Is it safe to use telephone for anaesthesia consultation in high-risk patients before non-invasive surgery? A pilot study in ophthalmology.

BACKGROUND: Although telemedicine with video support for preoperative evaluation has been found effective, there is limited research on anaesthesia consultation by phone without video support, particularly among high-risk patients. To evaluate the effectiveness, safety and potential benefits of performing pre-anaesthesia evaluation by phone before eye surgery in patients having non-invasive surgery, we performed an observational study in a French teaching hospital. METHOD: All elective patients having elective ophthalmic surgery were included to have a consultation by phone instead of an in-person consultation, regardless of the type of anaesthesia or ASA score. The incidence of day-of-surgery cancellations, patient satisfaction and time/distance saved through phone consultations were assessed. RESULTS: From February to October 2022, data of 3480 patients were analyzed, including 370 (11%) high-risk patients (ASA 3-4). Anaesthesia-related day-of-surgery cancellation rate was 0.5% (n = 20) due to non-compliance with pre-operative instructions. No cancellation was due to inadequate pre-operative evaluation. No difference in cancellation rate was observed between low-risk patients and high-risk patients. Telephone consultations saved patients a mean of 126 min and 86 km. A younger age, an active status and living far from the hospital were associated with phone consultation preference. CONCLUSION: Phone anaesthesia consultation seems to be effective and safe before ophthalmic surgery, regardless of patient's perioperative risk. In addition, phone consultation provides significant time and distance savings. Our results must be confirmed through a multicentric randomised study comparing phone and traditional consultation in ophthalmology as well as in other non-invasive surgical procedures in a high-risk patients population.

Risk Factors of Cystoid Macular Edema After Pars Plana Vitrectomy for Pseudophakic Retinal Detachment.

INTRODUCTION: This study aimed to investigate the prevalence of cystoid macular edema after pars plana vitrectomy for the treatment of pseudophakic rhegmatogenous retinal detachment and identify possible related risk factors. METHODS: A retrospective monocentric study was conducted within a cohort of pseudophakic patients undergoing vitrectomy for rhegmatogenous retinal detachment between January 2019 and December 2022. Demographic data, initial and intraoperative characteristics of rhegmatogenous retinal detachment, and postoperative data were analyzed. Cystoid macular edema was defined on optical coherence tomography exclusively. RESULTS: A total of 164 eyes of 164 patients were included for analysis. The mean age of the patients at surgery was 65.7 ± 12.0 years. The mean best-corrected visual acuity was 2.1 ± 1.0 logMAR preoperatively and 1.0 ± 0.7 logMAR postoperatively. The mean follow-up was 13.4 ± 7.7 months. The prevalence of cystoid macular edema was 17.1% [9.8-26.4]. In multivariate analysis, severe proliferative vitreoretinopathy (relative risk 3.6 [1.3-9.7]) and laser retinopexy (relative risk 8.4 [1.1-64.7]) were independently and significantly associated with cystoid macular edema. CONCLUSION: The prevalence of cystoid macular edema in pseudophakic rhegmatogenous retinal detachment after pars plana vitrectomy was 17.1%. Severe proliferative vitreoretinopathy stage and the use of endolaser retinopexy were independent risk factors for development of cystoid macular edema.

Investigating pupillometry to detect preoperative anxiety: a pilot study.

Guidelines from the European Society of Anesthesia (ESA) insist on the importance of preoperative anxiety management. However, its assessment currently relies on questionnaires that are long to submit and sometimes difficult to interpret. Exploring the balance between sympathetic and parasympathetic neural systems through the use of pupillometry is a promising path to identify anxiety and thus provides an objective and reproducible assessment tool. A single-center prospective observational study was conducted in a population of ambulatory ophthalmological surgery patients. Preoperative anxiety was assessed using the Surgical Fear Questionnaire (SFQ). Measurements were taken using an Algiscan® (IDMed) type pupillometer before, during, and after insertion of the peripheral IV catheter. A statistical correlation test was carried out between the different evaluations of anxiety and the coefficient of variation of the pupillary diameter (VCPD). A total of 71 patients were included in the study between July 2020 and February 2021, with a median SFQ score of 23 [IQR 11-34]. No significant statistical correlation was found between the baseline pupillary diameter, or VCPD, and preoperative anxiety levels. Similarly, the pupillometric variables did not differ significantly when adjusting for the level of anxiety during and after painful stimulation due to canulation. More studies are necessary to explore the potential correlation between preoperative anxiety and pupillometry.

