Postanesthesia Care Research Articles

Adapting general anaesthesia for a patient with class III obesity and obstructive sleep apnoea undergoing day case laparoscopic cholecystectomy: A case report.

This report describes the anaesthesia provided for a class III obese patient with obstructive sleep apnoea, undergoing an elective laparoscopic cholecystectomy. Several adaptations were required to provide safe anaesthesia. A McGrath video laryngoscopy was utilised for intubation. The patient was positioned in the ramped position, thereby increasing time to desaturation on induction of anaesthesia. Pressure controlled ventilation - volume guaranteed mode was selected for ventilation to provide consistent tidal volumes. An increased level of positive end-expiratory pressure was utilised to minimise atelectasis. Drug doses were carefully considered and calculated with the aid of The Society for Obesity and Bariatric Anaesthesia dose calculator. The airway management adaptations provided an unobstructed view for intubation. Peak airway pressures during surgery remained within safe limits and no atelectasis was evident postoperatively. Pain was kept under control and desaturation was avoided during postanaesthetic care. The patient was discharged home later that evening.

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.

LARINGOESPASMO EM CRIANÇAS DURANTE PROCEDIMENTOS SOB ANESTESIA

Introduction: Laryngospasm can result in partial or complete loss of the patient’s airway. It is an anesthetic emergency caused by an exacerbated reflex that can occur with the closure of the vocal cords, accompanied by the descent of the epiglottis over the laryngeal orifice, and which is still responsible for significant morbidity and mortality in pediatric patients. It is most common in children under two years of age. The management of laryngospasm consists of its prevention, recognition, treatment and post-anesthetic care. Objective: To identify recent approaches to laryngospasm in children during anesthetic procedures in the literature. Methodology: This is a literature review, highlighting laryngospasm in children undergoing anesthetic procedures. Final considerations: Laryngospasm in children during anesthesia is a critical situation. Effective management is important with rapid and appropriate interventions to restore airway patency and ensure adequate oxygenation of the child, avoiding complications. The anesthesiologist must pay attention to the risk factors involved, and an in-depth understanding of these aspects is crucial for doctors, who, together with the surgical team, can guarantee the safety and well-being of pediatric patients during anesthetic procedures.

Validation of the Health Index in the Postoperative Period: Use of the Nursing Outcome Classification to Determine the Health Level.

The postoperative period is the recovery time after surgery and is defined as an individual process whose purpose is to return the person to the state of normality and integrity that they had prior to surgery. Demonstrate the modification of the level of health of people in the early postoperative period through the development and validation of the Health Index Instrument, which is built from the Nursing Outcomes Classification (NOC) standardized language. The design used a mixed method, which involved a first phase of instrument development and a second phase of instrument validation. The methods was based on focus group techniques with text analysis techniques, internal validation with a group of care language experts, external validation with a group of clinical nursing experts and a clinical validation with quantitative and qualitative analysis. A panel of experts in Language of Care evaluated the (NOC) labels and their correlation with the 11 Health Variables to construct the instrument. The instrument developed was subjected to external validation with a panel of clinical nurse experts in post-anesthesia care. The clinical validation included a cross-sectional descriptive study in a postoperative unit. The final sample of the cross-sectional descriptive study was 139 cases. Of the 89 NOCs proposed in the preliminary construction phase of the instrument, 36 passed through the first round. Of those 36 NOCs, 25 passed through to the second round with a review performance and 11 directly as approved. The total number of approved NOCs were 4. The results of the research show that there are changes in the global score of the health level and in each health variable. It is observed that there was a significant increase in the scores of the health variables at admission and discharge (p < 0.001). The results of the data analysis show that six groups present a similar pattern of evolution of the health variables. A correlation was found between the time of stay in the unit with the scores obtained in the health variables, the physical functioning, comfort status and the presence of symptoms being particularly significant.

