fluid administration, which can cause laryngeal edema (LE) and increased morbidity. But there are no studies regarding its incidence in this patient population. As these patients often receive steroids for reducing peri-tumoral edema, which can also reduce LE, we hypothesized that incidence of LE in patients undergoing intracranial tumor resection in various positions might not be high. Thus, this prospective, observational study aimed to find LE incidence, as assessed by cuff leak test in these patients. MethodsASA I/ II, patients (18- 60 yrs) undergoing elective intracranial tumor resection were included after atraumatic tracheal intubation under standard general anesthetic technique. Cuff leak volume (CLV) was measured in supine position before start of surgery (CLVb) and completion (CLVc) of surgery. CLV ˂110 ml was considered to indicate LE. Important parameters were noted and patients were followed till discharge from the hospital. ResultsSeventy-three patients with male preponderance (58.9%) participated in study. Number of patients operated in supine, lateral, prone and sitting positions were 34, 16, 14 and 09, respectively. CLV decreased significantly in lateral and supine positions (p = 0.009 and 0.0002 respectively). Only, 02(2.74%) patients had CLVc <110 ml; both were male patients operated in supine position with head rotation. Anesthetic duration and intraoperative fluid administration were comparable across surgical positions. No PES was seen in any patient. ConclusionWe found that optimal intraoperative care of patients undergoing excision of intracranial tumors resulted in a low PLE incidence (2.74%) as detected by CLT at completion of surgery. However larger studies are required to further elaborate this issue.

Perioperative Observation and Nursing of a Child with Facial Venous Malformation Treated with Interventional Embolization

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: Venous malformations (VMs) are a rare disease with an incidence of only about 1/10,000 in children, but VMs can expand as the child grows, appearing more in shallow skin areas such as the neck of the head, can cause discomfort or degradation, and therefore, can seriously affect the physical and mental health of the child. There are numerous treatment options for VMs, and interventional embolosclerotherapy has become the clinically preferred treatment for VMs due to its many advantages. &amp;lt;i&amp;gt;Case Presentation&amp;lt;/i&amp;gt;: We summarize the perioperative care experience of a 10-year-old child with severe right facial malformation diagnosed as facial venous malformation (VMs) who underwent interventional embolization during hospitalization. After 14 days of careful treatment and nursing by medical staff, the child was discharged successfully. &amp;lt;i&amp;gt;Discussion&amp;lt;/i&amp;gt;: The key points of our perioperative care for this patient include paying attention to the mental health of the child and providing psychological support; strengthening health education and paying attention to the prevention of falls; preoperative preparation; intraoperative care; observation of the condition; pain assessment and care; strengthening discharge guidance; and doing a good job in continuous nursing. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: For the nursing of the child with facial venous malformations, it is necessary to pay attention not only to their physiological care but also to their psychological care to help them recover as soon as possible.

Evaluating the Safety and Quality of Intraoperative Anesthesia Handoffs from the Perspective of Anesthesia Providers

Handoffs, that is, care transitions, convey information, responsibility, and authority between care providers. Intraoperative handoffs, which occur during surgery either due to shift changes or breaks, are high-risk, error-prone and linked with inadequate verbal communication and documentation. We explored perspectives about safety and quality of intraoperative handoffs between anesthesia providers at an academic medical center. Through an anonymous online survey, we asked participants to share their opinions on current handoff practices including teamwork, staffing and work pace, and handoffs and information exchange. The results showed positive perceptions about teamwork, while only half of the participants were positive about staffing and work pace. We also found that opinions of participants about staffing and work pace vary based on their role. Our study emphasizes the importance of considering diverse perspectives and employing a systems-based approach to address challenges and implement effective interventions for safe, high-quality handoffs in intraoperative care.

