Abstract
Patient safety, satisfaction, and surgical efficiency are all core objectives of modern perioperative care practice. This issue brings together diverse studies across this landscape, including pharmacological prophylaxis, airway management, and streamlined recovery pathways.
The desire to improve patient experience continues to drive pharmacological innovation. Abdel-Wahab and colleagues demonstrate that a 10-mg dose of oral olanzapine is significantly more effective than 5 mg or a placebo in reducing the incidence and severity of postoperative nausea and vomiting (PONV) following laparoscopic surgery. For paediatric patients, Elbardan et al found that an oral formulation of intravenous fentanyl citrate is non-inferior to midazolam for preoperative sedation and parental separation, though midazolam remains more effective for facilitating mask induction. In the realm of recovery, a systematic review by Slowgrove and colleagues suggests that sugammadex provides superior reversal of neuromuscular blockade, without any clinically significant impact on reducing the incidence of postoperative delirium or cognitive dysfunction when compared to neostigmine.
Other included studies focus on vital technological and ventilatory advancements. Chauhan and colleagues highlight the clinical utility of video laryngoscopy, which achieved a significantly higher first-attempt intubation success rate (86.8%) than conventional Macintosh blades (63.2%) during emergency rapid sequence induction. Intraoperatively, Vejendla et al establish that pressure-controlled ventilation with volume-guaranteed (PCV-VG) mode offers superior airway mechanics and more efficient CO2 removal for patients undergoing scoliosis surgery in the prone position. Finally, McClanahan and colleagues provide evidence that implementing continuous capnography in the PACU allows for the earlier detection of respiratory decline than pulse oximetry alone, thereby bolstering postoperative safety.
Improving patient pathways requires a focus on both psychological wellbeing and operational efficiency. Chilkoti and colleagues observed that assigning the same anaesthetist for sequential preoperative visits significantly reduced preoperative anxiety. Efficiency is further addressed by Malshy and colleagues, whose 5-year analysis supports the safety of same-day discharge after transurethral resection of the prostate (TURP), which was associated with a 40% reduction in emergency department representations.
Finally, catering for complex populations demands targeted vigilance. Ferros and colleagues detail the successful use of total intravenous anaesthesia (TIVA) and bilateral scalp blocks for deep brain stimulation in a patient with refractory obesity, highlighting the need for specific TCI models in this cohort. Vigilance is also required to prevent life-threatening complications; Nsair et al identify older age (>55), higher body mass index (>26), and positive preoperative urine cultures as independent predictors of septic shock following ureteroscopy.
The landscape is complemented by the example of Kouhestani and co-authors’ study, revealing that professional knowledge among theatre personnel does not always correlate with adherence to bariatric care standards, emphasising the need for structured, ongoing training.
Together, these studies aim to further advance evidence-based perioperative practice, a pursuit that continues to form the ethos of the Journal of Perioperative Practice.
