Effectiveness of an ERAS-based exercise-nutrition management model in enhancing postoperative recovery for thoracoscopic radical resection of lung cancer: A randomized controlled trial.

BACKGROUND: To analyze the effect of an exercise-nutrition management model based on the Enhanced Recovery After Surgery (ERAS) concept on patients undergoing thoracoscopic radical surgery for lung cancer. METHODS: From June 2019 to December 2022, 85 lung cancer patients who underwent thoracoscopic radical lung cancer surgery were randomly divided into 2 groups. The control group, consisting of 42 patients, received routine nursing care during the perioperative period. The study group, comprising 43 patients, implemented an exercise-nutrition management model based on the ERAS concept during the perioperative period. We compared general data, perioperative indicators, compliance, and complications between the 2 groups. Additionally, we assessed the nutritional status using the patient-generated subjective global assessment (PG-SGA), albumin (ALB), prealbumin (PA), and hemoglobin (Hb), as well as lung function, including forced expiratory volume in the first second (FEV1) and maximum voluntary ventilation (MVV), in the patient population following the Piper intervention. RESULTS: In the study group, the times to first defecation and getting out of bed, the duration of thoracic drainage tube indwelling, and the length of hospital stay were shorter than those in the control group. The VAS scores on the 2nd and 3rd postoperative days were lower in the study group than in the control group (P < .05). Medication compliance was higher in the study group compared to the control group (P < .05). Post-intervention, the PG-SGA scores in the study group were lower, while PA, ALB, and Hb levels were higher than those in the control group (P < .05). The MVV, FEV1, and FVC values were higher in the study group than in the control group after the intervention (P < .05). The PFS and mMRC scores were lower in the study group compared to the control group after the intervention, and the QLQ-C30 scores were higher (P < .05). The incidence of complications was 6.98% in the study group, which was not significantly different from 11.90% in the control group (P > .05). CONCLUSION: The exercise-nutrition management model, based on the ERAS concept, exhibits significant perioperative effects in patients undergoing thoracoscopic radical resection of lung cancer, improving their nutritional status and reducing complications.

Use of herbal medication in the perioperative period: Potential adverse drug interactions.

Use of herbal medications and supplements has experienced immense growth over the last two decades, with retail sales in the USA exceeding $13 billion in 2021. Since the Dietary Supplement Health and Education Act (DSHEA) of 1994 reduced FDA oversight, these products have become less regulated. Data from 2012 shows 18% of U.S. adults used non-vitamin, non-mineral natural products. Prevalence varies regionally, with higher use in Western states. Among preoperative patients, the most commonly used herbal medications included garlic, ginseng, ginkgo, St. John's wort, and echinacea. However, 50-70% of surgical patients fail to disclose their use of herbal medications to their physicians, and most fail to discontinue them preoperatively. Since herbal medications can interact with anesthetic medications administered during surgery, the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) recommend stopping herbal medications 1-2 weeks before elective surgical procedures. Potential adverse drug effects related to preoperative use of herbal medications involve the coagulation system (e.g., increasing the risk of perioperative bleeding), the cardiovascular system (e.g., arrhythmias, hypotension, hypertension), the central nervous system (e.g., sedation, confusion, seizures), pulmonary (e.g., coughing, bronchospasm), renal (e.g., diuresis) and endocrine-metabolic (e.g., hepatic dysfunction, altered metabolism of anesthetic drugs). During the preoperative evaluation, anesthesiologists should inquire about the use of herbal medications to anticipate potential adverse drug interactions during the perioperative period.

