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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

10

Perioperative exercise

Dr Catrin Williams, Consultant in Anaesthesia and Perioperative Medicine, University College Hospital, London

01 Feb 2019

Discusses recent evidence for the effectiveness of perioperative exercise programmes in reducing complications.

9

Renin-angiotensin-aldosterone antagonists

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

20 Dec 2018

Discusses evidence for and against stopping renin-angiotensin-aldosterone antagonists perioperatively in cardiac and non cardiac surgery.

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).

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