Perioperative Care Of Patients Research Articles

Perioperative care bundle versus conventional perioperative care in pediatric patients undergoing minimally invasive digestive endoscopy

Objective: To investigate the effect of perioperative care bundle in pediatric patients undergoing minimally invasive digestive endoscopy. Methods: This was a retrospective study using clinical records of pediatric patients who underwent minimally invasive digestive endoscopy surgery at Hebei Children’s Hospital from May 2020 to October 2023. Patients were divided into Care bundle group and Conventional care group based on the treatment received and matched for age, gender, and body mass index in 1:1 ratio. Perioperative vital signs, postoperative recovery, incidence of complications, and family members’ satisfaction with nursing care were analyzed. Results: A total of 98 pediatric patients were included, with 49 patients in each group. After surgery, diastolic blood pressure (DBP), systolic blood pressure (SBP), heart rate (HR), and mean arterial pressure (MAP) of both groups increased compared to preoperative values and were significantly lower in the Care bundle group compared to the Conventional care group (P<0.05). The time for anal exhaust, time for defecation, time to first out-of-bed activity, time to start eating after surgery, and length of hospital stay were shorter in the Care bundle than the Conventional care group (all P<0.05). The incidence of complications in the Care bundle group (4.08%) was lower than the Conventional care group (16.32%) (P<0.05). The overall family members’ satisfaction with the nursing care was considerably higher in the Care bundle group (93.88%) compared to the Conventional care group (81.63%) (P<0.05). Conclusions: Perioperative care bundle in pediatric patients undergoing minimally invasive digestive endoscopy was shown to be more efficacious than the conventional perioperative care. doi: https://doi.org/10.12669/pjms.41.2.11369 How to cite this: Wang L, Zheng L, Zhao X, Gong X, Su Z, Gong S. Perioperative care bundle versus conventional perioperative care in pediatric patients undergoing minimally invasive digestive endoscopy. Pak J Med Sci. 2025;41(2):399-403. doi: https://doi.org/10.12669/pjms.41.2.11369 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Characterization of trends in preoperative hemoglobin A1c testing prior to metabolic and bariatric surgery: a retrospective, observational study

BackgroundIrrespective of baseline diabetes status, preoperative hemoglobin A1c (A1C) influences perioperative care in patients undergoing metabolic and bariatric surgery (MBS). Accordingly, the American Society of Metabolic and Bariatric Surgery (ASMBS) endorses that patients undergoing MBS should receive a preoperative A1C test. We aimed to assess the proportion of MBS patients who received a preoperative A1C test and determine whether baseline diabetes status influences receipt of a test.MethodsWe queried the 2017 to 2022 MBSAQIP database for patients undergoing open, laparoscopic, or robotic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy. Using descriptive methods, we compared the clinical and demographic characteristics of patients who received a preoperative A1C test with patients who did not. We performed logistic regression analysis using diabetes status as a predictor variable and receipt of a test as the outcome, covarying for sociodemographic and clinical factors.ResultsWe identified 996,217 patients who underwent RYGB or sleeve gastrectomy between 2017 to 2022. The average age of the cohort was 43.8 years (SD = 11.9) and 81.0% were female. Overall, 45.7% received a preoperative A1C test. The proportion who was tested increased over the six-year study period, from 35.5% in 2017 to 56.0% in 2022. Compared to those who were not tested, patients who were tested were more likely to have several cardiopulmonary comorbidities, including COPD (1.4% vs 1.2%, p < 0.001), PE (1.4% vs 1.2%, p < 0.001), sleep apnea (39.3 vs. 36.4%, p < 0.001), HTN (47.1% vs 44.0%, p < 0.001), and MI (1.2% vs. 1.0%, p < 0.001), though the differences in proportions were small and may not be clinically significant. Compared to patients who did not have diabetes or had diabetes controlled by diet alone, patients with non-insulin dependent diabetes had 77% increased odds of receiving a A1C test (adjusted OR (aOR) 1.77, p < 0.001); insulin dependent patients had 113% increased odds (aOR 2.13, p < 0.001).ConclusionDespite society recommendations endorsing measurement of preoperative A1C prior to MBS, less than half of patients undergoing MBS between 2017 and 2022 received a preoperative A1C test. Additionally, there were differential patterns in testing based on diabetes status. Preoperative glycemic evaluation is an area for continued quality improvement.