Critical care nursing

Critical care nursing plays a pivotal role in the healthcare system, providing specialized care to acutely ill patients who require intensive monitoring and treatment. Within the dynamic and high-stakes environment of critical care units, nurses serve as frontline caregivers, delivering comprehensive care, advocating for patients, and coordinating interdisciplinary interventions. The field of critical care nursing encompasses a diverse range of specialties, including intensive care, emergency care, trauma care, and post-anesthesia care, among others. The unique challenges inherent in critical care nursing demand specialized skills, clinical expertise, and a deep understanding of complex physiological processes. Critical care nurses must possess a keen ability to assess and manage patients with rapidly changing conditions, often in life-threatening situations.

Bedside ultrasound in post-anaesthetic care unit for the diagnosis of post-extubation negative pressure pulmonary oedema: A paediatric case.

Post-extubation negative pressure pulmonary oedema is a rare, potentially life-threatening complication associated with general anaesthesia. Chest radiography is used as a diagnostic tool, but it implies a non-negligible radiation exposure, a very important consideration, especially for the paediatric population. However, lung ultrasound can overcome this problem and can be used to detect postoperative pulmonary complications. A 16-year-old male was scheduled for tympanoplasty. General anaesthesia was conducted, and after extubation, the patient developed a laryngospasm. On arrival at the post-anaesthetic care unit, the patient started to cough, a pink frothy sputum and hypoxemia were noticed, and auscultation revealed crepitations. A bedside lung ultrasound showed more than three B-lines per intercostal window, suggesting an alveolar-interstitial syndrome. With this case report, we would like to raise awareness to this clinical entity and demonstrate bedside ultrasound has an important role in the diagnostic and therapeutic assessment during the perioperative period.

Parametric Modeling and Deep Learning for Enhancing Pain Assessment in Postanesthesia.

The problem of reliable and widely accepted measures of pain is still open. It follows the objective of this work as pain estimation through post-surgical trauma modeling and classification, to increase the needed reliability compared to measurements only. This article proposes (i) a recursive identification method to obtain the frequency response and parameterization using fractional-order impedance models (FOIM), and (ii) deep learning with convolutional neural networks (CNN) classification algorithms using time-frequency data and spectrograms. The skin impedance measurements were conducted on 12 patients throughout the postanesthesia care in a proof-of-concept clinical trial. Recursive least-squares system identification was performed using a genetic algorithm for initializing the parametric model. The online parameter estimates were compared to the self-reported level by the Numeric Rating Scale (NRS) for analysis and validation of the results. Alternatively, the inputs to CNNs were the spectrograms extracted from the time-frequency dataset, being pre-labeled in four intensities classes of pain during offline and online training with the NRS. The tendency of nociception could be predicted by monitoring the changes in the FOIM parameters' values or by retraining online the network. Moreover, the tissue heterogeneity, assumed during nociception, could follow the NRS trends. The online predictions of retrained CNN have more specific trends to NRS than pain predicted by the offline population-trained CNN. We propose tailored online identification and deep learning for artefact corrupted environment. The results indicate estimations with the potential to avoid over-dosing due to the objectivity of the information. Models and artificial intelligence (AI) allow objective and personalized nociception-antinociception prediction in the patient safety era for the design and evaluation of closed-loop analgesia controllers.

Comparison between low-volume local anesthetic with intravenous dexamethasone and conventional volume without dexamethasone for superior trunk block after arthroscopic shoulder surgery: a randomized controlled non-inferiority trial

IntroductionThis study aimed to investigate whether low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while maintaining the analgesic duration compared with conventional volume of local...

Assessment of Risk Variables in the Post-Anesthesia Care Unit of a Tertiary Care Hospital in Dhaka