Utilising a modified accelerated Delphi process to develop a national multidisciplinary consensus on peri-operative optimisation of patients with obesity undergoing non-bariatric surgery

BackgroundIn the last three decades, the worldwide prevalence of obesity has increased by threefold. Using a modified Delphi consensus technique, the Irish Surgical Research Collaborative (ISRC) aimed to formulate consensus guidelines on the peri-operative optimisation of patients with obesity undergoing non-bariatric surgery. MethodsSubgroups within the ISRC were established to formulate consensus statements using a nominal group technique (NGT) to address the three domains of pre-operative, intra-operative and post-operative care. Three Delphi rounds were circulated nationally to multidisciplinary members of the peri-operative team via electronic survey. Consensus was considered achieved for any statement with >80 % agreement. Data was analysed using Microsoft Excel (Microsoft Corp, Redmond, WA). ResultsFollowing three Delphi rounds, a total of 94 statements centred around optimising peri-operative care for patients with obesity undergoing non-bariatric surgery reached consensus. Pre-operatively, access to prehabilitation, use of pre-operative risk stratification tools and strategies to reduce obesity-related co-morbidities were all deemed important along with nomination of a hospital obesity lead. Intra-operatively, the prioritised domains were involvement of consultant anaesthetist and surgeon for safe and considered patient positioning, utilisation of minimally invasive surgical techniques, adherence to venous thromboembolism prophylaxis and surgical site infection prevention strategies as well as adoption of multimodal analgesia. Appropriate analgesia prescription, nutritional support, enhanced recovery after surgery and the role of physiotherapy were all deemed essential elements of post-operative care. ConclusionAs a multidisciplinary peri-operative group, through Delphi consensus, we report agreed perioperative standards to optimise the perioperative care of patients with obesity undergoing non-bariatric surgery. This consensus can be utilised to standardise clinical practice and identify areas for quality improvement.

Anesthetic Management of Acute Ischemic Stroke Undergoing Mechanical Thrombectomy: An Overview.

Ischemic stroke, caused by the interruption of the blood supply to the brain, requires prompt medical intervention to prevent irreversible damage. Anesthetic management is pivotal during surgical treatments like mechanical thrombectomy, where precise strategies ensure patient safety and procedural success. This narrative review highlights key aspects of anesthetic management in ischemic stroke, focusing on preoperative evaluation, anesthetic choices, and intraoperative care. A rapid yet thorough preoperative assessment is crucial, prioritizing essential diagnostic tests and cardiovascular evaluations to determine patient frailty and potential complications. The decision between general anesthesia (GA) and conscious sedation (CS) remains debated, with GA offering better procedural conditions and CS enabling continuous neurological assessment. The selection of anesthetic agents-such as propofol, sevoflurane, midazolam, fentanyl, remifentanil, and dexmedetomidine-depends on local protocols and expertise balancing neuroprotection, hemodynamic stability, and rapid postoperative recovery. Effective blood pressure management, tailored airway strategies, and vigilant postoperative monitoring are essential to optimize outcomes. This review underscores the importance of coordinated care, incorporating multimodal monitoring and maintaining neuroprotection throughout the perioperative period.

The Use of Point-of-Care Ultrasound (POCUS) in Anesthesiology: A Narrative Review.

Point-of-care ultrasound (POCUS) has become an essential tool in modern anesthesiology, offering real-time imaging that aids in diagnosis, treatment, and procedural guidance. Its applications have expanded significantly, from routine assessments to complex perioperative management, enhancing patient care across various domains. This study aimed to review and summarize the current literature on the applications of POCUS in anesthesiology, focusing on its utility in airway management, cardiac assessment, lung ultrasound (LUS), and abdominopelvic evaluations. Additionally, it discusses the challenges and strategies for overcoming barriers to its widespread adoption. A narrative literature review was conducted, encompassing studies on using POCUS in anesthesiology. Key databases were searched for relevant articles ("Point-of-care ultrasound,""Focused cardiac ultrasound,""Lung ultrasound"),and studies were selected based on their relevance to the main topics of interest: airway management, cardiac ultrasound, LUS, and abdominopelvic and gastric ultrasound. Both observational studies and randomized controlled trials were included. POCUS improves the safety and accuracy of regional anesthesia and airway procedures, enhancing patient outcomes by providing real-time visualization. Focused cardiac ultrasound is valuable in preoperative, intraoperative, and postoperative care, allowing for tailored anesthesia plans and timely interventions based on cardiac function. The US is an effective diagnostic tool for assessing pulmonary conditions, with specific signs and artifacts aiding in identifying pathologies such as pneumothorax, pleural effusions, and pulmonary congestion. Despite its benefits, POCUS faces barriers such as limited access to training, the need for standardized protocols, and the high equipment cost, especially in low-resource settings. While its integration into clinical practice continues to grow, overcoming challenges related to training, standardization, and equipment access is essential to realize its full potential. Continued efforts in education and research are needed to support the widespread adoption of POCUS in anesthesiology.

