Morning Of Surgery Research Articles

Utilization of Enhanced Recovery After Surgery (ERAS) protocol in pediatric laparoscopic sleeve gastrectomy: a quality improvement project.

The obesity epidemic has led to an increased number of adolescents requiring metabolic and bariatric surgery (MBS), but there is paucity of data on the impact of implementing all aspects of Enhanced Recovery After Surgery (ERAS) protocols to improve outcomes in this population. We implemented a comprehensive ERAS pathway for adolescents undergoing laparoscopic sleeve gastrectomy (LSG). Key elements included pre-operative fasting with carbohydrate loading in the morning of surgery, comprehensive anti-emetic and analgesic regimens including intra-operative lidocaine infusion (initiated before formal ERAS launch), regional anesthesia, and early goal-directed ambulation. We tracked opioidutilization, rescue anti-emetic use, time to oral intake,and hospital length of stay (HLOS) as outcome measures, and post-operative pain and returns to the system as balancing measures. Eighty-six patients(52 patients pre-ERAS and 34 patients post-ERAS) underwent LSGwith no differences in demographics. The post-ERAS group had earlier time to oral intake (3.0 vs. 5.5 h, p = 0.003), used less rescue anti-emetics, (8.0vs.16.0 mg, p < 0.001), and had shorter HLOS (33 vs. 54 h, p < 0.001) but no difference in opioid use (0.370 vs. 0.435 MME/kg, p = 0.17), post-operative pain scores or return to the system. Our novel use of bariatric-specific ERAS protocol with intra-operative lidocaine infusion accelerates the time to goal-directed oral intake and decreases HLOS without increasing the rate of returns to the system. This study highlights the feasibility and effectiveness of adapting adult ERAS protocols to the pediatric MBS population. Level III.

Effect of anesthetic technique on antitumor immunity in patients undergoing surgery for gall bladder cancer: A prospective randomized comparative study.

There is a paucity of literature regarding the effect of anesthetic techniques on antitumor immunity, especially in gall bladder malignancies. We designed a study to compare the effect of propofol-based total intravenous anesthesia and sevoflurane-based general anesthesia-on antitumor immunity, including tumor growth factor-β (TGF-β), T-helper cell profile, and inflammatory markers. A pilot prospective randomized trial was conducted in 64 patients undergoing surgery for gall bladder malignancy under general anesthesia in a tertiary specialty cancer hospital. Adult cancer patients of ASA physical status I-III fulfilling the inclusion criteria were randomized to either group S (sevoflurane-based general anesthesia) or group T (propofol-based total intravenous anesthesia). Preoperative (morning of surgery) and postoperative (24 h and 1 month after surgery) blood samples were obtained. Demographic profile and preoperative parameters were comparable between both groups. There was a statistically significant difference in the postoperative value of TGF-β (higher in group T). There was a statistically significant difference in postoperative interleukin-17A value (indicative of TH17 cells), and it was found to be higher in group S. Propofol-based TIVA increases serum TGF-β levels. At the same time, Sevoflurane modulates T-helper cells-based immunity to increase TH17 cells in patients with gall bladder cancer. Multiple larger studies will be required to validate the results and provide useful recommendations.

Do Previous Multiple Scorpion Bites Produce Resistance to Local Anesthetics Administered Via Repeated Subarachnoid and Epidural Blocks? A Case Report and Review of Available Evidence

