Journal of Perioperative Practice

Journal of Perioperative Practice, Ahead of Print. <br/>Aim:This study aimed to explore Australian health professionals’ perceptions and experiences regarding built environment planning for operating rooms.Methods:We conducted semi-structured interviews and a focus group using exploratory qualitative methods, involving 16 participants: anaesthetists, surgeons, nurses, theatre technicians and designers of operating rooms.Findings:Four core concerns of participants were analysed: Engagement, Respect & Collaboration; Foreseeing & Responding to Safety Concerns; Enhancing Design Planning to Minimise Internal & External Consequences; and Ambiguous Application of Standards in Operating Room Design Planning.Conclusion:Health professionals highlighted safety impacts related to patients and staff due to the built environment and emphasised the need for improved engagement, respect and collaboration in design processes. Consideration needs to be given to the lived experiences of health professionals in design planning to address safety concerns effectively. Hierarchies and cultural factors were identified as barriers to inclusive design processes.

Journal of Perioperative Practice, Ahead of Print. <br/>Background:Considering the vasopressor drug categories and doses that can be used for elderly patients following hypotension are few, the present trial aimed to compare the effect of different doses of phenylephrine infusion on the prevention of hypotension in elderly patients undergoing orthopaedic lower extremities surgery.Methods:This randomised, double-blind prospective clinical trial was conducted by including 60 elderly patients older than 60 years and classified as American Society of Anesthesiology class I and II who were candidates for femur fracture fixation surgery. White and black cards randomly allocated patients to: group A (25µg/kg/h phenylephrine) or group B (35µg/kg/h phenylephrine).Results:At the T3-T7 time points, group A’s systolic and diastolic blood pressure was significantly higher than in group B’s (p < 0.05). However, after 27 minutes (T0-T7) of phenylephrine infusion, statistical analysis showed no significant difference between the two groups regarding blood pressure (T8-Tend). The frequency of bradycardia and reactive hypertension in group B were significantly higher than in group A (p = 0.02) and (p = 0.03), respectively. There was no significant difference between the bleeding loss, blood transfusion and crystalloid volume in both groups (p > 0.05).Conclusion:Our trial illustrated that high-dose phenylephrine infusion could not assure haemodynamic stability and may cause some side effects.

Journal of Perioperative Practice, Ahead of Print. <br/>Background:Nasotracheal intubation is challenging for anaesthesiologists in faciomaxillary injuries due to the anticipated difficult airways. The effectiveness of a non-channelled McGrath video laryngoscope was compared with a conventional Macintosh laryngoscope during nasotracheal intubation.Methods:Sixty American Society of Anaesthesiologists I–II patients aged between 18 and 60 years of both sexes undergoing elective faciomaxillary surgeries from September 2019 to February 2020 were prospectively randomised into two groups (Macintosh laryngoscope Group, McGrath video laryngoscope Group) of 30. The primary outcome was ease of intubation (Modified Intubation Difficulty Scale) and Nasotracheal intubation time (T1 time: from nostril to nasopharynx, T2 time: from nasopharynx until the first ETCO2, total time: T1 + T2). The secondary outcomes were Cormac Lehane grade, additional manoeuvres requirement, intubation failure, tracheostomy incidence and associated complications.Results:T1, T2 and total (T1 + T2) time (mean ± SD) were statistically prolonged in the McGrath video laryngoscope than Macintosh laryngoscope group, with p = 0.044, p = 0.000 and p = 0.000, respectively. The McGrath video laryngoscope facilitated a better laryngoscopic view (p = 0.002), favourable intubation difficulty scale scores, less lifting force (p = 0.002), reduced lip trauma (p = 0.002) and decreased Magill’s forceps use (p = 0.002) than the Macintosh laryngoscope group.Conclusion:Despite longer intubation time, the non-channelled McGrath video laryngoscope offered favourable intubating conditions with superior glottis view, less lifting force and reduced Magill’s forceps requirement, causing decreased airway trauma, lower intubation difficulty scale scores than Macintosh laryngoscope for nasotracheal intubation.

Journal of Perioperative Practice, Ahead of Print. <br/>Abdominal aortic aneurysm poses a significant risk of rupture, with mortality rates of 80% to 90% if untreated. Management focuses on identifying and repairing the aneurysm before rupture, considering factors like size, type and symptoms. We report successful anaesthetic management in a case of intertrochanteric fracture of femur of an elderly patient who was to undergo elective surgery for abdominal aortic aneurysm. Few cases detail abdominal aortic aneurysm management during non-cardiac surgery, emphasising careful anaesthesia titration. This case report underscores the importance of precise intraoperative anaesthesia management in emergency non-cardiac surgery for abdominal aortic aneurysm patients.

Journal of Perioperative Practice, Ahead of Print. <br/>Background:Clonidine and dexmedetomidine are alpha-2 receptor blockers administered for haemorrhage control during surgery in limited settings. Functional endoscopic sinus surgery (FESS) may be associated with bleeding, thus making it challenging. This study aims to evaluate the effect of dexmedetomidine and clonidine on haemorrhage control during FESS and surgical outcomes.Methods:This three-blinded prospective study included 102 patients who underwent FESS at the Imam Khomeini public referral hospital at the Imam Khomeini public referral hospital, in Urmia, Iran. It was either American Society of Anaesthesiologists (ASA) class I or II. They were divided into three groups (clonidine, dexmedetomidine, and placebo). The volume of blood loss, mean arterial pressure, surgical field visualisation, and surgeon satisfaction were assessed in the three groups. Data analysis was performed using SPSS version 23.0.Results:Dexmedetomidine and clonidine decreased mean arterial pressure, heart rate, and blood loss volume while improving surgical field visualisation. The effect of dexmedetomidine was associated significantly statistically with surgeon satisfaction (p < 0.0001). Furthermore, dexmedetomidine improved the surgical field and reduced operating times in the dexmedetomidine group (p < 0.0001).Conclusion:The present clinical trial findings indicated that the administration of dexmedetomidine during FESS decreased mean arterial pressure, provided balanced anaesthesia and appropriate analgesia, and improved the visibility of the surgical field and increased surgeon satisfaction.