Clarifying Misconceptions About Iodine "Allergies" for Perioperative Patient Care.

Iodine is a trace element that is required to produce thyroid hormone. Some preoperative skin antiseptics and contrast media that are used in a variety of specialties (eg, cardiovascular, urology) contain iodine. Clinicians and patients may believe that a history of a reaction to shellfish, povidone-iodine, or radiopaque contrast media is an allergy requiring avoidance of all three substances. Because iodine is required for life and does not stimulate an immune response, there is no relationship between iodine and adverse reactions to iodine-containing products. Perioperative nurses should have knowledge of allergies associated with iodine-containing substances and should assess patients for allergies. During the assessment process, they can seek input on the cause of any previous reactions and share information on allergies with the patient. They also can collaborate with leaders and information technology personnel to update the electronic health record to avoid documentation of iodine as an allergen.

Letter to the editor: enhancing perioperative care for elderly spinal surgery patients.

Letter to the editor: enhancing perioperative care for elderly spinal surgery patients.

Physicians-in-training and advanced practice providers perceptions in managing perioperative obstructive sleep apnea: a multi-institutional survey.

Physicians-in-training (residents, fellows) and Advanced Practice Providers (APPs) receive limited education on sleep disorders, including obstructive sleep apnea (OSA). They often assess patients first. We aimed to understand their views on OSA and screening for OSA in the perioperative period. Electronic-mail surveys were sent to physicians-in-training and APPs, in five categories of practice (Anesthesiology, Internal Medicine, Family Medicine, Obstetrics/Gynecology/Gynecologic Oncology, and Surgery) at nine major institutions. Cochran-Mantel-Haenszel (CMH) tests evaluated associations between participant characteristics (clinical role, physician years of training, APP years of practice, categories of practice) and survey responses (perception of OSA, perioperative risk factor, screening/managing of perioperative OSA) stratified by institution. False discovery rate (FDR) adjustment accounted for multiple comparisons (FDR-adjusted-p-values) of associations between multiple characteristics and a given response. Breslow-Day tests evaluated the homogeneity of odds ratios from CMH tests. We received 2236/6724 (33.3%) responses. Almost all (97%) agreed OSA represents a risk factor for perioperative complications. Many (37.9%) were unaware which screening tool was used at their institution, with differences by clinical role (FDR-adjusted-p<0.001), with APPs reporting not knowing more than residents and fellows, and across category of practice (FDR-adjusted-p<0.001). While 66.5% routinely asked perioperative patients about signs/symptoms of OSA, 33.5% did not. There were differences by clinical role (FDR-adjusted-p<0.001), as APPs reported asking about OSA more frequently than residents/fellows; and, by category of practice (FDR-adjusted-p<0.001) as Anesthesia and medical specialties reported asking about OSA more than surgical services. Importantly, approximately half of the respondents in Surgery (48%) and OB/GYN (46%) reported not routinely asking. Differences also existed by physician PGY clinical training (FDR-adjusted-p=0.005) with those with higher PGY reporting they asked about OSA more often. Significant differences exist in screening by clinical roles and categories of care. This highlights the importance of improving provider education on the role of OSA in perioperative risk assessment and patient care.

Obesity and anesthesiology: A permanent association

Mexico is a country with a high prevalence of obesity in adults, reaching 36.9%1. Body mass index (BMI) linearly increases the risk of perioperative complications, such as atelectasis, obstructive sleep apnea, cardiovascular and thromboembolic diseases, among others. This situation highlights the importance of anesthesiologists being trained to adequately address the perioperative care of patients with obesity, since approximately one third of the population is in this category. Currently, there are multiple approaches to obesity management, ranging from lifestyle changes and surgeries for metabolic control and weight loss, to new generation medications, such as GLP-14 analogues. This has led to physicians from various specialties needing to update themselves on the mechanism of action and side effects of these new treatments.

Evidence-Based Perioperative Care of Patients with Continuous Glucose Monitoring Devices

Introduction Diabetes : Hyperglycemia Diabetes Management: CGM Devices Perioperative Nursing Education Patient Outcomes Background Adults with DM are rising in epidemic proportions worldwide. Metabolic disorder characterized by persistent changes in blood glucose levels. Hyperglycemia is a serum glucose level higher than 140mg/dl Postoperative variability in blood glucose levels = relative immunodeficiency. DM complicates the patient’s disease status. Detection of perioperative hyperglycemia is essential. CGMs provide real-time glucose monitoring. CGMs accuracy can be affected during surgery. Awareness of this inaccuracy is essential for making clinical decision.