Background: In a location apart from the regular intensive care unit (ICU), the postanaesthetic care unit (PACU) provides postoperative high-dependency or intense care for high-risk surgical patients. Therefore, it meets the population's well-documented need for better postoperative care. Objectives: The aim of the study was to Assess the risk variables in the post-anesthesia care unit of a tertiary care hospital in Dhaka. Methods: This cross-sectional descriptive study was carried out in the Department of anesthesiology, Uttara Adhunik Medical College Hospital, during October 2020 to September 2021. A total of 100 patients were participate in this study. Patients underwent tonsillectomy, hysterectomy, caesarean section, and laparoscopic cholecystectomy, both male and female were included in this study. Patients who have not given consent to participate in the study were excluded from the study. Statistical Packages for Social Sciences (SPSS-26), where required. Results: About 40% patients were male and 60% were female. 80% of the patients were under ASA classification-1, 15% under ASA classification-2 and 5% were under ASA classification ≥3. Here, 22.22% patients had pre-exixting co-morbidity of respiratory, CVS neurological disease respectively. 30% had DM. Only 3.33% and more than 1 pre-exixting co-morbidity. 94.20% patients had no risk of surgery and only 5.80% patients were under risk of surgery. About 40% patients stayed 60-120 minutes in the post anesthesia care unit, 30% patients stayed 120-180 minutes in the post anesthesia care unit, 20% patients stayed 180-240 minutes in the post anesthesia care unit and 10% patients stayed ≥240 minutes in the post anesthesia care unit. 5% patients had develop complication in the post anesthesia care unit for 1-2 hours, 32% for 2-3 hours, 20% for 3-4 hours and 25% for more than 4 hours. Conclusion: The main reasons for a prolonged stay in the post-anesthesia care unit are perioperative cardiovascular and respiratory ....

Negative pressure pulmonary oedema and alveolar haemorrhage due to upper airway obstruction after parathyroidectomy

36-year old female underwent elective parathyroidectomy at a Swiss tertiary teaching hospital for primary hyperparathyroid-ism. Induction, surgery and extubation were uneventful. During transfer to the post-anaesthetic care unit, some retching was interpreted as vomiting. At arrival, she was apnoeic and unresponsive but with palpable pulse.

Associations of postoperative delirium with activities of daily living in older people after major surgery: A prospective cohort study.

To assess the association of postoperative delirium developed in the post-anaesthetic care unit (PACU) with older patients' ability to perform activities of daily living (ADL) during the first five postoperative days. Previous studies have focused on the association between postoperative delirium and long-term function decline, however the association between postoperative delirium and the ability to perform ADL, particularly in the immediate postoperative period, needs further investigation. A prospective cohort study. A total of 271 older patients who underwent elective or emergency surgery at a tertiary care hospital in Victoria, Australia, participated in the study. Data were collected between July 2021 and December 2021. Delirium was assessed using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The Katz Index of Independence in Activities of Daily Living (KATZ ADL) scale was used to measure ADL. ADL was assessed preoperatively and daily during the first five postoperative days. The STROBE checklist was used to report this study. Results showed that 44 (16.2%) patients developed new episode of delirium. Postoperative delirium was independently associated with decline in ADL (RR = 2.83, 95% CI = 2.71-2.97; p < 0.001). Postoperative delirium was associated with a decline in ADL among older people during the first five postoperative days. Screening for delirium in the PACU is essential to identify delirium during the early stages of postoperative period and implement a timely comprehensive plan. Delirium assessment of older patients in the PACU, and for at least the first five postoperative days, is strongly recommended. We also recommend engagement of patients in a focused physical and cognitive daily activity plan, particularly for older patients undergoing major surgery. Patients and nurses helped in data collection at a tertiary care hospital.

Triggers for medical emergency team activation after non-cardiac surgery.

Deterioration after major surgery is common, with many patients experiencing a medical emergency team (MET) activation. Understanding the triggers for MET calls may help design interventions to prevent deterioration. We aimed to identify triggers for MET activation in non-cardiac surgical patients. A retrospective cohort study of adult patients who experienced a postoperative MET call at a single tertiary hospital was undertaken. The trigger and timing of each MET call and patient characteristics were collected.Four hundred and one MET calls occurred after 23,258 surgical procedures, a rate of 1.7% of all non-cardiac surgical procedures, accounting for 11.7% of all MET calls over the study period. Hypotension (41.4%) was the most common trigger, followed by tachycardia (18.5%), altered conscious state (11.0%), hypoxia (10.0%), tachypnoea (5.7%), 'other' (5.7%), clinical concern (4.0%), increased work of breathing (1.5%) and bradypnoea (0.7%). Cardiac and/or respiratory arrest triggered 1.2% of MET activations. Eighty-six percent of patients had a single MET call, 10.2% had two, 1.8% had three and one patient (0.3%) had four. The median interval between post-anaesthetic care unit (PACU) discharge and MET call was 14.7 h (95% confidence interval 4.2 to 28.9 h). MET calls resulted in intensive care unit (ICU) admission in 40 patients (10%), while 82% remained on the ward, 4% had a MET call shortly after ICU discharge and returned there, 2% returned to theatre, and 2% went to a high dependency unit.Hypotension was the most common trigger for MET calls after non-cardiac surgery. Deterioration frequently occurred within 24 h of PACU discharge. Future research should focus on prevention of hypotension and tachycardia after surgery.

