Journal of perioperative practice
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Enhanced recovery after surgery (ERAS) is a programme that aims to improve the care of elective surgical patients. Accelerated care pathways are delivered using a multidisciplinary approach, leading to reduced lengths of hospital stay, improved quality of treatment, and better outcomes. These programmes have gained considerable popularity in orthopaedics recently, however their widespread adoption remains to be seen. This article highlights the key evidence concerning ERAS in orthopaedic surgery.
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Inflation and measurement of endotracheal (ET) tube cuff pressure is often not seen as a critical aspect of care in surgical patients. The morbidity associated by an overinflated cuff has been regularly highlighted in literature, for example mucosal ulceration (Combes et al 2001) and vocal cord paralysis (Holley & Gildea 1971). This article will outline techniques for the methods of inflation based on the latest scientific evidence. The author will seek to examine if intra-operative cuff assessment and monitoring should become routine for the anaesthetic practitioner and if current practice for inflating cuffs creates pressures outside the safe range.
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Anaesthesia awareness is a terrifying prospect for any patient undergoing a surgical procedure and can cause considerable physical and psychological distress. Recommendations to reduce the risk of anaesthesia awareness include: undertaking a thorough preoperative assessment, ensuring that equipment has been checked, reducing drug error, consistent monitoring, and investment in safer technology. By implementing these recommendations it is hoped that patient safety and care can be improved during clinical anaesthesia.
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A multi-disciplinary simulation training course devised and implemented at Morriston Hospital is described. The participants in the simulation exercise included both medical and non-medical professionals in a pilot study intended to analyse the effectiveness of a multi-disciplinary approach to this training technique. Questionnaires completed by the participants both immediately after the training session and again some months later highlight the desirability of this multi-disciplinary training. The success of the training course and the lessons learned from its implementation are being used to plan a similar second session in the near future.