The StarvAnx Study-Comparison Between the Effects of Non-fasting Vs. Fasting Strategy on Surgical Outcomes, Anxiety and Pain in Patients Undergoing Cataract Surgery Under Topical Anesthesia: A Randomized, Crossover, Controlled Trial.

Background: Fasting is usually recommended in patients undergoing cataract surgery under topical anesthesia. However, starving before surgery may increase preoperative anxiety and affect surgical outcomes. It is not known which fasting or non-fasting strategy is best for cataract surgery. The aim of this study was to compare non-fasting and fasting strategy in patients undergoing cataract surgery under topical anesthesia with regard to surgical outcomes, anxiety and pain. Methods: This randomized, crossover, controlled trial enrolled patients undergoing surgery for bilateral cataract under topical anesthesia at Cochin Hospital (Paris, France), from February to May 2021. Patients were randomly assigned to the non-fasting or fasting group for the first eye surgery and were switched to the other group for the second eye surgery. The primary endpoint was to compare the rate of anesthetist's interventions during surgery. The secondary endpoints included intra-operative complications, duration of surgery, surgeon perception of surgical difficulty, anesthesia-related complications and anxiety and pain level. Results: one hundred and nine consecutive patients were included, with 60 of them being fasted first and non-fasted for the second eye surgery, while the other 59 were non-fasted first and fasted for the next surgery. The number of patients requiring sedation was significantly lower in the non-fasting group compared with the fasting group [1%; 95%IC (0-3.2) vs. 6%; 95%IC (2.9-8.9), P = 0.04]. No anesthesia-related complications were observed. There was no difference in the number of intra-operative complications between the non-fasting and the fasting groups (,respectively, 0 and 1; P = 1). Anxiety level and surgical pain were significantly lower in the non-fasting group compared to the fasting group (,respectively, 2.3 ± 2.0 vs. 4.1 ± 2.4, P = 0.01 and 0.6 ± 0.6 vs. 2.6 ± 3.4, P = 0.003). The mean duration of surgery was significantly shorter in the non-fasting group compared with the fasting group (,respectively, 16.0 ± 5.9 vs. 22.3 ± 6.1 min; P = 0.03). Conclusion: In conclusion pre-operatory non-fasting strategy provides a better patient experience with regards to preoperative anxiety and surgical pain. It allows to reduce operating times and is safe and well-tolerated as regards the anesthetic intervention.

Comparison between air and gas as tamponade in 25-gauge pars plana vitrectomy for primary superior rhegmatogenous retinal detachment.

BACKGROUND/OBJECTIVES: The aim of this study was to compare surgical outcomes and postoperative characteristics, between eyes that underwent pars plana vitrectomy (PPV) for RRD, with air or different gas agents as tamponade. SUBJECTS/METHODS: The records of 262 patients that underwent PPV for RRD with air or different gas tamponades and a follow-up of at least 6 months were examined. Only cases with superior retinal breaks were included. Demographic, pre-, intra- and postoperative characteristics including rate of recurrence and complications were analysed. RESULTS: 48 patients were treated with air and 214 were treated with gas. No differences were found in success rate between air and gas group at both 3 and 6 months (respectively, 93.8% vs 93.6 and 100% vs 100%, all P values > 0.05). Postoperative best-corrected visual acuity (BCVA) was significantly higher in the air group compared with the gas group 7 days and 1 month postoperatively (respectively, 0.2 ± 0.4 vs 2.6 ± 0.5, P < 0.001 and 0.1 ± 0.4 vs 0.4±0.9, P = 0.04). The occurrence ocular hypertension at 1 month postoperatively was significantly higher in the gas group compared with the air group (15.4 % vs 0%, P < 0.001). At 6 months, the prevalence of epiretinal membrane (ERM) was significantly higher in the gas group compared with air group (4.2% vs 16.8%, P = 0.02). CONCLUSIONS: Air was comparable to gas tamponades in terms of surgical outcome and BCVA at 6 months. In addition, air allowed an earlier visual recovery and resulted in a lower rate of postoperative ocular hypertension and ERM.