Comparative Evaluation of Intravenous Tramadol and Dexmedetomidine for Treatment of Shivering after Spinal Anesthesia

Background: Intraoperative shivering is a common complication in neuraxial anesthesia, with an incidence of 40%–50%. Shivering is an uncomfortable experience for the patient. It has many severe effects, such as increased oxygen consumption and carbon dioxide production, causing arterial hypoxia and myocardial ischemia. It contributes to delayed wound healing and late discharge from postanesthetic care. Our study aimed at a comparative evaluation of intravenous (IV) tramadol and dexmedetomidine to treat shivering after spinal anesthesia. Materials and Methods: The present work was a randomized, prospective, double-blinded study conducted at VIMSAR, Burla. One hundred patients of the American Society of Anesthesiologists Grades I and II (18–65 years of age), posted for various surgical procedures under spinal anesthesia who developed shivering, were included. After randomization, they were grouped into two groups (50 patients each). Injection dexmedetomidine (0.5 μg/kg) in Group D and injection tramadol (1 mg/kg) in Group T were given as a slow IV bolus. Grade and time taken for the onset of shivering were recorded after the spinal anesthesia. Time for cessation of shivering after IV bolus, recurrence of shivering, response rate, hemodynamic and side effects such as bradycardia, hypotension, nausea, sedation, and vomiting were analyzed. Results: Cessation of shivering was achieved earlier in Group D (3.04±0.94) than in Group T (6.62±1.49). The response rate was 100% in both groups. Vomiting and nausea were very high in Group T (30%). Twenty percent of patients were sedated with a sedation score of 2 in Group D only. A recurrence of shivering was observed in Group T (24%), requiring a repeat dose administration. Conclusion: Both tramadol and dexmedetomidine are effective in controlling shivering, but the time taken for cessation of shivering and adverse effects observed in the case of dexmedetomidine were lesser. Dexmedetomidine also provided complete cessation of shivering.

Perioperative temperature monitoring for patient safety: A period prevalence study of five hospitals

BackgroundMonitoring body temperature is essential for safe perioperative care. Without patient monitoring during each surgical phase, alterations in core body temperature will not be recognised, prevented, or treated. Safe use of warming interventions also depends on monitoring. Yet there has been limited evaluation of temperature monitoring practices as the primary endpoint. ObjectiveTo investigate temperature monitoring practices during all stages of perioperative care. We examined what patient characteristics are associated with the rate of temperature monitoring, along with clinical variables such as warming intervention or exposure to hypothermia. DesignAn observational period-prevalence study over seven days across five Australian hospitals. SettingsFour metropolitan, tertiary hospitals and one regional hospital. ParticipantsWe selected all adult patients (N = 1690) undergoing any surgical procedure and any mode of anaesthesia during the study period. MethodsPatient characteristics, perioperative temperature data, warming interventions and exposure to hypothermia were retrospectively collected from patient charts. We describe the frequencies and distribution of temperature data at each perioperative stage, including adherence to minimum temperature monitoring based on clinical guidelines. To examine associations with clinical variables, we also modelled the rate of temperature monitoring using each patient's count of recorded temperature measurements within their calculated time interval from anaesthetic induction to postanaesthetic care unit discharge. All analyses adjusted 95% confidence intervals (CI) for patient clustering by hospital. ResultsThere were low levels of temperature monitoring, with most temperature data clustered around admission to postanaesthetic care. Over half of patients (51.8%) had two or less temperatures recorded during perioperative care and one-third (32.7%) had no temperature data at all prior to admission to postanaesthetic care. Of all patients that received active warming intervention during surgery, over two-thirds (68.5%) had no temperature monitoring recorded. In our adjusted model, associations between clinical variables and the rate of temperature monitoring often did not reflect clinical risk or need: rates were decreased for those with greatest operative risk (American Society of Anesthesiologists Classification IV: rate ratio (RR) 0.78, 95% CI 0.68–0.89; emergency surgery: RR 0.89, 0.80–0.98), and neither warming interventions (intraoperative warming: RR 1.01, 0.93–1.10; postanaesthetic care unit warming: RR 1.02, 0.98–1.07) nor hypothermia at postanaesthetic care unit admission (RR 1.12, 0.98–1.28) were associated with monitoring rate. ConclusionsOur findings point to the need for systems-level change to enable proactive temperature monitoring over all phases of perioperative care to enhance patient safety outcomes. RegistrationNot a clinical trial.