Utilização da música na gestão da ansiedade perioperatória: Perceção de enfermeiros de cirurgia de ambulatório / Using music to manage perioperative anxiety: Perceptions of ambulatory surgery nurses

O presente Relatório de Estágio é constituído por duas componentes: uma referente ao estágio de natureza profissional e outra, de natureza investigativa, subordinada ao tema da perceção de enfermeiros de cirurgia de ambulatório sobre a utilização da música na gestão da ansiedade perioperatória. A seleção deste tema prendeu-se com a necessidade de se identificarem estratégias inovadoras para garantir intervenções diferenciadas dos enfermeiros, direcionadas ao bem-estar físico e psicológico da pessoa alvo dos cuidados, na medida em que muitas das pessoas que são submetidas a procedimentos cirúrgicos, e que necessitam de hospitalização, experienciam elevados níveis de ansiedade no percurso perioperatório. Assim, a utilização de música tem sido identificada na literatura como uma das opções que proporcionam distração e redução da ansiedade em diversos contextos de prestação de cuidados, incluindo no período perioperatório. O estágio de natureza profissional decorreu no serviço de Cirurgia de Ambulatório do Centro Hospitalar e Universitário de Coimbra, onde foram adquiridas e desenvolvidas competências comuns do enfermeiro especialista e competências específicas do enfermeiro especialista em enfermagem médico-cirúrgica, e que aqui temos oportunidade de relatar. Na componente de investigação foi desenvolvido um estudo descritivo de natureza interpretativa, com recurso a entrevistas individuais a enfermeiros com experiência profissional em contexto de cirurgia de ambulatório, e que teve como objetivo identificar a perceção de enfermeiros de cirurgia de ambulatório sobre a aplicabilidade e aspetos que poderão influenciar uma intervenção com música na gestão da ansiedade da pessoa em situação perioperatória. Os resultados permitiram destacar três categorias no que respeita à perceção dos enfermeiros relativamente à utilização de uma intervenção musical: i) a experiência a realizar intervenção com música; ii) a viabilidade da utilização de música em regime de cirurgia de ambulatório; e iii) os principais efeitos de uma intervenção musical. Deste modo, foi subsidiado o conhecimento sobre a aplicabilidade de uma intervenção não farmacológica, sustentada em música, nos processos de gestão da ansiedade perioperatória de pessoas submetidas a cirurgia de ambulatório, contribuindo para a melhoria da qualidade dos cuidados de enfermagem.

Application of Predictive Nursing Based on EuroSCORE in Perioperative Period of PCI.

Objective: Investigating the value of predictive care in the perioperative period of PCI is important because it directly affects patients' postoperative recovery and prognostic outcomes. To investigate the application value of predictive nursing based on the European system for cardiac operative risk evaluation (EuroSCORE) in the perioperative period of percutaneous coronary intervention (PCI). Methods: A total of 138 patients with coronary heart disease who underwent PCI in the hospital from January 2021 to December 2022 were selected as the study subjects. They were divided into the control group (from January 2021 to December 2021, n=69) and the observation group (from January 2022 to December 2022, n=69) according to the time of admission. The control group received routine nursing intervention, while the observation group received predictive nursing based on EuroSCORE. Implementation of EuroSCORE-based predictive care in the observation group includes EuroSCORE assessment, risk stratification, development of personalized care plans, clinical monitoring, medication management, rehabilitation and lifestyle advice, regular communication, and documentation and evaluation. All patients were followed up for 6 months. The situation of hospitalization, cardiac function, quality of life, and the incidence of adverse events were compared between the two groups. Results: The monitoring time, bed rest time, and total hospital stay of the observation group were shorter than those of the control group (P < .05). After the intervention, left ventricular ejection fraction (LVEF) in the observation group was higher than that in the control group, and left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were smaller than those in the control group (P < .05). After the intervention, the scores for symptoms, physical function, satisfaction, and adverse reactions in the quality of life scale of the observation group after PCI were higher than those of the control group (P < .05). The incidence of adverse events in the observation group during follow-up was lower than that in the control group (P < .05). Conclusion: Predictive nursing based on EuroSCORE can shorten patients' hospital stay undergoing PCI, improve their cardiac function and quality of life, and reduce adverse cardiovascular events. EuroSCORE-based predictive care is critical to PCI patient care and outcomes. It allows for personalized care planning, reduces the risk of complications, improves quality of life, reduces medical burden, and is expected to provide more comprehensive and personalized care and improve the quality of care and outcomes. Future research directions include optimizing the implementation of predictive care in different PCI patient groups, exploring long-term care effects, economic benefit analysis, and patient satisfaction research.