Behavioral Economic Strategies Increase Adverse Event Reporting in Pediatric Anesthesia.

Identification and reporting of severe adverse events (SAEs) during anesthesia care remains critical in identifying areas of improvement in perioperative patient care. Although many healthcare organizations rely on the self-reporting of SAEs, under-reporting may limit the identification of the true incidence of these events. To circumvent these barriers, many healthcare systems leverage the Electronic Medical Record (EMR) by incorporating an Anesthesia Information Management System (AIMS). We followed the Institute for Healthcare Improvement's Model of Improvement and implemented behavioral economic-based interventions to our perioperative practice including adding a deliberation-promoting "hard stop" that required the anesthesiologists to report the occurrence or absence of a "notable event" prior to closing a patient's encounter in the EMR system. At baseline, 53% of SAEs were self-reported. The interventions resulted in a baseline shift to more than 75% self-reporting, a relative increase of 42%. An increase in reporting of SAEs was achieved with simple interventions including modifications of the EMR which were done with limited financial impact or interruption in the work flow.

Impact of improving educational nursing interventions in perioperative nursing interventions on outcomes of prostate cancer patients with laparoscopic radical prostatectomy.

Recent studies have reported that perioperative nursing intervention (PNI) plays important roles in the outcomes of prostate cancer (PC) patients undergoing laparoscopic radical prostatectomy (LRP). This study aimed to further investigate the role of educational nursing intervention in PNI on the recovery of PC patients with LRP. A total of 98 PC patients who underwent LRP were enrolled in this study. These patients were randomly divided into control (n = 49) and experimental (n = 49). Both groups received routine PNI, while the experimental group also received personalised PNI with enhanced educational nursing interventions. The study compared blood loss during surgery, surgery success rate, clinical signs of intestinal motility, postoperative hospital stay and postoperative complications between these two groups. Both the control and experimental groups achieved a 100% surgery success rate. The experimental group experienced significantly less blood loss. Moreover, the recovery of intestinal function was faster, and the postoperative hospital stay was shorter in the experimental group. Furthermore, the incidence of postoperative complications was lower in the experimental group. Our findings confirmed the importance of enhanced educational nursing interventions in personalised perioperative nursing care for PC patients undergoing LRP.

Effectiveness of the Pediatric Nursing Excellence Model on Nurses' Knowledge and Practice in Pediatric Orthopedic Surgery Care: A Randomized Controlled Trial.

Pediatric orthopedic nursing requires specialized competencies to optimize patient outcomes, particularly in the complex realm of pediatric surgery. This study explores the effectiveness of the Pediatric Nursing Excellence (PNE) Model in enhancing nurses' knowledge and clinical practice in providing perioperative care for pediatric orthopedic patients in tertiary care inpatient settings. A double-blind, randomized controlled trial was conducted from February to July 2024, involving 100 nurses from two tertiary care hospitals in Tanta, Egypt. Participants were randomly assigned to receive PNE Model training (n = 50) or routine care (n = 50). Nurses' knowledge, practical skills, and adherence to PNE principles were assessed at baseline, immediately post-intervention, and after one, three, and six months using validated tools. The intervention group showed significantly greater improvements in knowledge (20.62 ± 6.7 vs. 8.16 ± 5.5, p < 0.001) and practice scores (62.28 ± 4.1 vs. 40.06 ± 14.7, p < 0.001) post-intervention, sustained over six months. Path analysis revealed that the PNE Model enhanced nursing practice directly (β = 0.25, p < 0.001) through improvements in engagement and adherence to excellence principles and indirectly (β = 0.53, p < 0.001) by significantly enhancing nurses' knowledge (β = 0.70, p < 0.001), which in turn positively influenced their clinical practice (β = 0.75, p < 0.001). Post-intervention, 82% of nurses in the intervention group achieved high levels of professional excellence, compared to 8% at baseline (p < 0.001). The PNE Model demonstrates robust effectiveness in enhancing nurses' knowledge, clinical practice, and professional excellence in pediatric orthopedic surgery care, with sustained long-term benefits. This evidence supports implementing specialized nursing education models to improve pediatric care quality in orthopedic settings.

