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A series of short articles on key topics in perioperative medicine, published in the British Journal of Hospital Medicine

POM in a Nutshell

8

Assessing volume status and fluid responsiveness in critical care

Miss Ana-Catarina Pinho-Gomes ST2, Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester M23 9LT

01 Oct 2018

Although insufficient and excessive resuscitation are both associated with worse clinical outcomes, most decisions regarding fluid therapy are still made empirically.

The quintessential questions in fluid resuscitation are what the current state of the patient’s intravascular volume is and whether the patient’s physiological variables will improve if he/she receives continued fluid resuscitation or a fluid bolus?

7

Smoking and surgery

Dr Tom Blincoe BM(Hons), Royal Bournemouth Hospital & Dr Duncan Chambler MbChB FRCA FFICM, Dorset County Hospital

08 Mar 2018

Introduction
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.

6

Postoperative cognitive dysfunction

Dr C Sathananthan Consultant Anaesthetist, Department of Anaesthetics, Guys and St. Thomas’ Hospital London NHS Foundation Trust

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).

5

Cardiopulmonary Exercise Testing

Dr Catrin Williams ST7 Anaesthetics, Department of Anaesthetics, Morriston Hospital, Swansea SA6 6NL

08 April 2018

Cardiopulmonary exercise testing is a non-invasive test providing objective information about the cardiovascular, pulmonary and muscle function under physiological stress and the ability to deliver oxygen to peripheral tissues (Wasserman et al, 2004). Increasingly cardiopulmonary exercise testing is being used for preoperative risk assessment and to enable shared decision-making conversations with patients (Huddart et al, 2013).

4

The Perioperative Quality Improvement Programme: improving outcomes

Dr D Gilhooly & Dr SR Moonesinghe, Royal College of Anaesthetists, London

12 Feb 2018

Introduction
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.

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