Introduction: Failure to achieve a subarachnoid block, even after a second attempt, and the inability to activate epidural analgesia, despite a properly placed catheter, can be both frustrating and perplexing. This case presents a situation where these incidents occurred, and two well-conducted attempts at a subarachnoid block and a properly placed epidural catheter block were unable to produce surgical anesthesia. Case Presentation: A 55-year-old female, classified as American Society of Anesthesiologists (ASA) grade II, was scheduled for a total abdominal hysterectomy with bilateral salpingo-oophorectomy. After adequate pre-operative preparation, an epidural catheter was inserted on the morning of surgery, followed by a subarachnoid block with all the proper precautions, which completely failed. After waiting for 10 minutes, the epidural block was activated with a local anesthetic mixture. To our surprise, it also did not produce any desirable effect, so the subarachnoid block was repeated, which again failed to produce any clinical block. Consequently, the surgery had to be conducted under balanced general anesthesia. Recalling previous experience and evidence, a history of scorpion bites was elicited. The patient had a history of multiple encounters (five) and was from a geographical area known to be endemic for scorpions. Conclusions: This case represents another instance of developing resistance to the effects of local anesthetics after exposure to scorpion venom. We believe there is a strong correlation between previous scorpion bites, the number of bites, and the duration between the most recent bite and the development of resistance to local anesthetic agents (LAAs). From a detailed search, it was evident that enough clinical evidence has emerged to irrefutably support this proposal.

ThP5.5 - Outcomes Of Laparoscopic Common Bile Duct Exploration And Laparoscopic Cholecystectomy; A Single Centre Review From A District General Hospital In Northern Ireland

Abstract Aim Laparoscopic cholecystectomy with laparoscopic common bile duct exploration is a one-stage therapeutic option for patients presenting with choledocholithiasis. This is a review of outcomes for patients who underwent this procedure in a district general hospital setting in Northern Ireland over a two-year period. Method This is a retrospective review of prospectively collected data concerning all patients who underwent laparoscopic cholecystectomy and laparoscopic common bile duct exploration between October 2021 and October 2023. Data were reviewed to include pre-operative liver function, pre-operative imaging, rate of conversion to open procedure, length of stay, and readmission rate due to complications. Results 106 patients were included in the review. The average length of stay was 2.7 days (with a median of 1 day) and readmission rate was 7.5%. 87.7% of patients had deranged liver function tests on the morning of surgery, and 100% had proven choledocholithiasis on cross-sectional imaging prior to proceeding to theatre. Only two patients required conversion to open cholecystectomy. No patients developed postoperative pancreatitis. The complication rate was 11.3%, with most complications being of Clavien-Dindo Grade I or II. Conclusions Laparoscopic common bile duct exploration at the time of laparoscopic cholecystectomy represents a safe and effective method for management of choledocholithiasis. It can be considered as an alternative to endoscopic retrograde cholangiopancreatography as a therapeutic option in an appropriately selected patient group.

Effects of music on perioperative anxiety in patients undergoing cesarean section – A randomised prospective controlled study

Premedication with sedative drugs is one of the most preferred methods to reduce anxiety. Due to concerns about maternal and fetal side effects, their use in obstetric anesthesia is not preferred. The primary aim of the authors of this study is to investigate the effect of music on perioperative anxiety in pregnant. The patients were randomized into three groups; Group M was listened to music during the surgery, Group S isolated from ambient noise and Group C was the control group. Anxiety status was measured at the preoperative anesthesia examination, on the morning of surgery, and at the first hour postoperatively. Although we observed the lowest postoperative anxiety in Group M, it wasn’t statistically significant. Music is an easy-to-apply and no-side-effect method. Therefore, we believe that more clinical studies with more patients are needed for clearer results.

Efficacy and Safety of Preoperative Prophylaxis in Cataract Surgery with Combined Topical Antiseptics: A Microbiological Study.