Effectiveness of simulation in psychiatry for nursing students, nurses and nurse practitioners: A systematic review and meta-analysis.

AIMS: Mental disorders constitute one of the main causes of disease and disability worldwide. While nurses are often at the frontline of mental health care, they have limited access to dedicated psychiatric training opportunities. Simulation training may foster the development of the appropriate competencies required when supporting people with mental disorders. To evaluate the effectiveness of simulation training in psychiatry for nursing students, nurses and nurse practitioners. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Eight electronic databases, trial registries, key journals and reference lists of selected studies were searched from inception to August 20, 2020 without language restriction. REVIEW METHODS: We included randomized and non-randomized controlled studies and single group pre/post studies. Cochrane Risk of Bias tool 2.0 was used for randomized controlled study appraisal, and the Medical Education Research Study Quality instrument was completed for all other studies. Meta-analysis was restricted to randomized controlled studies. The other studies were synthesized narratively. The main outcomes were based on Kirkpatrick levels. RESULTS: A total of 118 studies (6738 participants) were found. Interventions included simulated patients (n = 55), role-plays (n = 40), virtual reality (n = 12), manikins (n = 9) and voice simulations (n = 9). Meta-analyses based on 11 randomized controlled studies found a significant large effect size on skills at immediate post-test for simulation compared with active control; and a small and medium effect size on learners' attitudes for simulation compared with inactive control, at immediate post-test and at three-month follow-up respectively. Three quarters of non-randomized controlled studies and pre/post-tests assessing attitudes and skills showed significant differences, and three quarters of participants in randomized controlled studies and pre/post-tests showed significant differences in behaviours. Among the few studies assessing people with mental health outcomes, almost all reported significant differences. CONCLUSION: These findings support the effectiveness of simulation training in psychiatric nursing throughout professional development grades, despite heterogeneity in methods and simulation interventions.

Efficacy of Preoperative Music Intervention on Pain and Anxiety in Patients Undergoing Cataract Surgery.

The aim of the present study was to investigate the impact of preoperative music exposure on intra- and post-operative pain during cataract surgery. This study was conducted alongside a prospective single-masked randomized controlled trial (ClinicalTrials.gov NCT02892825). Patients undergoing first eye cataract surgery were included and randomly assigned to either the intervention or control group. Patients in the intervention group had a 20-min music session through earphones before surgery, while patients in the control group wore earphones without music. Anxiety level evaluated using the visual analog scale and heart rate were collected before and after music intervention. Pain level was assessed using the Numerical Pain Rating Scale, during the surgical procedure, prior to discharge and 7 days postoperatively. A total of 243 patients were included: 119 in the intervention group and 124 in the control group. No significant differences in baseline characteristics, including age, sex and rate of treated hypertension were found between the 2 groups (all p-values > 0.05). In addition, no significantly differences were found in heart rate and anxiety level before music intervention between the 2 groups (all p-values > 0.05). Conversely, anxiety level was significantly lower in the music group after the intervention (respectively, 1.3 ± 1.1 vs 3.2 ± 2.2; p < 0.05). Patients in the music group reported a lower mean pain level during surgical procedure and before discharge compared with control group (respectively, 1.2 ± 0.5 vs 2.1 ± 1.1, p = 0.03 and 0.23 ± 0.4 vs 0.81 ± 0.7, p = 0.04). No difference was found in pain level 7 days postoperatively (0.1 ± 0.3 vs 0.2 ± 0.4, p = 0.1). A significant correlation was found between anxiety level and intraoperative pain level (R = 0.64, p = 0.02). In conclusion, music intervention was effective in reducing anxiety level and self-reported pain both during surgery and in the early postoperative period. Clinical Trial Registration: https://clinicaltrials.gov/ct2/home, identifier NCT02892825.