Examining the Anxiety and Preparedness Levels of Nurses and Nurse Candidates for Artificial Intelligence Health Technologies.

This study examined the anxiety levels of nurses and nurse candidates regarding humanoid nurse robots and artificial intelligence health technologies in perioperative patient care. Descriptive and cross-sectional study. The research was conducted with 158 intern students and 167 surgical nurses. Socio-demographic characteristics form, Questions Form Regarding Humanoid Nurse Robots and Artificial Intelligence Health Technologies, Artificial Intelligence Anxiety Scale and The Medical Artificial Intelligence Preparedness Scale were used. The independent t-test and one-way analysis of variance (ANOVA) were used. This study complied with Appendix S1. The total scores on the Artificial Intelligence Anxiety Scale for nurses and nursing students are 73.089 ± 31.667 and 73.624 ± 28.029, respectively. The total scores on the Artificial Intelligence Readiness Scale for nurses and nursing students are 71.736 ± 15.064 and 72.183 ± 13.714, respectively. When comparing the sociodemographic characteristics and scale scores of nurses, a statistically significant difference was found between age and the Artificial Intelligence Anxiety Scale scores (p < 0.05). There was also a statistically significant difference between age, gender and work duration and the Artificial Intelligence Readiness Scale scores for nurses (p < 0.05). Both groups exhibited moderate levels of anxiety and readiness regarding artificial intelligence. Comprehensive research is needed to elucidate the impact of artificial intelligence technologies on nursing professionals. The proper use of Artificial Intelligence technologies can enhance the quality of patient care, alleviate the workload, increase patient and staff satisfaction and foster new perspectives on acceptance. With their integration into clinics, a patient-centred care environment will emerge, improving patient safety, outcomes and overall well-being. Thus, the anxieties of nurses and students towards artificial intelligence technologies will decrease, and their readiness will increase. No Patient or Public Contribution.

Perioperative Management of Opioid-Tolerant Patients: A Comprehensive Guide

The perioperative management of opioid-tolerant patients presents significant challenges, necessitating a tailored approach to pain management and the prevention of opioid-related complications. This review discusses the essential aspects of preoperative assessment, intraoperative strategies, and postoperative care for opioid-tolerant patients. Emphasis is placed on the continuation of baseline opioid therapy, the use of multimodal analgesia, and the importance of individualized opioid dosing to achieve effective pain control while minimizing the risk of withdrawal, respiratory depression, and opioid-induced hyperalgesia. The role of a multidisciplinary team in optimizing patient outcomes and the necessity of thorough discharge planning and follow-up are also highlighted. By addressing these critical factors, healthcare providers can ensure safe and effective perioperative care for opioid-tolerant patients.

Improving Enhanced Recovery after Surgery (ERAS): The Effect of a Patient-Centred Mobile Application and an Activity Tracker on Patient Engagement in Colorectal Surgery.

The Enhanced Recovery After Surgery (ERAS) protocol improved perioperative colorectal care. Although the protocol is firmly implemented across hospital settings, there are benefits to gain by actively involving patients in their recovery. The main objective of this study was to investigate whether compliance with selected items in the ERAS protocol could further improve by using a patient-centred mobile application. This multicentre, randomised controlled trial was conducted between October 2019 and September 2022. Patients aged 18 years or older who underwent elective colorectal surgery, and in possession of a smartphone were included. The intervention group used a mobile application combined with an activity tracker to be guided and supported through the ERAS pathway. The control group received standard care and wore an activity tracker to monitor their daily activities. The primary outcome was overall compliance with selected active elements of the ERAS protocol. In total, 140 participants were randomised to either the intervention (n = 72) or control group (n = 68). The use of the ERAS App demonstrated a significant improvement in overall compliance by 10%, particularly in early solid food intake by 42% and early mobilization by 27%. Postoperative or patient reported outcomes did not differ between groups. The smartphone application 'ERAS App' is able to improve adherence to the active elements of the ERAS protocol for colorectal surgery. This is an important step towards optimizing perioperative care for colorectal surgery patients and enabling patients to optimize being in control of their own recovery. Trial registration: ERAS APPtimize, NTR7314 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON29410).