[Progress of the application research of modern acupuncture anesthesia in perioperative period of thoracic surgery].

Modern acupuncture anesthesia is the application of acupuncture-related therapies to optimize the perioperative management which is based on the combined acupuncture-medicine anesthesia technology, and building a perioperative acupuncture anesthesia accelerated rehabilitation system. Based on the thoracic surgery, this paper analyzes and summarizes the application effects of modern acupuncture anesthesia, focusing on preoperative anxiety relief and advanced analgesia； reduce the dosage of anesthetics, stable respiration and hemodynamics, anti-stress and organ protection during surgery； postoperative analgesia, prevention of nausea, vomiting and cognitive impairment, improvement of gastrointestinal function, prevention of cognitive impairment, and enhancement of immunity. It is anticipated that this review may provide a basis for the further promotion and application of modern acupuncture anesthesia in clinical practice.

Effectiveness of Enhanced Recovery After Surgery in the Perioperative Period for Patients with Ureteral Calculi.

Objective: This study aimed to investigate the effectiveness of enhanced recovery after surgery (ERAS) during the perioperative period for patients with ureteral stones. Methods: A total of 105 patients with ureteral stones who underwent holmium laser lithotripsy at our hospital between January 2020 and January 2021 were included in the study. They were randomly divided into two groups using a random number table: the research group (n = 53) received ERAS, while the control group (n = 52) received conventional care. Postoperative recovery parameters were compared between the two groups, including time to mobilization, time to void, time to rehydration, time to remove the urinary catheter, and length of hospital stay. Visual analogue scoring (VAS) scores were assessed at 12, 24, 36, and 48 hours postoperatively. The General Quality of Life Questionnaire (GQOLI-74) scores and complication rates were compared. Results: The research group exhibited significantly shorter postoperative time to mobilization, time to void, time to rehydration, time to remove the urinary catheter, and length of hospital stay compared to the control group (P < .05). VAS scores at 12, 24, 36, and 48 hours postoperatively were significantly lower in the research group than in the control group (P < .05). Furthermore, post-intervention, all GQOLI-74 scores were significantly higher in the research group than in the control group (P < .05). The complication rate in the research group was 5.66% lower than in the control group (25.00% vs. 30.66%, respectively, P < .05). Conclusions: The application of ERAS during the perioperative period for patients with ureteral stones is associated with improved postoperative recovery, reduced postoperative pain, lower complication rates, and enhanced quality of life. These findings suggest that ERAS is a valuable approach to be promoted for clinical use.

[Possibilites of application of traditional Chinese medicine - acupuncture - in the perioperative period.] / A hagyományos kínai orvoslás ­ akupunktúra ­ alkalmazásának lehetoségei a perioperatív idoszakban.

Chinese medicine is a holistic method of therapy with thousands of years of history. There are more assumptions regarding the mechanism of action, nevertheless, several studies have demonstrated its therapeutic effect. Nowadays, patients and physicians have become open to complementary medicine, but acupuncture used in the perioperative period has not yet widespread in Hungary. The aim of the article is to describe traditional Chinese medicine, primarily the effect of acupuncture and laser acupuncture on patients undergoing surgery. Relieving anxiety before surgery, alleviating pain, nausea and vomiting during and after surgery is a basic anesthesiology task, however, the drug therapy can be supplemented with any technique of acupuncture. Based on numerous studies, acupuncture effectively reduces the incidence of postoperative nausea, has an anxiolytic and analgesic effect, and also has an anti-inflammatory effect caused by surgical stress. There are rarely contraindications to its application, accurate knowledge of the rules of point selection and with proper technique acupuncture is a low-risk, pain-free procedure that can be performed by inducing a mild needling sensation. Based on all this, it can become a part of multimodal therapy. Orv Hetil. 2023; 164(30): 1187-1193.