Pre-operative administration of butorphanol mitigates emergence agitation in patients undergoing functional endoscopic sinus surgery: A randomized controlled clinical trial.

This study explored the effectiveness of pre-operative intravenous injection of butorphanol in the alleviation of emergence agitation (EA) in patients undergoing functional endoscopic sinus surgery (FESS). Patients (n = 708) were randomized into two groups. The butorphanol group (Group B, n = 358) received butorphanol infusion (20 ug/kg) before anesthesia induction, while the control group (Group C, n = 350) received an equal volume of normal saline infusion. General anesthesia was induced with sufentanil, propofol, and rocuronium, and was maintained with sevoflurane and remifentanil. Vasoactive drugs maintained the hemodynamic indices within 20% of the baseline. The incidence of EA was significantly lower in Group B than that in Group C (Group B vs. C: 24.3% vs. 31.4%, respectively; P = 0.034). The times to spontaneous breathing (26.5 min vs. 23.7 min, P = 0.011), verbal response (36.0 min vs. 33.4 min, P = 0.012), and extubation (31.0 min vs. 28.7 min, P = 0.025) were longer in Group B, and the grade of cough (0.33 vs. 0.43, P = 0.024) at extubation in Group B was lower than that in Group C (P = 0.024). The mean arterial pressure at the end of the operation (P = 0.004) and at 5 min after extubation (P = 0.008) was higher and hypotension was less prominent (0.6% vs. 2.6%, P = 0.030) in Group B. Pre-operative intravenous injection of butorphanol decreased the incidence of EA after FESS and provided smooth and hemodynamically stable emergence without extending the stay in post-anesthesia care unit. https://www.clinicaltrials.gov/, identifier NCT03398759.

Validation of Two Screening Tools for Detecting Delirium in Older Patients in the Post-Anaesthetic Care Unit: A Diagnostic Test Accuracy Study

(1) Background: Delirium is a common complication among surgical patients after major surgery, but it is often underdiagnosed in the post-anaesthetic care unit (PACU). Valid and reliable tools are required for improving diagnoses of delirium. The objective of this study was to evaluate the diagnostic test accuracy of the Three-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) and the 4A's Test (4AT) as screening tools for detection of delirium in older people in the PACU. (2) Methods: A prospective diagnostic test accuracy study was conducted in the PACU and surgical wards of a university-affiliated tertiary care hospital in Victoria, Australia. A consecutive prospective cohort of elective and emergency patients (aged 65 years or older) admitted to the PACU were recruited between July 2021 and December 2021 following a surgical procedure performed under general anaesthesia and expected to stay in the hospital for at least 24 h following surgery. The outcome measures were sensitivity, specificity positive predictive value and negative predictive value for 3D-CAM and 4AT. (3) Results: A total of 271 patients were recruited: 16.2% (44/271) had definite delirium. For a diagnosis of definite delirium, the 3D-CAM (area under curve (AUC) = 0.96) had a sensitivity of 100% (95% CI 92.0 to 100.0) in the PACU and during the first 5 days post-operatively. Specificity ranged from 93% (95% CI 87.8 to 95.2) to 91% (95% CI 85.9 to 95.2) in the PACU and during the first 5 days post-operatively. The 4AT (AUC = 0.92) had a sensitivity of 93% (95% CI 81.7 to 98.6) in the PACU and during the first 5 days post-operatively, and specificity ranged from 89% (95% CI 84.6 to 93.1) to 87% (95%CI 80.9 to 91.8) in the PACU and during the first 5 days post-operatively. (4) Conclusions: The 3D-CAM and the 4AT are sensitive and specific screening tools that can be used to detect delirium in older people in the PACU. Screening with either tool could have an important clinical impact by improving the accuracy of delirium detection in the PACU and hence preventing adverse outcomes associated with delirium.