A survey and analysis of peri-operative quality indicators promoted by National Societies of Anaesthesiologists in Europe: The EQUIP project.

To capture preventable peri-operative patient harm and guide improvement initiatives, many quality indicators (QIs) have been developed. Several National Anaesthesiologist Societies (NAS) in Europe have implemented quality indicators. To date, the definitions, validity and dissemination of such quality indicators, and their comparability with validated published indicators are unknown. The aim of this study was to identify all quality indicators promoted by NAS in Europe, to assess their characteristics and to compare them with published validated quality indicators. A cross-sectional study with mixed methods analysis. Using a survey questionnaire, representatives of 37 NAS were asked if their society provided quality indicators to their members and, if so, to provide the list, definitions and details of quality indicators. Characteristics of reported quality indicators were analysed. The 37 NAS affiliated with the European Society of Anaesthesiology and Intensive Care (ESAIC) at the time. Data collection, translations: March 2018 to February 2020. Representatives of all 37 NAS completed the survey. QIs reported by NAS. Only 12 (32%) of the 37 NAS had made a set of quality indicators available to their members. Data collection was mandatory in six (16.2%) of the 37 countries. We identified 163 individual quality indicators, which were most commonly descriptive (60.1%), anaesthesia-specific (50.3%) and related to intra-operative care (21.5%). They often measured structures (41.7%) and aspects of safety (35.6%), appropriateness (20.9%) and prevention (16.6%). Patient-centred care (3.7%) was not well covered. Only 11.7% of QIs corresponded to published validated or well established quality indicator sets. Few NAS in Europe promoted peri-operative quality indicators. Most of them differed from published sets of validated indicators and were often related to the structural dimension of quality. There is a need to establish a European-wide comprehensive core set of usable and validated quality indicators to monitor the quality of peri-operative care. No registration.

Complex Fractures of the Radial and Ulnar Shaft.

Successful management of radial and ulnar shaft fractures is an essential skill for all orthopaedic surgeons. The frequent presentation of these injuries coupled with the nuanced anatomic considerations that must be observed for successful outcomes dictate that these injuries require a thorough understanding by the treating surgeon. Intraoperative care to restore the anatomic radial bow and rotation is essential for the resumption of functional forearm rotation postinjury. Often, problems arising during the operative treatment of radial and ulnar shaft fractures come in predictable patterns that can be mitigated with preoperative planning and sound technique. Cases of increased complexity with segmental bone defects and soft tissue defects require a variety of advanced reconstructive techniques.

The Effect of The ERACS Method on The Acceleration of Mobilization of Post Sectio Caesaria Patients at Academic Hospital Universitas Gadjah Mada In 2023

Background: ERACS (Enhanced Recovery After Caesarian Surgery) is a fast programrecovery after a Caesarean section in the form of a series of care starting from preoperativepreparation, intraoperative and post-operative care until the patient is discharged. InIndonesia itself, the implementation of the ERACS protocol began to be implemented in2019. UGM Academic Hospital, the ERACS method is still a new service from the MaternalPerinatal Installation and will start running in November 2022. This research aims todetermine the difference in maternal mobilization time post Sectio Caesaria with the ERACSmethod and mobilization of mothers post non-eracs SC at UGM Academic Hospital in 2023.This research is a quantitative research using a quasi-experimental method with anonequivalent posttest control group design. The research was conducted at the UGMAcademic Hospital in April - September 2023. The sampling technique was accidentalsampling. The research results showed that the average mobilization of post-Sc patientsusing the ERACS method was 13.1 hours and the average mobilization of non-ERACS post-Scpatients was 33.7 hours. From the results of the analysis of 54 respondents using theIndependent Sample Test, it shows a value of 0.000. So H0 is rejected and Ha is accepted.Conclusion: there is an effect of giving the ERACS method by accelerating the mobilizationof women giving birth post sc.Keywords: Sectio Caesaria, Maternity, Mobilization, Rapid Mobilization, ERACS

Early Cognitive Function after Deep Sedation Using Different Anesthetic Agents in Pediatric Patients: A Prospective, Randomized Controlled Trial.

