Journal of clinical anesthesia
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Review Meta Analysis
Rapid cognitive assessment tools for screening of mild cognitive impairment in the preoperative setting: A systematic review and meta-analysis.
Mild cognitive impairment (MCI) is a high-risk precursor to dementia, post-operative delirium, and prolonged hospitalization. There is a need for preoperative rapid cognitive screening tools. ⋯ No rapid screening tools had been validated in the surgical population. In other populations, RCS may be a promising screening tool for MCI with stronger sensitivity and specificity than Mini-Cog, SIS, and CDT. CDT alone is ineffective for MCI detection. Further validation in the preoperative setting is required to determine the efficacy of these screening tools.
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The optimal methods of preoperative assessment and prehabilitation specific to patients with obesity undergoing non-bariatric surgery have not been described. We investigated two questions: 1) which methods of preoperative assessment in patients with obesity are associated with improved patient management, and 2) which methods of prehabilitation in patients with obesity are associated with improved patient outcomes? ⋯ There is a limited body of work addressing preoperative assessment and prehabilitation specific to surgical patients with obesity, especially when undergoing non-bariatric surgery. Preoperative polysomnography was shown to improve both the diagnosis of obstructive sleep apnoea and the prediction of postoperative complications. Half of the prehabilitation studies showed evidence of benefit. From this review, we were unable to make strong recommendations as to best practice in patients with obesity presenting for non-bariatric surgery.
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Review Meta Analysis
Perioperative ketamine for postoperative pain management in patients with preoperative opioid intake: A systematic review and meta-analysis.
Postoperative pain management in opioid users remains challenging. The perioperative administration of ketamine might lead to favourable pain outcomes in these patients. ⋯ Prospero CRD42020185497.
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The concept of patient blood management (PBM) was introduced by the World Health Organization in 2011 and is defined as a "patient-focused, evidence-based and systematic approach for optimizing the management of patients and transfusion of blood products to ensure high quality and effective patient care". Patient blood management is a multimodal approach based on three pillars: optimization of blood mass, minimization of blood loss and optimization of patient tolerance to anaemia. Antifibrinolytics play a major role in cardiac surgery, where the risk of perioperative bleeding is high and affects a majority of patients, by effectively reducing bleeding, transfusions, re-operations, as well as their associated morbidity and mortality. ⋯ Thus, the implementation of PBM programs in Europe is still challenging. In 2021, the WHO published a new document highlighting the urgent need to close the gap in PBM awareness and implementation and announced their upcoming initiative to develop specific PBM implementation guidelines. This review aims first, to summarize the role played by fibrinolysis in haemostatic disorders; second, to give an overview of the current available guidelines in Europe detailing PBM implementation in cardiac surgery; and third, to analyse the place and use of antifibrinolytics in these guidelines.