British journal of anaesthesia
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This narrative review presents a biological rationale and evidence to describe how the preoperative condition of the patient contributes to postoperative morbidity. Any preoperative condition that prevents a patient from tolerating the physiological stress of surgery (e.g. poor cardiopulmonary reserve, sarcopaenia), impairs the stress response (e.g. malnutrition, frailty), and/or augments the catabolic response to stress (e.g. insulin resistance) is a risk factor for poor surgical outcomes. Prehabilitation interventions that include exercise, nutrition, and psychosocial components can be applied before surgery to strengthen physiological reserve and enhance functional capacity, which, in turn, supports recovery through attaining surgical resilience. Prehabilitation complements Enhanced Recovery After Surgery (ERAS) care to achieve optimal patient outcomes because recovery is not a passive process and it begins preoperatively.
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Unlike elective lists, full utilisation of an emergency list is undesirable, as it could prevent patient access. Conversely, a perpetually empty emergency theatre is resource wasteful. Separately, measuring delayed access to emergency surgery from time of booking the urgent case is relevant, and could reflect either deficiencies in patient preparation or be because of an occupied (over-utilised) emergency theatre. ⋯ This simple graphical analysis indicates whether more emergency capacity is necessary. We discuss potential applications in managing emergency surgery theatres.
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There is variation in care quality and outcomes for children undergoing emergency abdominal surgery, such as appedectomy. Addressing this requires paediatric-specific quality metrics. The aim of this study was to identify perioperative structure and process measures that are associated with improved outcomes for these children. ⋯ PROSPERO CRD42017055285.
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Letter Randomized Controlled Trial
A randomised trial of adaptive support ventilation in patients with neuroparalytic snake envenomation.
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Despite substantial advocacy for the scientific community to focus on sex-specific differences in biology, the role of sex hormones remains inadequately studied in the field of anaesthesia-induced developmental neurotoxicity. A recent study by Yang and colleagues published in this journal addresses the importance of studying sex hormones during critical stages of brain development. The authors demonstrate that exogenous testosterone administered to immature mice pups around the time of sevoflurane exposure increased brain levels of testosterone, attenuated tau phosphorylation, inhibited glycogen synthase kinase-3β activation and its interaction/binding with tau, reversed sevoflurane-induced decreases in neuronal activation, and attenuated cognitive impairments. Their well-designed experiments suggest an important role that testosterone plays in balancing several important pathways crucial for neuronal protection and normal function of neuronal circuits in the male mammalian brain.