Management of postoperative respiratory complication in a child with severe obstructive sleep apnoea syndrome during Covid-19

IntroductionCoronavirus disease (Covid-19) was first discovered in December 2019 with no signs of conceding to date. Many operations which are regarded as not lifesaving are postponed indefinitely owing to hospital bed shortage as well as to reduce the spread of infection among patients and staff. However, healthcare professionals are thrown down a huge challenge when deciding the timing of treatment for non-life-threatening conditions like severe paediatric obstructive sleep apnoea syndrome (OSAS) with a substantial impact on the development of very young children.AimTo outline management of postoperative respiratory complication in a child with severe obstructive sleep anoea syndrome during Covid-19.Case studyWe present a case of a major respiratory event requiring reintubation that developed post-adenotonsillectomy in a 3-year-old child with severe OSAS.Results and discussionThe child was given close monitoring for 6 h in the post-anaesthetic care unit (PACU) before he was transferred to the general paediatric ward, without PICU admission during his stay in the hospital.ConclusionsPostoperative monitoring at the step-down unit with a high nurse-to-patient ratio appears to be beneficial as it does not compromise the need for close postoperative observation, meanwhile saving costs.

Pain-free DrEaMing – the impact of a 7-day inpatient pain team on colorectal recovery in a postoperative care unit

Background: An ageing colorectal surgical population has resulted in an increasing emphasis on the minimisation of postoperative complications. The advent of enhanced recovery programmes1 coupled with postoperative or post-anaesthetic care units, support the delivery of multi-modal analgesia whilst prioritising mobilisation and oral intake in the postoperative period. Integral to this perioperative pathway is a dedicated inpatient pain team as safe and effective analgesia is vital to facilitate mobilisation and oral intake. Adapting enhanced recovery strategies enabled us to focus on encouraging drinking, eating, and mobilisation (DrEaM). Methods: Patients for colorectal surgery were screened for suitability for the enhanced recovery programme at the time of booking, with data shared between colorectal secretaries and the inpatient pain team when patients were identified. All eligible elective colorectal surgery patients were seen regularly by the inpatient pain team for up to 5 days postoperatively (including weekends) either on the postoperative care unit or subsequent surgical ward. Data were collected prospectively via an electronic pain team database over a 42-week period between June 2020 and May 2021. Results: There were 136 colorectal surgical patients enrolled onto the enhanced recovery programme in the 42-week period: 55% were female with 86% undergoing laparoscopic surgery. There were no patients who reported severe pain at rest throughout the postoperative period. The facilitation of good pain management ensured that all patients were drinking free fluids and 60% were eating by the first postoperative day. The analgesia regimen facilitated early mobilisation of 18.5% of patients on the day of surgery and 85.9% by the first postoperative day (Fig. 4). Conclusions: Postoperative pain remains a major factor in limiting mobilisation for the colorectal surgery patient population. The formation of enhanced recovery pathways with an integrated inpatient pain team facilitated an optimisation of analgesia, which then encourages early mobilisation and nutrition resulting in a decreased length of stay. 1.Gustafsson UO, Scott MJ, Hubner M, et al. World J Surg 2019; 43: 659

Non-Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): a pilot randomised control trial