Background and Objectives: The impact of anesthetic agents on memory and cognitive function following general anesthesia is of great interest, particularly regarding their effects on the developing pediatric brain. While numerous studies have examined the relationship between anesthetic drugs and brain function, research focusing on early cognitive function following sedation remains limited. Materials and Methods: This study was a prospective, randomized controlled trial involving 148 pediatric patients scheduled for hematological procedures, specifically bone marrow aspiration (BMA) and intrathecal chemotherapy (ITC). Patients were divided into two groups based on the primary anesthetic used: the inhalational sedation group (IHG), in which sevoflurane was used, and the intravenous sedation group (IVG), which received propofol infusion. Apart from the main anesthetic agent, all sedation methods were consistent across both groups. A cognitive function test administered before sedation involved memorizing four distinct images, each associated with a different number. Then, the patients were asked to identify the omitted image upon awakening in the recovery room. Herein, this pre- vs. post-sedation test is called the early recognition assessment (ERA) tool. The primary outcome was the correct response rate after sedation for the two groups. Secondary outcomes included the sedation score, the behavior response score, and the correct response rates according to the number of sedation procedures. Results: This study included 130 patients in the final analysis, with 74 originally assigned to each group. The initial cognitive assessment revealed no significant difference in performance between the anesthetic agents. In addition, no differences were observed in the rates of correct responses or post-sedation scores after repeated procedures. However, the IVG demonstrated higher behavior response scores compared to the IHG. Conclusions: There were no significant differences in the rates of correct responses using the ERA tool between the two groups, irrespective of the number of sedation procedures performed. While some differences were noted in preoperative, intraoperative, and post-anesthesia care, these did not significantly impact the cognitive outcomes measured.

Task-sharing spinal anaesthesia care in three rural Indian hospitals: a non-inferiority randomised controlled clinical trial

BackgroundTask-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether...

Anaesthesia considerations in heart transplantation: A comprehensive review

In over 56 years since the first heart transplant, the science of heart transplantation has evolved from an experimental procedure to an established standard of care for end-stage heart failure. The process involves appropriate patient selection, the listing of recipients, pre-operative optimization, intraoperative management, post-operative care, and follow-up. A robust transplant team, strong government backing, and positive support from the population are essential criteria for the success of any transplant program. Management of heart transplant recipients from the Anaesthesia perspective is challenging due to a myriad of patient risk factors; and the urgent nature of surgery due to the unpredictable nature of donor heart availability. The intraoperative aim is safe induction of anaesthesia, strict asepsis, immunosuppressive therapy, anticipation of major vascular injury, managing pulmonary vascular resistance, ventricular support, optimal ventilatory strategy, and good haemostasis. The postoperative goal is preventing infection, haemodynamic management, gradual weaning of supports, adequate analgesia, monitoring for complications, physiotherapy, and early discharge of the patient from the intensive care unit. There is an increased complexity of heart transplant recipients, due to the increasing use of pre-transplantation mechanical circulatory support devices. The cardiac anaesthesiologist needs to have knowledge of the modern changes in the field of Heart Transplant. The goal of this paper is to provide an overview of the heart transplant origins in India, donor pre-operative workup, intra-operative anaesthesia care, and early post-operative management of heart transplant patients.

