Journal of perioperative practice
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Advances in liver resection surgery have lead to reductions in both mortality and morbidity. However morbidity remains high so effective multidisciplinary teamwork is essential to optimise the perioperative care of this patient group. In this article we review the current literature on the perioperative management of patients undergoing liver resection surgery.
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Hip fracture is a major cause of morbidity, mortality and loss of independence for the elderly. Surgical fixation of the fractured hip remains the standard of care to allow for early mobilisation and a return to independence. ⋯ The altered physiological state of the older person, often coupled with significant comorbidity, can present challenges for the anaesthetist, the surgeon and the rest of the perioperative team. This article provides an evidence-based review of the important perioperative factors associated with hip fractures in the older person and their management.
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This article describes the development of a new service - the post-anaesthesia care unit (PACU) - that provides extended care in a recovery unit for patients who would have formerly been 'fast-tracked' through a high dependency unit (HDU). Patients requiring major surgery who stay in the recovery unit overnight are invasively monitored, have tight fluid management, blood chemistry analysis and frequently have pharmacological support. However, our overnight recovery service is not considered suitable for ventilated patients. Over 90% of patients are able to be discharged to a surgical ward within 24 hours of admission, following medical review.
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Adverse events are unintended injuries or complications that are caused by the management of a patient's care rather than by their underlying medical condition. Research into adverse events in hospitals has demonstrated that the operating theatre is one area of healthcare where there is room for improvement, with 41% of all adverse events occurring in the operating theatre, according to one systematic review (deVries et al 2008). Despite technical guidelines, there are still instances of sponges and instruments being retained within patients (Gawande et al 2003) and the factors contributing to this may include assertiveness issues and communication between perioperative and medical staff, i.e. non-technical skills.