To evaluate the antimicrobial efficacy of an ophthalmic formulation containing hexamidine diisethionate (HD) 0.05%, polyhexamethylene biguanide (PHMB) 0.0001%, and edetate disodium (EDTA) 0.01% (Keratosept®, Bruschettini, Genova, Italy) on the microbial flora of a healthy ocular surface. Patients were enrolled consecutively. Each patient applied two drops of Keratosept® in the eye scheduled for cataract surgery (study eye) three times daily in the 2 days prior to surgery and one time in the morning of surgery. The contralateral eyes were considered as control (control eye). Bilateral conjunctival swabs were collected before the first administration (T0) and the morning of surgery (T1). The swabs were processed within 3 h from sampling for the automated detection of the presence of replicating microorganisms (colony-forming units, CFU/mL) and the provision of real-time growth curves. Conjunctival swabs of 32 patients (n = 128) were examined. Six patients were excluded from the efficacy analysis because of microbial load < 50 CFU/mL at T0 in the study eye. No difference between study and control eyes was observed at T0 (p = 0.40). Compared with T0, 20 (76.9%) study eyes and 10 (38.5%) control eyes showed a ≥ 1 log reduction of the microbial load at T1, with a significant difference between groups (p = 0.005). Keratosept® showed good tolerability, and no adverse events or eye discomfort were recorded. This study showed that the low-dose combination of antiseptic agents in the Keratosept® ophthalmic solution effectively reduces the bacterial load of healthy flora on the ocular surface.

540 Outcomes of Laparoscopic Common Bile Duct Exploration and Laparoscopic Cholecystectomy; a Single Centre Review from a District General Hospital in Northern Ireland

Abstract Aim Laparoscopic cholecystectomy and common bile duct exploration is a one-stage therapeutic option for patients presenting with choledocholithiasis. This is a review of outcomes for patients who underwent this procedure in a district general hospital setting in Northern Ireland over a two-year period. Method This is a retrospective review of prospectively collected data concerning all patients who underwent laparoscopic cholecystectomy and common bile duct exploration between October 2021 and October 2023. Data were reviewed to include pre-operative liver function, pre-operative imaging, rate of conversion to open procedure, length of stay, and readmission rate due to complications. Results 106 patients were included in the review. The average length of stay was 2.7 days (with a median of 1 day). 87.7% of patients had deranged liver function tests on the morning of surgery, and 100% had proven choledocholithiasis on cross-sectional imaging prior to proceeding to theatre. Only two patients required conversion to open cholecystectomy. No patients developed post-operative pancreatitis. The complication rate was 11.3%, with most complications being of Clavien-Dindo Grade I or II. The readmission rate was 7.5%. Conclusions Common bile duct exploration at the time of laparoscopic cholecystectomy represents a safe and effective method for management of choledocholithiasis. It can be considered as an alternative to endoscopic retrograde cholangiopancreatography as a therapeutic option in an appropriately selected patient group.

Renal artery embolization in a case of renal cell carcinoma with intractable hematuria with acute myocardial infarction

Introduction: Renal artery embolization is a valuable treatment option for various renal tumors, both malignant and benign. The indications for this procedure include preoperative arterial embolization of large and vascular renal cell carcinoma to reduce intraoperative hemorrhagic complications, management of malignant renal tumors in patients who are not suitable candidates for surgery, treatment of symptomatic hematuria and palliative care for metastatic renal cancer. Case Report: In this case report, we present the case of a 56-year-old female with a known history of hypertension and cerebrovascular accident, who presented with complaints of hematuria and urinary retention. A diagnosis of left renal mass suggestive of renal cell carcinoma was made. The patient was planned for left radical nephrectomy and advised to discontinue aspirin for a week. However, on the morning of surgery, she experienced acute myocardial infarction and had to be hospitalized in intensive cardiac care. Aspirin was restarted, leading to recurrent severe hematuria. The patient underwent renal artery embolization, which successfully controlled the hematuria. Following cardiac stabilization, radical nephrectomy was performed three months later. The surgery and post-operative period were uneventful. Conclusion: This case study demonstrates the use of renal artery embolization as an effective modality for controlling hematuria, and temporizing management in a case of renal cell carcinoma where surgery was not immediately feasible due to a medical emergency.

Pill in the pyriform sinus, What anaesthesiologists should know about it

In a 51-year-old male scheduled for elective surgery, a video laryngoscopy showed a foreign body near the right pyriform sinus. It was removed with Magill forceps and found to be remnants of the tablet. He had taken a tablet of Pantoprazole 2 hours prior to surgery with sips of water. In the postoperative period, he confirmed he had no difficulty in swallowing and his lower cranial nerve examination was normal. He did mention he needed more water to swallow the tablet given prior to surgery. Our departmental protocol has been allowing sips of water for tablets on the morning of surgery. The factors like size of the tablet, amount of water, and position of the head do affect the swallowing of a tablet. Following this incident now we provide clear instructions to our patients about morning oral medications.

Hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers on the day of prone positioning spinal surgery in elderly patients.

The hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers (ARBs) before surgery in elderly patients undergoing spinal surgery in a prone position during anesthesia induction to skin incision are still unknown. In this prospective study, 80 patients undergoing spinal surgery in a prone position with general anesthesia, aged 60-79 years, American Society of Anesthesiologists (ASA) II or III, were enrolled. Patients who had ARBs only in their preoperative medication list were randomly divided into two groups at a 1:1 ratio: In Group A, ARBs were continued on the morning of surgery, while in Group B, they were withhold. Norepinephrine was infused to maintain the blood pressure at the baseline level of ±20% during anesthesia induction in all patients. The primary outcome was the consumption of norepinephrine in each group from anesthesia induction to skin incision. The secondary outcomes include changes in invasive arterial blood pressure and heart rate, the fluid infusion volumes, the amounts of anesthetic drugs, and the total time from induction to skin incision. There were no significant differences in the demographics, the fluid infusion volumes, the amounts of anesthetic drugs, the total time from induction to skin incision, and hemodynamics at different time points (p > 0.05), while significant differences were found in norepinephrine consumption between the two groups (p < 0.001). Compared with Group B, the consumption of norepinephrine increased significantly in Group A (93.3 ± 29.8 vs. 124.1 ± 38.7 μg, p = 0.000). In addition, the same trend was illustrated in the pumping rate of norepinephrine between Group B (0.04 ± 0.01 μg·kg-1·min-1) and Group A (0.06 ± 0.02 μg·kg-1·min-1) (p = 0.004). Our study conducted in elderly patients with hypotension undergoing prone spinal surgery demonstrated a greater pumping rate of norepinephrine during anesthesia induction in patients with ARBs continuing before surgery than those withholding, indicating that it was more difficult to maintain hemodynamic stability.Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=141081, ChiCTR2100053583.

Trends in preoperative carbohydrate load practice: A systematic review.

The preoperative carbohydrate load (PCL) is intended to improve surgical outcomes by reducing the catabolic state induced by overnight fasting. However, there is disagreement on the optimal PCL prescription, leaving local institutions without a standardized PCL recommendation. Results from studies that do not prescribe PCL in identical ways cannot be pooled to draw larger conclusions on outcomes affected by the PCL. The aim of this systematic review is to catalog prescribed PCL characteristics, including timing of ingestion, percentage of carbohydrate contribution, and volume, to ultimately standardize PCL practice. A comprehensive search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials were included if they studied at least one group of patients who were prescribed a PCL and the PCL was described with respect to timing of ingestion, carbohydrate contribution, and total volume. A total of 67 studies with 6551 patients were included in this systematic review. Of the studies, 49.3% were prescribed PCL on the night before surgery and morning of surgery, whereas 47.8% were prescribed PCL on the morning of surgery alone. The mean prescribed carbohydrate concentration was 13.5% (±3.4). The total volume prescribed was 648.2 ml (±377). Variation in PCL practices prevent meaningful data pooling and outcome analysis, highlighting the need for standardized PCL prescription. Efforts dedicated to the establishment of a gold standard PCL prescription are necessary so that studies can be pooled and analyzed with respect to meaningful clinical end points that impact surgical outcomes and patient satisfaction.