[Progress on the researches of acupuncture preconditioning before surgery].

This paper reviews the researches on acupuncture preconditioning before surgery in recent years and explores its application value from three aspects, i.e. relieving preoperative anxiety, preventing from postoperative cognitive dysfunction, and preventing from postoperative gastrointestinal dysfunction. As a relatively safe non-drug treatment, acupuncture has the underlying advantages in participating into multidisciplinary coordination in the enhanced recovery after surgery (ERAS). By building up higher-quality medical evidences and revealing the effect mechanism of acupuncture from multi-dimenisonal aspects, it is expected that acupuncture technology can be coordinated with ERAS to optimize the clinical path in the perioperative period, and boost the development of the perioperative medicine ultimately.

Progress on the researches of acupuncture preconditioning before surgery / 中国针灸

This paper reviews the researches on acupuncture preconditioning before surgery in recent years and explores its application value from three aspects, i.e. relieving preoperative anxiety, preventing from postoperative cognitive dysfunction, and preventing from postoperative gastrointestinal dysfunction. As a relatively safe non-drug treatment, acupuncture has the underlying advantages in participating into multidisciplinary coordination in the enhanced recovery after surgery (ERAS). By building up higher-quality medical evidences and revealing the effect mechanism of acupuncture from multi-dimenisonal aspects, it is expected that acupuncture technology can be coordinated with ERAS to optimize the clinical path in the perioperative period, and boost the development of the perioperative medicine ultimately.

A triple-masked, two-center, randomized parallel clinical trial to assess the superiority of eight weeks of grape seed flour supplementation against placebo for weight loss attenuation during perioperative period in patients with cachexia associated with colorectal cancer: a study protocol.

Background: Progressive, involuntary weight and lean mass loss in cancer are linked to cachexia, a prevalent syndrome in gastrointestinal malignancies that impacts quality of life, survival and postoperative complications. Its pathophysiology is complex and believed to involve proinflammatory cytokine-mediated systemic inflammation resulting from tumor-host interaction, oxidative stress, abnormal metabolism and neuroendocrine changes. Therapeutic options for cachexia remain extremely limited, highlighting the need for clinical research targeting new interventions. Thus, this study primarily assesses the effects of grape-seed flour (GSF), rich in polyphenols and fibers, for attenuating perioperative weight loss in colorectal cancer. Methods: This is a dual-center, triple-masked, placebo-controlled, parallel-group, phase II, randomized clinical trial designed to investigate GSF supplementation in subjects with pre- or cachexia associated with colorectal cancer during the perioperative period. Eighty-two participants will receive 8g of GSF or cornstarch (control) for 8 weeks. Assessments are scheduled around surgery: pre-intervention (4 weeks prior), day before, first week after, and post-intervention (4 weeks later). The primary endpoint is the difference in body weight mean change from baseline to week 8. The secondary endpoints describe the harms from 8-week supplementation and assess its superiority to improve body composition, post-surgical complications, quality of life, anorexia, fatigue, gastrointestinal symptoms, and handgrip strength. The study will also explore its effects on gut bacteria activity and composition, systemic inflammation, and muscle metabolism. Discussion: The current trial addresses a gap within the field of cancer cachexia, specifically focusing on the potential role of a nutritional intervention during the acute treatment phase. GSF is expected to modulate inflammation and oxidative stress, both involved in muscle and intestinal dysfunction. The research findings hold substantial implications for enhancing the understanding about cachexia pathophysiology and may offer a new clinical approach to managing cachexia at a critical point in treatment, directly impacting clinical outcomes. Trial registration: The Brazilian Registry of Clinical Trials (ReBEC), RBR-5p6nv8b; UTN: U1111-1285-9594. Prospectively registered on February 07, 2023.