The Impact of a Care Bundle on the Prevention of Post-cesarean Surgical Site Infection

Background: The most common complication in the first 10 days after a cesarean section is surgical site infection (SSI), leading to poorer health outcomes, financial consequences, and maternal mortality. However, about 40 to 60% of such complications are preventable. Objectives: The present study aimed to examine the effect of a care bundle on the prevention of post-cesarean surgical site infection. Methods: This clinical trial was conducted on pregnant women undergoing cesarean section at Ali Ibne Abitalib Hospital, Zahedan, in the summer of 2022. A total of 60 full-term pregnant women who were candidates for cesarean section were selected using convenience sampling based on the inclusion criteria and were divided into two groups (each with 30 members) using random permuted blocks. The patients in the intervention group received preoperative, intraoperative, and postoperative care using an infection prevention care bundle, while the patients in the control group received routine care in the surgical department and operating room. The participants’ demographic, pregnancy, and surgical data were collected through interviews with the patients and by reviewing their medical files and were recorded in a checklist. The surgical incision was checked using the wound assessment checklist and the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) Scale, 24 hours after surgery and on the 10th and 30th days after surgery to confirm or reject wound infection. A score greater than 6 confirmed a surgical site infection. The data were analyzed with SPSS-21 software using independent samples t-test and chi-square test. The level of significance in this study was set at P &lt; 0.05. Results: The data in this study showed that the patients in the two groups did not have statistically significant differences in terms of demographic, pregnancy, and surgical variables, except for the history of infection (P &gt; 0.05). The mean REEDA scores for the patients in the intervention group 24 hours after surgery and on the 10th and 30th days after surgery were 2.52 ± 4.6, 1.3 ± 2.7, and 0, respectively. The corresponding values for the patients in the control group were 3.64 ± 5.26, 1.7 ± 3.07, and 0.08 ± 0.3, respectively. The independent samples t-test showed that the mean REEDA scores in the intervention and control groups 24 hours after surgery and on the 10th and 30th days after surgery did not have a statistically significant difference (P &gt; 0.05). Moreover, 2 patients (6.67%) in the intervention group and 5 patients (16.67%) in the control group showed signs and symptoms of SSI, but the chi-square test did not show a significant intergroup difference (P &gt; 0.05). Conclusions: The findings suggested that the care bundle was not effective in the prevention of cesarean wound infection, but we cannot deny the positive effects of care bundles on the prevention of surgical site infections. Thus, the components of the care bundle should be carefully examined, and any potential issues need to be more carefully analyzed in subsequent studies, especially intraoperative interventions that should be performed with extensive collaboration between surgical and operating room nurses and technicians.

Effect of standardized EHR-integrated handoff report on intraoperative communication outcomes.

We evaluated the effectiveness and implementability of a standardized EHR-integrated handoff report to support intraoperative handoffs. A pre-post intervention study was used to compare the quality of intraoperative handoffs supported by unstructured notes (pre) to structured, standardized EHR-integrated handoff reports (post). Participants included anesthesia clinicians involved in intraoperative handoffs. A mixed-method approach was followed, supported by general observations, shadowing, surveys, and interviews. One hundred and fifty-one intraoperative permanent handoffs (78 pre, 73 post) were included. One hundred percent of participants in the post-intervention cohort utilized the report. Compared to unstructured, structured handoffs using the EHR-integrated handoff report led to: (1) significant increase in the transfer of information about airway management (55%-78%, P < .001), intraoperative course (63%-86%, P < .001), and potential concerns (64%-88%, P < .001); (2) significant improvement in clinician satisfaction scores, with regards to information clarity and succinctness (4.5-4.7, P = .002), information transfer (3.8-4.2, P = .011), and opportunities for fewer errors reported by senders (3.3-2.5, P < .001) and receivers (3.2-2.4, P < .001); and (3) significant decrease in handoff duration (326.2-262.3 s, P = .016). Clinicians found the report implementation highly acceptable, appropriate, and feasible but noted a few areas for improvement to enhance its usability and integration within the intraoperative workflow. A standardized EHR-integrated handoff report ensures the effectiveness and efficiency of intraoperative handoffs with its structured, consistent format that-promotes up-to-date and pertinent intraoperative information transfer; reduces opportunities for errors; and streamlines verbal communication. Handoff standardization can promote safe and high-quality intraoperative care.

Anesthetic considerations for joint replacement surgery in hemophilic arthropathy: a comprehensive review.