No requirement of perioperative glucocorticoid replacement in patients with endogenous Cushing’s syndrome – a pilot study

PurposeSurgical therapy represents the first-line treatment for endogenous Cushing’s syndrome (CS). While postoperative glucocorticoid replacement is mandatory after surgical remission, the role of perioperative glucocorticoid therapy is unclear.MethodsWe recruited patients with central or adrenal CS in whom curative surgery was planned and patients who underwent pituitary surgery for other reasons than CS as a control group. Patients did not receive any perioperative glucocorticoids until the morning of the first postoperative day. We performed blood samplings in the morning of surgery, immediately after surgery, in the evening of the day of surgery, and in the morning of the first and third postoperative day before any morning glucocorticoid intake. We continued clinical and biochemical monitoring during the following outpatient care.ResultsWe recruited 12 patients with CS (seven with central CS, five with adrenal CS) and six patients without CS. In patients with CS, serum cortisol concentrations <5.0 µg/dL (<138 nmol/L) were detected in the morning of the first and third postoperative day in four (33%) and six (50%) patients, respectively. Morning serum cortisol concentrations on the third postoperative day were significantly lower when compared to preoperative measurements (8.5 ± 7.6 µg/dL vs. 19.9 ± 8.9 µg/dL [235 ± 210 nmol/L vs. 549 ± 246 nmol/L], p = 0.023). No patient developed clinical or biochemical signs associated with hypocortisolism. During follow-up, we first observed serum cortisol concentrations >5.0 µg/dL (>138 nmol/L) after 129 ± 97 days and glucocorticoids were discontinued after 402 ± 243 days. Patients without CS did not require glucocorticoid replacement at any time.ConclusionPerioperative glucocorticoid replacement may be unnecessary in patients with central or adrenal CS undergoing curative surgery as first-line treatment.

Outcomes after pancreaticoduodenectomy with or without preoperative hyperbaric oxygen therapy

Background: Hyperbaric oxygen (HBO2 ) therapy is an alternative method against the deleterious effects of ischemic/reperfusion (I/R) injury and its inflammatory response. This study assessed the effect of preoperative HBO2 on patients undergoing pancreaticoduodenectomy. Study design: Patients were randomized via a computer-generated algorithm. Patients in the HBO2 cohort received two sessions of HBO2 the evening before and the morning of surgery. Measurements of inflammatory mediators and self-assessed pain scales were determined pre-and postoperatively. In addition, perioperative variables and long-term survival were collected and analyzed. Data are presented as median (mean ± SD). Results: 33 patients were included; 17 received preoperative HBO2 , and 16 did not. There were no intraoperative or postoperative statistical differences between patients with or without preoperative HBO2 . Erythrocyte sedimentation rate (ESR), IL-6, and IL-10 increased slightly before returning to normal, while TGF-alpha decreased before increasing. However, there were no differences with or without HBO2 . At postoperative day 30, the pain level measured with VAS score (Visual Analog Score) was lower after HBO2 (1 ± 1.3 vs. 3 ± 3.0, p=0.05). Eleven (76%) patients in the HBO2 cohort and 12 (75%) patients in the non-HBO2 had malignant pathology. The percentage of positive lymph nodes in the HBO2 was 7% compared to 14% in the non-HBO2 (p&lt;0.001). Overall survival was inferior after HBO2 compared to the non-HBO2 (p=0.03). Conclusion: Preoperative HBO2 did not affect perioperative outcomes or significantly change the inflammatory mediators for patients undergoing robotic pancreaticoduodenectomy. Long-term survival was inferior after preoperative HBO2 . Further randomized controlled studies are required to assess the full impact of this treatment on patients’ prognosis.

Clonidine premedication in spinal anaesthesia: Effect on hemodynamic status and vasopressor response to ephedrine