ObjectivesPostoperative pulmonary complications (PPCs) are a common serious complication following upper abdominal surgery. Postoperatively, physiotherapy-led non-invasive ventilation (NIV) may be a promising method to reduce PPC incidence. The objectives of this pilot trial were to examine preliminary effectiveness, feasibility and safety of additional intermittent physiotherapy-led NIV compared to continuous high-flow nasal cannula oxygen therapy (HFNC) alone. DesignSingle-centre, assessor-blinded, parallel-group, pilot randomised control trial. SettingPrimary-referral hospital in Australia. Participants130 high-risk patients undergoing upper abdominal surgery. InterventionsContinuous HFNC for 48-hours following surgical extubation, or HFNC plus five 30-minute physiotherapy-led NIV sessions. OutcomesPPC incidence, trial feasibility and safety. ResultsPPC incidence was similar between groups (HFNC alone 12/65 (18%) vs HFNC plus NIV 10/64 (16%) adjusted HR 0.95; 95% CI 0.40–2.29). Delivery of HFNC as per-protocol was achieved in 81% (n = 105) of all participants. Physiotherapy-led NIV initiated within four-hours of surgical extubation was achieved in 81% (n = 52) of intervention group participants, with a mean 4.2 (SD 1.3) total number of NIV sessions delivered in the first two postoperative days. NIV was delivered as per-protocol in 52% of this cohort. Two episodes of severe hypotension during NIV requiring medical intervention were reported. ConclusionDelivery of continuous HFNC was feasible. Delivery of NIV within four-hours of extubation was achieved and delivered safely with< 1% adverse events. The planned NIV intervention of five sessions within two postoperative days was not feasible. The results of this pilot study have informed the decision not to proceed to a fully powered trial. Clinical Trial RegistrationAustralian New Zealand Clinical Trials Registry, www.anzctr.org.au ACTRN12617000269336. Contribution of the Paper•A protocol of continuous postoperative HFNC is feasible, well-tolerated and acceptable to high-risk adults following elective upper abdominal surgery.•Prophylactic physiotherapy-led NIV within the early postoperative period is feasible in some cases. Physiotherapy-led NIV can be delivered safely to high-risk adults following elective upper abdominal surgery in the post-anaesthetic care unit, ICU and surgical ward setting.•Delivery of a physiotherapy-led NIV protocol of five sessions over two postoperative days is not feasible to warrant progression to a future definitive trial.

Continuous Monitoring of Vital Signs Using Cameras: A Systematic Review.

In recent years, noncontact measurements of vital signs using cameras received a great amount of interest. However, some questions are unanswered: (i) Which vital sign is monitored using what type of camera? (ii) What is the performance and which factors affect it? (iii) Which health issues are addressed by camera-based techniques? Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, we conduct a systematic review of continuous camera-based vital sign monitoring using Scopus, PubMed, and the Association for Computing Machinery (ACM) databases. We consider articles that were published between January 2018 and April 2021 in the English language. We include five vital signs: heart rate (HR), respiratory rate (RR), blood pressure (BP), body skin temperature (BST), and oxygen saturation (SpO2). In total, we retrieve 905 articles and screened them regarding title, abstract, and full text. One hundred and four articles remained: 60, 20, 6, 2, and 1 of the articles focus on HR, RR, BP, BST, and SpO2, respectively, and 15 on multiple vital signs. HR and RR can be measured using red, green, and blue (RGB) and near-infrared (NIR) as well as far-infrared (FIR) cameras. So far, BP and SpO2 are monitored with RGB cameras only, whereas BST is derived from FIR cameras only. Under ideal conditions, the root mean squared error is around 2.60 bpm, 2.22 cpm, 6.91 mm Hg, 4.88 mm Hg, and 0.86 °C for HR, RR, systolic BP, diastolic BP, and BST, respectively. The estimated error for SpO2 is less than 1%, but it increases with movements of the subject and the camera-subject distance. Camera-based remote monitoring mainly explores intensive care, post-anaesthesia care, and sleep monitoring, but also explores special diseases such as heart failure. The monitored targets are newborn and pediatric patients, geriatric patients, athletes (e.g., exercising, cycling), and vehicle drivers. Camera-based techniques monitor HR, RR, and BST in static conditions within acceptable ranges for certain applications. The research gaps are large and heterogeneous populations, real-time scenarios, moving subjects, and accuracy of BP and SpO2 monitoring.