11Postoperative Cognitive Dysfunction
15 Nov 2017
Post-operative cognitive dysfunction (POCD) is defined as a new cognitive impairment arising after a surgical procedure. It is a recognised clinical phenomenon in patients undergoing major cardiac and non-cardiac surgery(1) and is commonly described as a short-term decline in cognitive function (especially in memory and executive functions), lasting a few days to a few weeks after major surgery(2) but may persist for several months(2) and has been implicated in long-term cognitive decline.
10Cardiopulmonary Exercise Testing
12 Oct 2017
Cardiopulmonary exercise testing (CPET) is a non-invasive technique that measures the simultaneous cardiovascular and respiratory response to exercise stress. In a cardiac exercise test, a patient with known or suspected cardiac disease runs on a treadmill whilst their electrocardiogram (ECG) is monitored for any signs of ischaemia. CPET goes one step further by attaching a mask or mouthpiece to perform analysis of the respiratory gases.
9Perioperative exercise programmes
02 Sep 2017
Hippocrates (c. 460 – c. 370 BC) was a Greek physician often referred to as the ‘Father of modern medicine’. Along with creating the Hippocratic Oath he is also credited with the quote “Walking is a man’s best medicine”. He was not the only person of this era to recognise the benefit of physical activity as the above quote from Plato the Greek philosopher demonstrates.
8The importance of pain management in perioperative outcomes
16 August 2017
Inadequate analgesia can result in an exaggerated stress-response, prolonged time to mobilisation, sleep deprivation, increased likelihood of side-effects from higher medication requirements and lower patient satisfaction (Fawcett, Mythen, & Scott, 2012). The need to effectively manage a patient’s analgesia begins at an early stage of the perioperative process and should form an integral part of the anaesthetic plan from the pre-assessment stage.
7Prehabilitation and Patient Optimisation
05 July 2017
Prehabilitation is essentially the process of enhancing a patient’s ability to cope with a particular stressor. It requires a multidisciplinary approach to the care of the surgical patient in order to modify behaviours that will impact on postoperative recovery. This is a relatively new area of interest with lots of research currently being undertaken. Previously the focus has been on rehabilitation but it is now hypothesised that more meaningful gains can be achieved if the process is commenced at the initial decision to operate.