Introduction: Premedication has an important role to play in modern day anaesthesia care. In recent years, clonidine is making a comeback as a premedicant. Our study deals with haemodynamic changes to ephedrine after oral clonidine premedication for spinal anaesthesia with or without concurrent administration of drugs.The purpose of the study is to know the effect of oral clonidine premedication on haemodynamic status including vasopressor response of ephedrine during spinal anaesthesia. Materials: This is a prospective randomized double blinded controlled study. Sixty adult patients belonging to ASA I scheduled for elective surgery under spinal anaesthesia were selected. The patients were randomly assigned to 2 groups.Oral clonidine 4 microgram/kg was administered to group A(Clonidine group, n equal to 30) and 90 and one tablet of vitamin (placebo) orally 90 minutes was administered to group B (Control group, n equal to 30)90 minutes prior to anaesthesia. On the morning of surgery, blood pressure was measured before premedication and 90 minutes later. Sedation and anxiolysis were scored during clonidine premedication and 90th minute afterwards. When SBP decreased to 80% of the pre-spinal value, bolus IV injection of ephedrine 0.1 mg/kg was administered. After ephedrine injections, blood pressure and heart rate were recorded at 1 minute interval for 10 minutes. Results: Group A patients were found to have low SBP, DBP, MBP and HR when compared to group B. Intravenous ephedrine augmented blood pressure more than the control group. Statistically significant difference was found for SBP after 5 minutes, for MBP after 4 minutes of ephedrine administration and no significant difference was found for DBP. Conclusion: We conclude from our study that clonidine administered orally in a dose of 4 microgram/kg as a premedicant increases the pressor responses to IV injection ephedrine 0.2 mg/kg in patients with subarachnoid block.

906 A Prospective Clinical Audit of Pre-Operative Fasting Practices at a Tertiary Care Hospital in India

Abstract Aim Even in the face of evidence-based recommendations, the ‘nil by mouth from midnight’ regimen has persisted because it is easy to administer and allows for theatre flexibility. We aimed to audit preoperative fasting practices at Kasturba Medical College Hospital Attavar, India against the Indian Society of Anaesthesiologists (ISA) national guidelines. Method Prospective clinical audit involving ASA 1 and 2 patients undergoing elective, non-obstetric surgery under general/regional anaesthesia or sedation. Data were collected from patient notes and from an interview on the morning of surgery (at least one hour prior to induction of anaesthesia). Results Baseline Data (N = 100) Median fasting durations of 10 hours and 12.5 hours from clear fluids and solids, respectively. 99% of patients gave an incorrect reason or did not know at all the reason for preoperative fasting. Interventions:Patient information leaflets (in English and the local language) were made and distributed to every ward; to be shown to elective surgery patients on the day before surgery.Surgical trainees, anaesthesiology trainees and nurses were made aware of the audit findings. Re-Audit (N = 40) Median fasting duration of 3 hours and 11 hours respectively clear fluids and solids. Thirty-five percent of patients knew the correct reason for preoperative fasting. 50% gave an incorrect reason, while 15% did not know the reason. Conclusions Prolonged fasting was observed initially despite guidelines. Significant reduction in clear fluid fasting duration was achieved (10 hours to 3 hours) by creating awareness.

Effect of Preoperative Antianxiety Medications on Blood Pressure and Blood Loss in Total Knee Arthroplasty: A Case-Control Study.

The increasing number of canceled operations in patients undergoing total knee arthroplasty (TKA) due to high blood pressure readings has put a considerable burden on surgeons. In this study, we aim to assess the effect of giving antianxiety drugs preoperatively on maintaining blood pressure (BP) and blood loss for patients undergoing TKA surgery. This retrospective case-control study included patients who underwent total knee arthroplasty and divided them into two main groups: those who had taken a 3 mg bromazepam oral tablet at the night preoperatively and the control group. The blood pressure of patients was then measured preoperatively (baseline), in the morning of surgery, in the operating room before anesthesia, and during the surgery. The percentage of measured BP was calculated by dividing the measured BP by the baseline, then multiplying by 100. 301 patients were included in our study: 137 received bromazepam and 164 as a control group. The ratio of systolic BP (SBP) in the morning of surgery to the baseline (percentage of morning SBP) decreased significantly in the bromazepam group compared with the controls. The ratio of SBP, in the operating room before anesthesia (percentage of preanesthesia SBP) also decreased significantly in the bromazepam group. However, the percentage of SBP in the middle of surgery did not change significantly. In addition, there was a significant difference change from the baseline in diastolic BP and mean arterial BP between the two groups in the morning of surgery, inside the theatre, and in the middle of the operation. The bromazepam group also showed a significant decrease in blood loss. Preoperative oral antianxiety drugs (bromazepam) helps in controlling hemodynamic changes associated with anxiety, including maintaining BP in well-controlled hypertensive and healthy patients undergoing TKA, and it plays a role in decreasing the total blood loss.

