ABSTRACT
Perioperative medicine is a rapidly growing multidisciplinary field with significant advances published each year. In this review, we highlight important perioperative publications in 2022. A multi-database literature search from January to December of 2022 was undertaken. Original research articles, systematic reviews, meta-analyses, and guidelines were included. Abstracts, case reports, letters, protocols, pediatric and obstetric articles, and cardiac surgery literature were excluded. Two authors reviewed each reference using the Distiller SR systematic review software (Evidence Partners Inc., Ottawa, Ont, Canada). A modified Delphi technique was used to identify 8 practice-changing articles. We identified another 10 articles for tabular summaries. We highlight why these articles have the potential to change clinical perioperative practice and areas where more information is needed.
Subject(s)
Cardiac Surgical Procedures , Perioperative Medicine , Pregnancy , Female , Humans , Child , CanadaABSTRACT
Recent literature published in a variety of multidisciplinary journals has significantly influenced perioperative patient care. Distilling and synthesizing the clinically important literature can be challenging. This review summarizes practice-changing articles in perioperative medicine from the years 2020 and 2021. Embase, Ovid, and EBM reviews databases were queried from January 2020 to December 2021. Inclusion criteria were original research, systematic review, meta-analysis, and important guidelines. Exclusion criteria were conference abstracts, case reports, letters, protocols, pediatric and obstetric articles, and cardiac surgery literature. Two authors reviewed each reference using the Distiller SR systematic review software (Evidence Partners Inc., Ottawa, Ont., Canada). A modified Delphi technique was used to identify 9 practice-changing articles. We identified another 13 articles for tabular summaries, as they were relevant to an internist's perioperative evaluation of a patient. Articles were selected to highlight the clinical implications of new evidence in each field. We have also pointed out limitations of each study and clinical populations where they are not applicable.
Subject(s)
Cardiac Surgical Procedures , Perioperative Medicine , Child , Female , Humans , Pregnancy , Canada , Perioperative CareABSTRACT
The medical complexity of surgical patients is increasing and medical specialties are frequently asked to assist with the perioperative management surgical patients. Effective pre-anesthetic medical evaluations are a valuable tool in providing high-value, patient-centered surgical care and should systematically address risk assessment and identify areas for risk modification. This review outlines a structured approach to the pre-anesthetic medical evaluation, focusing on the asymptomatic patient. It discusses the evidence supporting the use of perioperative risk calculation tools and focused preoperative testing. We also introduce important key topics that will be explored in greater detail in upcoming reviews in this series.
Subject(s)
Preoperative Care , Surgical Procedures, Operative , Anesthesia/adverse effects , Anesthesia/methods , Humans , Preoperative Care/methods , Risk Assessment , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/methodsABSTRACT
This summary reviews 18 key articles published in 2016 which have significant practice implications for the perioperative medical care of surgical patients. Due to the multi-disciplinary nature of the practice of perioperative medicine, important new evidence is published in journals representing a variety of medical and surgical specialties. Keeping current with the evidence that drives best practice in perioperative medicine is therefore challenging. We set out to identify, critically review, and summarize key evidence which has the most potential for practice change. We integrated the new evidence into the existing body of medical knowledge and identified practical implications for real world patient care. The articles address issues related to anticoagulation, transfusion threshold, immunosuppressive medications, postoperative delirium, myocardial injury after noncardiac surgery, postoperative pain management, perioperative management of antihypertensives, perioperative fasting, and perioperative diabetic control.
Subject(s)
Amines/standards , Anticoagulants/standards , Cyclohexanecarboxylic Acids/standards , Cyclooxygenase 2 Inhibitors/standards , Evidence-Based Practice , Haloperidol/standards , Perioperative Care/standards , Postoperative Complications/prevention & control , Tumor Necrosis Factor-alpha/standards , gamma-Aminobutyric Acid/standards , Amines/administration & dosage , Analgesics/administration & dosage , Analgesics/standards , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , Antipsychotic Agents/standards , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/drug therapy , Blood Transfusion/standards , Cyclohexanecarboxylic Acids/administration & dosage , Cyclooxygenase 2 Inhibitors/administration & dosage , Delirium/etiology , Delirium/prevention & control , Disease Progression , Gabapentin , Haloperidol/administration & dosage , Haloperidol/adverse effects , Hemorrhage/chemically induced , Humans , Pain, Postoperative/prevention & control , Perioperative Care/trends , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Practice Guidelines as Topic , Risk Assessment , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & control , Thromboembolism/prevention & control , Tumor Necrosis Factor-alpha/administration & dosage , Tumor Necrosis Factor-alpha/adverse effects , Tumor Necrosis Factor-alpha/antagonists & inhibitors , gamma-Aminobutyric Acid/administration & dosageABSTRACT
Evidence in perioperative medicine is published in a wide variety of journals, given the multidisciplinary nature of its practice which spans medicine and its subspecialties, as well as surgery and anesthesiology. It can be difficult to identify new and important evidence, as perioperative practice continues to evolve in multiple areas such as medication management, anticoagulation and cardiac risk stratification, among others. New, high-quality evidence is published each year, and must be placed into the context of not only existing literature, but also practical real-world patient care. We sought to systematically identify, critically evaluate and concisely summarize the practice implications of 10 articles published in 2015 for the practicing perioperative clinician.