Manejo del paciente anticoagulado en una cirugía dental / Management of the anticoagulated patient in dental surgery / Gerenciamento do paciente anticoagulado em cirurgia odontológica

Introducción: una adecuada hemostasia es crucial para el éxito del tratamiento odontológico invasivo, ya que los problemas de sangrado pueden dar lugar a complicaciones asociadas a una importante morbimortalidad. El tratamiento odontológico de pacientes que tienden a un mayor riesgo de sangrado debido al uso de fármacos anticoagulantes plantea un desafío en la práctica diaria de los profesionales de la odontología. El conocimiento adecuado de los mecanismos subyacentes a la hemostasia y el manejo optimizado de estos pacientes son, por lo tanto, cuestiones muy importantes. Se realiza un estudio de los fármacos anticoagulantes actualmente disponibles en el mercado, evaluando los riesgos y beneficios de suspender dicho fármaco previo a un tratamiento odontológico invasivo. Además, se hace una revisión de los protocolos de manejo actuales que se utilizan en estos pacientes. Material y métodos: se realizó una búsqueda bibliográfica en las bases de datos Epistemonikos y Medline/PubMed; en el portal Timbó y en la biblioteca virtual Scielo. Abarcando todos los estudios publicados en los últimos 15 años en inglés y español. Se encontraron 30 artículos, se seleccionaron 15 en primera instancia para finalizar con 11 artículos. En dicha selección el filtro fue que los demás artículos se referían a otros anticoagulantes que no eran parte de este trabajo. Resultados: se han desarrollado múltiples protocolos de manejo, aunque en todos los casos se requiere una historia clínica completa, junto con pruebas hemostáticas complementarias para minimizar los riesgos derivados del tratamiento odontológico. Discusión: muchos autores consideran que la medicación de los pacientes indicada para el tratamiento de una enfermedad de base no debe ser alterada o suspendida a menos que así lo indique el médico prescriptor. Se ha demostrado que las medidas hemostáticas locales son suficientes para controlar los posibles problemas de sangrado derivados del tratamiento dental.

Introduction: Adequate hemostasis is crucial for the success of invasive dental treatment, since bleeding problems can lead to complications associated with significant morbidity and mortality. The dental treatment of patients who are prone to an increased risk of bleeding due to the use of anticoagulant drugs poses a challenge in the daily practice of dental professionals. Adequate knowledge of the mechanisms underlying hemostasis and optimized management of these patients are therefore very important issues. A review is made of the anticoagulant drugs currently available on the market, evaluating the risks and benefits of suspending such a drug prior to invasive dental treatment. In addition, a review is made of the current management protocols used in these patients. Material and methods: A bibliographic search was carried out in the Epistemonikos and Medline/PubMed databases; in the Timbo portal and in the Scielo virtual library. All the studies published in the last 15 years in English and Spanish were included. Thirty articles were found, 15 were selected in the first instance to end up with 11 articles. In this selection, the filter was that the other articles referred to other anticoagulants that were not part of this work. Results: multiple management protocols have been developed, although in all cases a complete clinical history is required, together with complementary hemostatic tests to minimize the risks derived from dental treatment. Discussion: many authors consider that the patient's medication indicated for the treatment of an underlying disease should not be altered or suspended unless so indicated by the prescribing physician. It has been shown that local hemostatic measures are sufficient to control possible bleeding problems derived from dental treatment.