Clinical impact of multidisciplinary team management on postoperative short-term outcomes in colorectral cancer surgery.

The multidisciplinary team (MDT) approach has become the standard for perioperative patient care. At our institution, a multidisciplinary perioperative care team called "Surgical, Nutrition and Rehabilitation Integrated Services for Excellence Team (SUNRISE)" was established for all patients with gastrointestinal cancer undergoing surgery. This study aimed to elucidate the significance of SUNRISE as a perioperative MDT by comparing short-term postoperative outcomes before and after the introduction of SUNRISE in patients with colorectal cancer. We included 181 patients diagnosed with colorectal who underwent radical surgical resection with regional lymphadenectomy. The patients were divided into two groups: the pre-SUNRISE group, consisting of 105 patients who underwent radical colorectal surgery before the introduction of the SUNRISE, and the SUNRISE group, consisting of 76 patients who underwent radical colorectal surgery after the introduction of the SUNRISE. We compared the short-term postoperative outcomes between these two groups and analyzed the risk factors affecting postoperative complications using logistic regression models. The incidence of postoperative complications in the SUNRISE group was significantly lower than that in the pre-SUNRISE group (22.4% vs. 41.0%, p = 0.011). Multivariate analysis identified the presence of SUNRISE (odds ratio, 0.33, 95% confidence interval, 0.15-0.73, p < 0.006) as an independent risk factor for postoperative complications. The median postoperative hospital stay in the SUNRISE group was significantly shorter than that in the pre-SUNRISE group (9 vs. 11days, p < 0.01). The MDT approach is useful for optimizing preoperative patient care and improving short-term postoperative outcomes in patients with colorectal cancer.

Use of Transverse Abdominis block for Post Operative pain management in Patients undergoing Emergency Cesarean Sections : a prospective study

INTRODUCTION Postoperative pain management is an essential aspect of perioperative care for patients undergoing emergency Cesarean sections. Adequate pain control not only improves patient comfort and satisfaction but also facilitates early mobilization, reduces the risk of complications, and shortens hospital stays. Transverse abdominis plane (TAP) block is a well-established technique for providing analgesia to the anterior abdominal wall, which can significantly reduce postoperative pain. In recent years, ultrasound guidance has been increasingly used to improve the accuracy and safety of TAP block. This research article aims to review the use of ultrasound-guided TAP block for postoperative analgesia in patients undergoing emergency Cesarean Sections. Methodology : A total of 60 patients who underwent Emergency Cesarean Sections were included in the study. All received bilateral US-guided TAP blocks with either ropivacaine 0.5% 20 ml on each side i. e. 40 ml total or saline. All participants received a spinal anaesthetic with bupivacaine, followed by postoperative acetaminophen, non-steroidal anti-inflammatory drugs, and patient-controlled i.v. tramadol . Each patient was assessed 24 h after delivery for PCA Tramadol usage, average pain score, nausea, vomiting, itch and duration of hospital stay. Results and Conclusion Out of the total 60 patients , 30 were in the study group and 30 in placebo group. Total PCA Tramadol use in 24 h was reduced in the study group compared with the placebo group ( P&lt;0.05). The active group reported improved satisfaction with their pain relief measured by visual analogue scale as compared with the placebo group ( P=0.008). There were no local complications attributable to the TAP block. Transverse abdominis plane block was effective in providing analgesia with a substantial reduction in tramadol use during 24h after cesarean section when used as adjunctive to standard analgesia.

Perioperative nutrition in older patients: what are the priorities?

This review aimed to synthesize recent literature on perioperative nutritional interventions for older patients. This review underscores the role of comprehensive preoperative optimization, strategic use of nutritional supplements focusing on calorie, protein, and fluid intake, and active involvement of health consumers in co-designing solutions. Tools like the Geriatric Nutritional Risk Index offer a prediction value for nutrition-related complications in preoperative patients, guiding management strategies. Oral nutritional supplements, particularly those rich in protein and carbohydrates, prevent weight loss and improve functional outcomes postsurgery. However, patient satisfaction with these interventions is inconsistent and often unmeasured. Evidence suggests that prolonged fluid deprivation is harmful and preoperative hydration protocols reduce surgical stress and improve recovery outcomes. Yet, the benefit of preoperative hydration remains under-researched. Multimodal interventions for frail older adults are increasingly considered more effective than single-aspect interventions, which involve combining prehabilitation programs targeting malnutrition with smoking cessation and stabilization of preexisting conditions. Comprehensive preoperative nutritional assessment, evidence-based interventions, and health consumer involvement are crucial for improving perioperative care for elderly patients. Implementing multimodal interventions, including nutritional support and proper hydration, can enhance recovery, reduce complications, and improve the quality of life for older surgical patients.