Anesthetic and analgesic techniques used for cats undergoing ovariohysterectomies in general practice in the United States

ObjectiveTo better document anesthetic and analgesic protocols used by veterinarians in general practice within the United States (US) when performing elective ovariohysterectomy in cats. Study designCross-sectional survey. PopulationVeterinary practitioners in the US who are members of the Veterinary Information Network Inc. (VIN). MethodsAn online anonymous survey was distributed to VIN members. The survey included questions pertaining to preanesthetic evaluation, premedication, induction, monitoring and maintenance protocols, and postoperative analgesia and sedation protocols when performing ovariohysterectomy in cats. ResultsA total of 1324 veterinarians completed the survey. Respondents (number; %) reported performing preanesthetic laboratory tests [packed cell volume (256; 19.3%), complete blood cell count (893; 67.4%) and biochemistry panels (1101; 83.2%)] and preanesthetic examinations (1186; 89.6%) on the morning of surgery. The most frequently administered drugs for premedication were dexmedetomidine (353; 26.7%) and buprenorphine (424; 32.0%). The most frequently administered induction agent was propofol (451; 61.3%), and isoflurane (668; 50.4%) was the most common agent for maintenance of anesthesia. The majority of respondents reported placing intravenous catheters (885; 66.8%), administering crystalloid fluids (689; 52.0%) and providing heat support (1142; 86.3%). Participants reported using perioperative and postoperative analgesia including opioids (791; 59.7%), non-steroidal anti-inflammatory drugs (NSAIDs; 697; 52.6%) and NSAIDs dispensed for home use (665; 50.2%). Cats were commonly released home on the day of surgery (1150; 86.9%), and most participants reported contacting owners for follow-up within 1–2 days (989; 74.7%). Conclusions and clinical relevanceAnesthetic protocols and management techniques for routine feline ovariohysterectomy differ widely among US veterinarians who are VIN members, and results from this study may be of use to evaluate anesthetic practices from this population of veterinarians.

Effect of messaging content on engagement with a short messaging service for perioperative smoking cessation.

We determined whether a tobacco cessation intervention targeting brief perioperative abstinence ("quit for a bit") increased engagement of surgical patients with treatment compared with an intervention targeting long-term postoperative abstinence ("quit for good"). Surgical patients who smoke were stratified according to intended duration of postoperative abstinence, and then randomized within strata to receive either a "quit for a bit" or a "quit for good" intervention. Both employed initial brief counseling and short message service (SMS) to deliver treatment up to 30 days after surgery. The primary outcome of treatment engagement was defined as the rate at which subjects actively responded to system requests delivered via SMS. The engagement index did not differ between intervention groups (median [25th, 75th] of 23.7% [8.8, 46.0] for "quit for a bit" group (n=48) and 22.2% [4.8, 46.0] for "quit for good" group (n=50), p=0.74), nor did the proportion of patients continuing SMS use after study completion (33% and 28%, respectively). Exploratory abstinence outcomes at morning of surgery and 7 and 30 days after surgery did not differ between groups. Program satisfaction was high in both groups and did not differ. There was no significant interaction between intended abstinence duration and any outcome, i.e., alignment of intent with intervention did not affect engagement. Tobacco cessation treatment delivered via SMS was well-accepted by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates. Treatment of surgical patients for tobacco use is efficacious and reduces postoperative complications. However, implementation in clinical practice has proved challenging, and new methods of engaging these patients in cessation treatment are needed. We found that tobacco use treatment delivered via short message service (SMS) was feasible and well-utilized by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates.