Introdução: A hemostasia adequada é crucial para o sucesso do tratamento dentário invasivo, pois problemas de sangramento podem levar a complicações associadas a uma morbidade e mortalidade significativas. O tratamento odontológico de pacientes que são propensos a um risco maior de sangramento devido ao uso de drogas anticoagulantes representa um desafio na prática diária dos profissionais da odontologia. O conhecimento adequado dos mecanismos subjacentes à hemostasia e o gerenciamento otimizado desses pacientes são, portanto, questões muito importantes. É realizada uma revisão dos anticoagulantes atualmente disponíveis no mercado, avaliando os riscos e benefícios de descontinuar tal medicamento antes do tratamento dentário invasivo. Além disso, é feita uma revisão dos protocolos de gerenciamento atuais usados nesses pacientes. Material e métodos: Foi realizada uma pesquisa bibliográfica nas bases de dados Epistemonikos e Medline/PubMed; no portal Timbo e na biblioteca virtual Scielo. Todos os estudos publicados nos últimos 15 anos, em inglês e espanhol, foram incluídos. Trinta artigos foram encontrados, 15 foram selecionados em primeira instância para acabar com 11 artigos. Nesta seleção, o filtro foi que os outros artigos se referiam a outros anticoagulantes que não faziam parte deste trabalho. Resultados: foram desenvolvidos múltiplos protocolos de gerenciamento, embora em todos os casos seja necessário um histórico clínico completo, juntamente com testes hemostáticos complementares para minimizar os riscos derivados do tratamento odontológico. Discussão: muitos autores consideram que a medicação os pacientes indicada para o tratamento de uma doença subjacente não deve ser alterada ou descontinuada, a menos que o médico que a prescreve dê instruções nesse sentido. Medidas hemostáticas locais demonstraram ser suficientes para controlar potenciais problemas de sangramento resultantes do tratamento odontológico.

A low-dose therapy of fibrinogen supplement during perioperative period of total knee arthroplasty in an asymptomatic man with congenital dysfibrinogenemia: A case report.

RATIONALE: Congenital dysfibrinogenemia (CD) is a rare coagulation system disease that is often treated without unified management. Individualized treatment thereof presents clinicians with great challenges. PATIENT CONCERNS: A patient who was about to undergo total knee arthroplasty was found to have CD. DIAGNOSES: Coagulation screening revealed low fibrinogen, prolonged thrombin time, minor prolonged prothrombin time, and normal activated partial thromboplastin time were detected during admission, but no abnormal personal and family history findings were observed. Therefore, CD and hypofibrinogenemia were suspected. The gene sequencing confirmed the diagnosis of CD. INTERVENTIONS: The patient received plenty and low level of fibrinogen concentrate during 2 perioperative periods, respectively. OUTCOMES: Successful clinical outcomes were obtained using different treatment strategies. LESSONS: In contrast to prior case reports, this case illustrates the feasibility of low dosing of fibrinogen supplements within an asymptomatic patient in a selective operation. Changes in the level of fibrinogen and fibrin degradation product are of great importance for individualized treatment after supplementation.

Effects of Postdischarge High-Protein Oral Nutritional Supplements and Resistance Training in Malnourished Surgical Patients: A Pilot Randomized Controlled Trial.

The presence of malnutrition is increasingly becoming a postdischarge problem in surgical patients. We aimed to investigate whether oral nutritional supplements combined with resistance training could minimize skeletal muscle atrophy in surgical patients after discharge. This randomized controlled study was conducted at the Department of Surgery, National Hospital of Faroe Islands from 2018 to 2020. A total of 45 patients aged 37−74 years participated and were allocated to one of three groups: diet (DI; n = 13), exercise and diet (EX + DI; n = 16), or control (CON; n = 16). The intervention period lasted 8 weeks. The intervention groups received individual dietary counselling and a protein-rich oral nutritional supplement twice a day containing 22 g of protein/day. Patients in the EX + DI group were assigned to resistance training sessions. Patients in the CON group received standard care. The primary outcome was change in lean body mass (LBM). Secondary outcomes were change in body weight, handgrip strength, quality of life, surgery-related side effects, energy and protein intake, length of stay and one-year mortality. To estimate within-group changes, linear mixed models including group−time interactions as fixed effects and patients as random effects were fitted. Within-group change in LBM was 233, 813 and 78 g in the DI, EX + DI and CON groups, respectively, with no significant between-group difference (p > 0.05). Pain score declined more (p = 0.04) in the EX + DI group compared with the CON group. Body weight, handgrip strength, quality of life and surgery-related side effects did not differ between groups. At the end of study, mean cumulative weight change in the DI and EX + DI groups was 0.4% and 1.6%, respectively, whereas the CON group experienced a weight loss of −0.6%. No significant difference in primary outcome between groups was noted. However, our results indicate some benefits from exercise and nutrition for malnourished surgical patients.