Managing hemophilia in patients undergoing joint replacement surgery requires a comprehensive approach encompassing preoperative assessment, meticulous intraoperative care, and tailored postoperative management. Evaluation of joint integrity, bleeding history, and inhibitor presence guides surgical planning and hemostatic therapy selection to optimize outcomes. During surgery, careful attention to factor replacement, antibiotic prophylaxis, anesthetic techniques, and orthopedic strategies minimizes bleeding risk and enhances surgical success. Postoperatively, effective pain management, continued hemostatic therapy, and individualized rehabilitation programs are vital for facilitating recovery and preventing complications. Close monitoring for potential complications, such as periprosthetic joint infection and recurrent hemarthrosis, allows for prompt intervention when necessary. Overall, a collaborative approach involving hematologists, orthopedic surgeons, anesthesiologists, and rehabilitation specialists ensures comprehensive care tailored to the unique needs of patients with hemophilia undergoing joint replacement surgery, ultimately optimizing outcomes and improving quality of life. This holistic approach addresses the multifaceted challenges posed by hemophilia and joint replacement surgery, providing patients with the best possible chance for successful outcomes and long-term joint function. By integrating specialized expertise from multiple disciplines and implementing evidence-based strategies, healthcare providers can effectively manage hemophilia in the context of joint replacement surgery, mitigating risks and maximizing benefits for patients.

Implementation of surgical site infection care bundle in patients undergoing gastrointestinal surgeries

PurposeSurgical site infection (SSI) is one of the frequent healthcare associated infections linked with significant morbidity, prolonged hospitalization, and death. SSI can be reduced by implementation of customized care bundle components as per standard guidelines. Hence this study was undertaken with the objective to implement care bundle in patients undergoing elective gastrointestinal surgeries and assess their impact on SSI rate. MethodsThe study was an interventional study conducted in the department of surgical gastroenterology for 8 months. Sample size was calculated to be 196 and only elective surgeries are included. CDC NHSN 2023 guidelines are used for surveillance of SSI and global guidelines for prevention of SSI was used for preparation of list of pre-operative, intraoperative and post-operative care bundle components and were implemented before the start of the study. ResultsOverall SSI rate and compliance to SSI care bundle in this study are 13.8% and 28.6%, respectively. When compared with the baseline SSI rate of 19.4%, there is reduction of 28.9% in SSI rate after the implementation of care bundle. Escherichia coli (54.2%) is the most commonly isolated organism. Care bundle non-compliant surgeries are associated with 2.3 times (relative risk-2.3) increased risk of SSI. There is fluctuating trend in compliance of care bundle and SSI rates across months. ConclusionThis study shows the importance of implementation of set of care bundle for prevention of SSI which can be customized and adapted for reducing SSI.

Liver autotransplantation and atrial reconstruction on a patient with multiorgan alveolar echinococcosis: a case report

BackgroundAlveolar echinococcosis (AE) primarily affects the liver and potentially spreads to other organs. Managing recurrent AE poses significant challenges, especially when it involves critical structures and multiple major organs.Case presentationWe present a case of a 59-year-old female with recurrent AE affecting the liver, heart, and lungs following two previous hepatectomies, the hepatic lesions persisted, adhering to major veins, and imaging revealed additional diaphragmatic, cardiac, and pulmonary involvement. The ex vivo liver resection and autotransplantation (ELRA), first in human combined with right atrium (RA) reconstruction were performed utilizing cardiopulmonary bypass, and repairs of the pericardium and diaphragm. This approach aimed to offer a potentially curative solution for lesions previously considered inoperable without requiring a donor organ or immunosuppressants. The patient encountered multiple serious complications, including atrial fibrillation, deteriorated liver function, severe pulmonary infection, respiratory failure, and acute kidney injury (AKI). These complications necessitated intensive intraoperative and postoperative care, emphasizing the need for a comprehensive management strategy in such complicated high-risk surgeries.ConclusionsThe multidisciplinary collaboration in this case proved effective and yielded significant therapeutic outcomes for a rare case of advanced hepatic, cardiac, and pulmonary AE. The combined approach of ELRA and RA reconstruction under extracorporeal circulation demonstrated distinct advantages of ELRA in treating complex HAE. Meanwhile, assessing diaphragm function during the perioperative period, especially in patients at high risk of developing pulmonary complications and undergoing diaphragmectomy is vital to promote optimal postoperative recovery. For multi-resistant infection, it is imperative to take all possible measures to mitigate the risk of AKI if vancomycin administration is deemed necessary.