Perioperative care of a patient with immune thrombocytopenia purpura undergoing tubo-ovarian abscess incision and drainage: Case report.

Tubo-ovarian abscess (TOA) is a serious health hazard for women, causing severe sepsis. Antimicrobial treatment is effective, but one-third of patients experience unfavorable outcomes. ITP, an autoimmune condition, can lead to bruising and bleeding. Diagnosing TOA in women of childbearing age is crucial, and combining emergency surgery with ITP patients can increase treatment costs and reduce quality of life. ITP can lead to severe complications, including postoperative hemorrhage, and may require platelet transfusions, glucocorticosteroids, and immunoglobulin. These treatments increase costs, decrease quality of life, and impact prognosis. Preventing ITP is crucial. Patients should be administered blood products based on platelet count and anemia or spontaneous bleeding tendencies. Perioperative blood management should aim for a target platelet level of 30 × 109/L and a hemoglobin concentration of 80 g/L before surgery. Post-surgery, perioperative care is crucial and vigilant for secondary bleeding. A tubo-ovarian abscess (TOA) is a frequently encountered inflammatory mass in therapeutic settings. TOA is a serious consequence of pelvic inflammatory disease (PID) that can lead to severe sepsis. In recent years, the incidence of TOA has increased, presenting a significant health hazard for women. To effectively target the diverse range of bacteria responsible for TOA, it is essential to use antimicrobial medicines that have a wide spectrum of activity. Nevertheless, the efficacy of antibiotic treatment stands at approximately 70%, while a significant proportion of patients, around one-third, experience unfavorable clinical outcomes necessitating drainage or surgical intervention. Immune thrombocytopenia (ITP) is an autoimmune condition characterized by a marked decrease in the quantity of platelets present in the bloodstream. ITP is characterized by thrombocytopenia, which leads to a heightened susceptibility to bruising and bleeding. The diagnosis of ITP and the prediction of treatment response continue to pose important and persistent issues in the field of hematology. The platelet count is commonly employed as a surrogate indicator of disease severity in patients with ITP and thus plays a crucial role in determining the necessity of treatment. A 25-year-old woman with a history of sexual activity underwent open abdominal exploration due to the sudden onset of lower abdominal pain. During the operation, a left TOA was discovered, and an incision and drainage were performed. Symptomatic treatments, such as anti-infectives and abdominal drainage, were administered. The culture of pus in the abdominal cavity suggested the presence of Escherichia coli. However, the patient presented with ITP and had a platelet count of less than 50 × 109/L before the operation. After the operation, the patient developed incisional and pelvic hematomas with signs of infection. As a result, the patient was discharged from the hospital after undergoing another laparotomy and receiving platelet transfusions and immunotherapy. Clinicians should be vigilant when diagnosing TOA in women of childbearing age, even in the absence of high-risk factors. A timely antibiotic or surgical intervention is necessary to preserve fertility and ensure quality of life. Combining emergency surgery with ITP patients poses a significant challenge for clinicians in terms of treatment. ITP can lead to serious complications, such as postoperative bleeding, which may require platelet transfusions, glucocorticoids, and immunoglobulin. This can increase the cost of treatment, reduce the quality of life, and seriously affect the prognosis. Therefore, preventing ITP is crucial. It is important to pay attention to the perioperative care of patients after surgery and be alert to the possibility of secondary hemorrhage.

Successful use of ultrasound guided pecto-intercostal fascial plane block to provide intraoperative analgesia in four dogs undergoing median sternotomy.