Analysis of EBN Interventions in the Perioperative Period of Minimally Invasive Surgery for Intrahepatic and Extrahepatic Bile Duct Stones.

Context: Evidence-based nursing (EBN) is a model of care that emphasizes the formation of scientific findings, together with the development of individualized care plans that consider a patient's condition. Few studies have occurred on EBN interventions for patients with intrahepatic or extrahepatic bile duct stones who are in the perioperative period of minimally invasive surgery. Objective: The study intended to investigate the benefits of EBN interventions for patients with intrahepatic or extrahepatic bile duct stones who are in the perioperative period of minimally invasive surgery. Methods: The research team designed a prospective, randomized controlled trial. Setting: The study took place in the Department of Hepatobiliary Surgery at Wuhan No.1 Hospital in Wuhan, Hubei, China. Participants: Participants were 72 patients with intrahepatic or extrahepatic bile duct stones who had been admitted to the hospital between April 2019 and September 2021. Intervention: Participants were randomly assigned to one of two groups, an intervention group, which received an EBN intervention (n = 36), or a control group, which received conventional perioperative care (n = 36). Randomization occurred using a random number table. Outcome Measures: At baseline and postintervention, the study measured participants' early postoperative-recovery indicators, identified surgical complications, and assessed quality of life (QoL), using World Health Organization's (WHO's) Quality of Life-BREF (WHOQOL-BREF) scale, and psychological status, using the Hamilton depression (HAMD) and Hamilton anxiety (HAMA) scales. Results: In the intervention group, the mean values within 72 h after surgery for time to first gastric discharge after surgery, postoperative exhaust (P < .001); length of hospital stay (P = .0032), and pain score were significantly lower than those in the control group (P < .001). For QoL, the intervention group's score was significantly higher than that of control group in all domains (P < .05). The intervention group's depression (P < .001) and anxiety scores were significantly lower than those of the control group (P = .0001). In the intervention group, complications were all significantly lower than those in the control group (P < .05). Conclusion: For patients with intrahepatic or extrahepatic bile duct stones who are in the perioperative period for minimally invasive surgery, EBN interventions can improve their quality of life, improve their psychological statuses, reduce the occurrence of related complications, and facilitate their recovery.

Implementation of an electronic identification system in the setting of perioperative autologous cell salvage transfusion: Experience at a university hospital.

Perioperative autologous cell salvage (PACS) is one of the effective strategies in patient blood management (PBM). However, mistransfusion, in which the wrong blood is transfused to the wrong patient, of PACS units has been reported. In this study, we implemented a bar code-based electronic identification system (EIS) for blood transfusion in the setting of PACS transfusion. Between February 2009 and December 2020, a total of 12341 surgical patients (9% of whom received surgical interventions) received blood transfusion, among whom 6595 (54 %) received autologous blood transfusion alone, 2877 (23 %) both autologous and allogeneic blood transfusions, and 2869 (23 %) allogeneic blood transfusion alone. Among autologous blood conservation techniques, PACS units were transfused to 7873 patients (83 %) without a single mistransfusion. Rates of overall compliance with the electronic pre-transfusion check at the bedside for all autologous units and PACS units were 98.8 and 98.5 %, respectively. Our observations suggest that a bar code-based EIS can be successfully applied to PACS transfusion, as well as allogeneic blood transfusion in operating rooms.

Aromatherapy Plus Music Therapy Improve Pain Intensity and Anxiety Scores in Patients With Breast Cancer During Perioperative Periods: A Randomized Controlled Trial.

