6Post Operative Cognitive Dysfunction
08 Jun 2018
Some patients emerge from surgery and anaesthesia with noted deficits in cognitive function that were not present preoperatively. This cognitive impairment – postoperative cognitive dysfunction – is a recognized clinical phenomenon in patients undergoing major cardiac and non-cardiac surgery (Rundshagen, 2014). It represents a decline in neuropsychological domains including memory, executive functioning and speed of processing (Tsai et al, 2010).
5Smoking and Surgery. Assessment of volume status and fluid responsiveness in Critical Care
08 Mar 2018
Smoking prevalence is decreasing but remains common: in 2014 17% of adults were current smokers compared to 50% in 1974 (Action on Smoking and Health, 2017). As smoking is conclusively harmful, acute care providers are advised to provide support and advice for smoking cessation (NICE, 2013). Preoperative clinics offer an opportunity to modify patient behaviour prior to surgery.
4The Perioperative Quality Improvement Programme: improving outcomes
12 Feb 2018
The Perioperative Quality Improvement Programme has been set up as a multidisciplinary initiative to look at the quality of care and outcomes of patients undergoing major surgery in the NHS. Its aim is to reduce variation while effecting an overall improvement in morbidity.
14 Dec 2017
Prehabilitation is the process of enhancing a patient's ability to cope with particular stressors. Morbidity and mortality after elective surgery remain significant despite advances in anaesthetic and surgical techniques (Levett et al, 2016). By initiating prehabilitation programmes patients may be more receptive to implementing behavioural and lifestyle changes to improve their perioperative journey.
2Enhanced recovery: pathways to better care
11 Oct 2017
Enhanced recovery after surgery comprises clinical pathways which aim to improve the quality of perioperative care and accelerate recovery. Benefits of enhanced recovery after surgery include reduced postoperative morbidity (Greco et al, 2014) and shorter length of stay, leading to reduced costs, greater throughput of patients and greater patient satisfaction. The underlying principles are reducing the surgical stress response and maintaining normal postoperative physiological functions. Strict adherence to the entire pathway produces better aggregate outcomes than implementing individual components (Gustafsson et al, 2011).