To evaluate the impact of pecto-intercostal fascial plane block on providing intraoperative analgesia in dogs undergoing median sternotomy. 4 dogs. The dogs were presented with a history of inappetence, lethargy and respiratory distress. Thoracic radiographs, point of care ultrasound, thoracocentesis, bronchoscopy and computed tomography was performed to characterize the disease. 4 male castrated, 5.3 ± 3 years old dogs weighing 19.7 ± 13.5 kg and belonging to Dalmatian, Beagle, Siberian Husky and Rottweiler breeds were included. Three dogs were diagnosed with suppurative pleural effusions because of pulmonary abscesses and one dog with spontaneous pneumothorax due to the presence of pulmonary bullae. All dogs underwent median sternotomy under general anesthesia to explore the thorax. A pecto-intercostal fascial plane block was performed by injecting local anesthetic bupivacaine in the parasternal fascial plane between the deep pectoral and external intercostal muscles to provide antinociception by anesthetizing ventral cutaneous branches of intercostal nerves second through sixth. Analgesia from the block resulted in reduced requirement of inhalant anesthesia and minimal requirement for opioid to augment analgesia intraoperatively. Median sternotomy is required to perform thoracic surgery in dogs with various thoracic pathologies. Pecto-intercostal fascial plane block is a locoregional technique that can blunt nociception arising from the ventral thorax and can significantly improve perioperative patient care in dogs undergoing median sternotomy by providing effective intraoperative and potentially postoperative analgesia.

A Framework for Bariatric Surgery Patient Care: Patient and Professional Perceptions

Abstract Introduction A multidisciplinary health team for perioperative care of the bariatric patient, sustained in a viable framework to support a long-term follow-up service, may decrease rates of complications, help the recognition of the complexity of this chronic disease, and provide a comprehensive bariatric surgery process analysis. This study aimed to analyze patients’ and professionals’ experiences with the perioperative care process and identify their perceptions of the bariatric surgery process to support the long-term management of obesity surgical treatment. Methods This qualitative study was conducted in a bariatric surgery center in south Portugal. Seven health professionals participated in one focus group, and sixteen patients participated in one of the three focus groups. Patients’ focus group script had eleven open main questions with follow-up questions to probe for more information, addressing motivations, experiences with the pre-surgery and post-surgery process, and perceptions of lifestyle changes. Results Participants reported the need for a reference professional in the hospital to contact, the importance of psychological support to help patients deal with the ‘ups and downs’ of post-surgery life, and the financial support for physical activity programs. Conclusions This research helped identify a need for a framework for long-term follow-up and showed priorities to tailor health services for managing bariatric surgery patients. New bariatric surgery programs should incorporate a diverse health team, focusing on patient support in the long-term follow-up. This team should be led by a dedicated case manager and include physical activity specialists. Key messages • The positive effects of bariatric surgery go beyond weight loss, reinforcing the importance of developing a new conceptual framework based on a patient-centered care model. • A case manager specialist on the bariatric surgery process may be the key to improving the long-term benefits of bariatric surgery.

Impact of fast-track surgery on perioperative care in patients undergoing hepatobiliary surgery.

Fast-track surgery (FTS) is a modern nursing approach that has gained popularity in the perioperative phase of surgery. To investigate the impact of FTS on perioperative care for hepatobiliary surgery. A retrospective analysis was performed on 98 patients who underwent hepatobiliary surgery and were admitted to our hospital from August 2021 to October 2023. They were divided into an observation group and a control group with 49 patients in each group according to different nursing directions. The control group was treated with standard nursing and the observation group was treated with FTS concept nursing. The length of hospital stay, visual analog scale (VAS) score, wound complications, nursing satisfaction, self-rating scale (SAS) score, and SF-36 quality of life (QoL) score were compared between the two groups before and after care. The duration of hospitalization, hospitalization cost, operation time, first implantation time, exhaust time, and first defecation time were shorter than the observation group (P < 0.05). Additionally, the observation group showed a significant difference between the VAS and SAS scores on days 1, 3, and 7 (P < 0.05). The complication rate in the observation group was 4.05% was significantly lower than the 18.36% in the control group, and the comparison groups were statistically significant (χ 2 = 5.018, P = 0.025). The observation group had a significantly higher level of nurse satisfaction (94.92%) than the control group (79.59%; χ 2 = 6.078, P = 0.014). Both groups showed higher QoL scores after nursing care, with higher scores in the observation group than in the control group (P = 0.032). FTS in patients undergoing hepatobiliary surgery can effectively improve negative mood, QoL, and nursing satisfaction; reduce wound complications; and accelerate patient rehabilitation.