Incorporation of pharmacist pre-surgical calls to improve medication history completion rates.

The accuracy and timeliness of documenting a medication history is an important aspect to ensure appropriate medication reconciliation during transitions of care. Surgical patients often have their medication history recorded just moments before surgery which may be rushed, incomplete or missed entirely. Between January and May 2020, 76.7% of surgical patients admitted to our institution had a medication history completed by a pharmacist prior to surgery. The objective of this work is to improve the pharmacist medication history completion rates for pre-surgical patients before surgery by integrating pharmacist-led medication histories into the pre-operative pathway. Through interdisciplinary collaboration, the pre-operative pathway for surgical patients was evaluated for opportunities to complete medication histories days prior to their scheduled procedure. Plan-Do-Study-Act (PDSA) cycles were utilized to make incremental improvements in practice. Through an iterative process, the pathway for cardiovascular surgery (CVS) patients was modified to include a scheduled pharmacist phone appointment in the days leading up to their surgical procedure. Utilizing these phone appointments, pharmacists complete patient medication history reviews and share a feedback loop to cardiovascular and peri-operative health care providers. The iterative PDSA cycles revealed challenges to completing pre-surgical medication history calls without advance notice. Patient responsiveness to pre-surgical medication history calls improved with the incorporation of scheduled phone appointments. Between January 18 and May 31, 2021, pharmacists completed 359 of 376 scheduled CVS appointments (95.5%), improving the medication history completion rates for cardiovascular surgery patients from 84.8 to 93.0% (p = 0.000025). The completion rate for all surgical patients also improved from 76.7 to 85.1% (p<0.00001). Incorporating scheduled pharmacist medication history appointments as a part of the pre-operative pathway was shown to expand the capacity for pharmacists to complete medication histories for patients prior to surgery. By reducing pharmacist workload on the morning of surgery, fewer patients were admitted to surgery without having their medication history reviewed by pharmacy. Future investigation should be considered to evaluate the impact on patient outcomes.

The Effect of a Simple Perioperative Video on Maternal Anxiety and Satisfaction Before Regional Anesthesia in a Caribbean Setting: A Randomized Controlled Trial.

Anxiety before regional anesthesia and surgery is common among women undergoing cesarean section. Although perioperative education has been shown to reduce this level of anxiety, the optimal form and timing of this intervention are not known. The goal of this study was to evaluate the efficacy of an educational anesthetic video on reducing anxiety and improving maternal satisfaction in patients scheduled for elective cesarean section under regional anesthesia. Eighty patients scheduled for cesarean sectionat a tertiary-level obstetric centerwere randomized to either an interventional group (viewed an educational video onthe evening before surgery) or the control group (no educational video). Both groups received a standard preoperative assessment on the morning of surgery.Anxiety was assessed using the Spielberger State-Trait Anxiety Inventory (STAI) and the visual analog scale for anxiety (VAS-A). Maternal satisfaction was assessed using the Maternal Satisfaction Scale Score for Cesarean Section (MSSSCS). Anxiety was assessed at baseline (the evening before surgery) and immediately before surgery. Maternal satisfaction was assessed on the first postoperative day. Patients in the intervention group also had their state anxiety measured immediately after viewing the educational anesthetic video using the VAS-A. Both groups were equally matched at baseline, and a statistically significant reduction in anxiety measured using VAS-A was seen in the intervention group vs. the control group (6 vs. 4.6, p = 0.018). State-trait anxiety measured using STAI, however, was not significantly lower in the intervention vs. control group (44 vs. 46, p = 0.99). VAS-A immediately after looking at the video was also not significantly different (5 vs. 4, p = 0.323) from the control group. Maternal satisfaction was also higher in the intervention group (113 vs. 104.5, p = 0.015). The use of a simple educational anesthetic video may be associated with reduced anxiety and improved maternal satisfaction in patients scheduled for elective cesarean section under regional anesthesia.