INTRODUCTION: To investigate the effect of perioperative aromatherapy (AT) or/plus music therapy (MT) on pain and anxiety level, and the potential mechanism in women experiencing breast cancer surgery. METHODS: A total of 160 patients with breast cancer were randomly assigned in a 1:1:1:1 ratio to receive usual care (UC), AT, MT, or combination therapy (CT) during perioperative periods. Pain intensity and anxiety scores were measured by visual analog scale. Interleukin (IL)-6 and high mobility group box 1 (HMGB-1) were measured by enzyme-linked immunosorbent assay. RESULTS: There was a significant group effect on pain, anxiety, and IL-6 and HMGB-1 levels, with the greatest improvement occurring in the CT group (P < .001). Compared with the UC group, the AT and MT groups had lower mean changes of pain intensity and IL-6 and HMGB-1 levels, and greater anxiety reduction (P < .001). However, the differences between the AT and MT groups did not reach significance (P > .05). CONCLUSION: In patients with breast cancer, perioperative CT achieves greater pain improvement and anxiety reduction and less marked increase in IL-6 and HMGB-1 levels. These results suggest that CT is an acceptable complementary and alternative medicine for breast cancer patients.

The impact of oral carbohydrate-rich supplement taken two hours before caesarean delivery on maternal and neonatal perioperative outcomes -- a randomized clinical trial.

BACKGROUND: To evaluate the impact of oral carbohydrate-rich (Ch-R) supplement taken 2 hours before an elective caesarean delivery (CD) on maternal and neonatal perioperative outcomes. METHODS: Ninety pregnant women undergoing elective CD were randomized into the Ch-R group, placebo group and fasting group equally. Participants' blood was drawn at three time points, before intervention, immediately after and 1 day after the surgery to measure maternal and neonatal biochemical indices. Meanwhile women's perioperative symptoms and signs were recorded. RESULTS: Eighty-eight pregnant women were finally included in the study. Women who had drunk Ch-R supplement had lower postoperative insulin level (ß = - 3.50, 95% CI - 5.45 to - 1.56), as well as postoperative HOMA-IR index (ß = - 0.74, 95% CI - 1.15 to - 0.34), compared with women who had fasted. Additionally, neonates of mothers who were allocated in the Ch-R group also had a higher glucose level, compared with neonates of mothers in the fasting group (ß = 0.40, CI 0.17 to 0.62). CONCLUSION: Oral Ch-R solution administered 2 hours before an elective CD may not only alleviate maternal postoperative insulin resistance, but also comfort women's preoperative thirst and hunger, compared to fasting. Additionally, it may increase neonatal glucose level as well. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000033163 . Data of Registration: 2020-5-22.

[Progress on acupuncture intervention for perioperative stress response].

To summarize the application value of acupuncture in perioperative stress response. Perioperative acupuncture can not only effectively relieve pain and stress response during operation, but also relieve psychological stress response represented by preoperative anxiety before operation, and regulate adaptive immune response after operation. Acupuncture, as a safe non-drug therapy, shows its core advantage of participating in the multidisciplinary intervention of enhance recovery after surgery (ERAS). The future studies need to explore and evaluate the role of acupuncture during perioperative period from multiple dimensions, and gradually reveal the mechanism of acupuncture while establishing the evidence-based basis for acupuncture during perioperative period.

[Application of transcutaneous electrical acupoint stimulation in perioperative period].

Transcutaneous electrical acupoint stimulation (TEAS) has the characteristics of simple operation, non-invasive, and high patient acceptability, and is widely used in clinical practice. This article summarized the effects of TEAS on analgesia, gastrointestinal tract regulation, circulation regulation, postoperative cognitive function improvement, immune function regulation, anti-inflammatory and anti-stress during the perioperative period. At the same time, this article analyzed the problems of the application of TEAS in the perioperative period, and aimed to promote its clinical application.