Journal of Perioperative Practice

Journal of Perioperative Practice, Ahead of Print. <br/>Patients with allergy to multiple drugs who have experienced anaphylaxis multiple times present a significant challenge in perioperative management. This report presents a 27-year-old female patient diagnosed with cholelithiasis scheduled for cholecystectomy. The patient has a history of adverse reaction to multiple drugs, including Amoxicillin/Clavulanic acid, Cefpodoxime, Levofloxacin and two additional drugs (one analgesic and the other multivitamin) each resulting in symptoms suggestive of anaphylaxis on separate occasions. However, the patient has demonstrated tolerance to Amikacin and Paracetamol on several occasions. Given the patient’s drug hypersensitivity state, the patient’s anaesthetist sought clearance for use of anaesthetic drugs and disinfectants prior to surgery. Comprehensive skin testing was conducted for the same, and all drugs tested negative. The outcomes of this testing guided the selection of anaesthesia agents, ensuring safe perioperative care. Subsequently, surgery was performed, using Succinylcholine, Propofol, Rocuronium, Atropine and Neostigmine for general anaesthesia and Chlorhexidine for disinfection, and the postoperative period was uneventful. This case highlights the significance of preoperative assessment and drug testing in patients with a history of drug allergies or anaphylaxis to multiple drugs, to prevent any perioperative complications.

Journal of Perioperative Practice, Ahead of Print. <br/>Background:A critical incident is described as any unplanned event which causes, or has the potential to cause, injury to a patient. Critical incident debriefing is a team discussion to gather facts and analyse the experience, evaluate lessons learned and provide staff with support. However, this phase is often neglected.Methods:This UK-based explorative qualitative study aims to explore perioperative practitioners’ experiences of critical incident debriefing. Data were collected from six participants through audio-recorded, semi-structured interviews. Data were analysed using a thematic analysis framework.Results:Five themes emerged detailing the advantages of critical incident debriefing, including addressing staff’s personal needs and learning lessons from incidents, and the disadvantages such as time constraints and unsupportive/uninformative debriefs leading to poor-quality debriefs.Conclusions:Implementation of a short debrief immediately post-incident to address immediate concerns, a later in-depth debrief and additional training for facilitators were recommended to improve debrief quality.

Journal of Perioperative Practice, Ahead of Print. <br/>Background:Airway management skills form the cornerstone of routine anaesthesia practice. Its role becomes more significant in emergency areas where time is of the essence. Patients presenting for emergency surgery require definitive airway management with endotracheal intubation. Rapid sequence induction with direct laryngoscopy using a Macintosh blade has been used consistently with varying success. With the advent of video laryngoscopes, their utility is being explored in emergency areas. We aimed to assess the role of a video laryngoscope (Medizintechnik, Sulz, Germany) in rapid sequence induction and intubation during emergency surgeries.Aim:We hypothesised that video laryngoscope would improve the first-attempt intubation success rate in patients undergoing emergency surgery.Methodology:In total, 76 patients presenting for emergency surgery were enrolled and randomly assigned into two groups (38 each), who were intubated with either a video laryngoscope or Macintosh blade during rapid sequence induction. This study aimed to compare and evaluate direct laryngoscopy using a Macintosh blade and a video laryngoscope during rapid sequence induction.Results:The two groups were similar in the type and indication for surgery. Airway characteristics were also compared, and there were no significant differences in all airway parameters, including mouth opening, thyromental distance, Mallampati grading and neck circumference. The first-attempt intubation success rate was significantly higher in the video laryngoscope group (p = 0.017, χ2 = 5.684). The Cormack–Lehane grade distribution was compared in both groups, with better glottis visualisation in group video laryngoscope (p = 0.028, χ2 = 9.123).Conclusion:This prospective, randomised, controlled study aimed to compare the first-attempt intubation success rate using direct laryngoscopy with a Macintosh blade and a video laryngoscope during rapid sequence induction in patients undergoing emergency surgeries and observed that first-attempt intubation success rate was significantly higher in group video laryngoscope (86.8%) than in group direct laryngoscopy (63.2%). Therefore, video laryngoscopy offers an attractive alternative to conventional laryngoscopy while securing the airway in patients presenting for emergency surgery.

Journal of Perioperative Practice, Ahead of Print. <br/>Preoperative checklists have demonstrated efficacy in improving patient care in the surgical setting. While the assessment of perioperative risks through patient inquiry is extensive, the menstrual status of the patient is one question that is not frequently discussed. If a patient is menstruating during their surgical procedure, unknown use of an intravaginal menstrual hygiene product, such as a tampon or menstrual cup, places the patient at risk of infection. This review seeks to bring attention to these risks by exploring Boyer v. Morimoto, a case where a patient developed toxic shock syndrome after a tampon was left in after surgery. We conclude with recommendations for standardised documentation of intravaginal menstrual hygiene products, with the aim to minimise perioperative risks.

Journal of Perioperative Practice, Ahead of Print. <br/>Background:Reusable surgical textiles have substantial environmental benefits over single-use, disposable items. However, staff satisfaction with the performance of reusable textiles is unclear. During a trial period using reusable drapes, staff were surveyed regarding satisfaction with the products.Results:A total of 30 staff members responded to the survey. Overall, 90% of respondents were either satisfied/very satisfied (80%) or neutral (10%) when asked about their satisfaction with the reusable drapes, while 10% were unsatisfied/very unsatisfied; 87% of staff responded that reusable drapes were either as effective or more effective than disposable drapes. Reusable drapes showed very high levels of staff satisfaction in terms of durability (87%), fluid protection (70%) and provision of a sterile field (80%). There were no staff who did not support the ongoing use of reusable surgical drapes.Conclusion:There is extremely high staff satisfaction with reusable surgical drapes.