Improving Wellness of Operating Room Personnel: A Light-Based Intervention on Perceived Nursing-Related Stress.

Background: Nursing is an emotionally demanding and physically draining occupation. Well-being of health care workers is essential to achieve success in care and have good cooperation relationships with other health professionals. Objective: The purpose of this study was to evaluate the effectiveness of a light-based intervention on perceived nursing-related stress in health care personnel working in an operating room environment. Methods: A total of 84 nurses participated in this randomized, cross-over controlled study. Intervention consisted of 4 weeks of bright blue-enriched light exposure using a LED head-mounted portable device (n = 42) or no light exposure (n = 42) separated by a 2-week washout period in a crossover fashion. Participants completes questionnaires for the Nursing Stress Scale (NSS). Results: Intervention and control groups were comparable in terms of demographics, with a median age of 34 (IQR: 27-49) and 69 (82%) female. The mean baseline NSS score was similar in both groups before intervention. The NSS score of the intervention group was significantly lower after intervention than the baseline score: the NSS score difference before and after intervention was 15.1 (SD 7.6) (p < 0.001) and 19.7 (SD 7.5) (p < 0.001) during the two successive periods of intervention, respectively. The cross-group comparison after intervention showed a significantly higher NSS score difference after intervention in the intervention group than the control group: 15.1 (SD 7.6) vs. 1.4 (SD 8.4) (p < 0.001) and 19.7 (SD 7.5) vs. 1.7 (SD 8.9) (p < 0.001) during the two successive periods of intervention, respectively. Conclusion: Alternative person-directed initiatives should be considered to improve the well-being of the health workforce in operating rooms, especially during the coronavirus pandemic.

Efficacy of a Web App-Based Music Intervention During Cataract Surgery: A Randomized Clinical Trial.

IMPORTANCE: Hypertensive events during cataract surgery may induce complications. Information and communication technologies applied to health are popular, but clinical evidence of its usefulness is rare and limited to treating anxiety without specific analysis. Recent publications have described the potential effects of personalized music choices as mobile-based intervention on pain but not on anxiety. OBJECTIVE: To demonstrate the effects of a web app-based music intervention on the incidence of hypertension in participants during cataract surgery performed under local anesthesia. DESIGN, SETTING, AND PARTICIPANTS: This randomized, single masked, controlled clinical trial was composed of 2 arms and took place at a single center at Cochin Hospital in Paris, France. A total of 313 participants were screened between February 2017 and July 2018. Among these, 311 participants undergoing a phacoemulsification procedure for elective surgery for their first eye cataract under local anesthesia were enrolled. Analysis was intention to treat and began in September 2018 and ended November 2018. INTERVENTIONS: Participants requiring cataract surgery were assigned randomly to either the experimental arm (web app-based music listening intervention delivered via headphones) or control arm (noise-canceling headphones without music) for 20 minutes before surgery. MAIN OUTCOMES AND MEASURES: The occurrence of at least 1 hypertensive event during surgery. RESULTS: A total of 310 participants were randomized in the study (155 to each arm) and 309 were analyzed (1 participant in the music arm had already undergone cataract surgery to the other eye). The mean (SD) age of the participants was 68.9 (10.8) years, and there were 176 female individuals (57%). On the primary end point, the incidence of hypertension was significantly lower in the music arm (21 [13.6%]) than in the control arm (82 [52.9%]), with a difference between the 2 arms of 39.3% (95% CI, 21.4%-48.9%; P < .001). Regarding the secondary end points, the mean (SD) visual measure of anxiety was lower in the music arm (1.4 [2.0]) than in the control arm (3.1 [2.4]), with a difference of 1.5 (95% CI, 1.0-2.1; P = .005). The mean (SD) number of sedative drug injections required during surgery was 0.04 (0.24) vs 0.54 (0.74) in the music vs control arms, respectively, with a difference of 0.50 (95% CI, 0.43-0.57; P < .001). CONCLUSIONS AND RELEVANCE: For participants similar to those enrolled in this study, the trial suggests that a web app-based personalized music intervention before cataract surgery may be considered to lower anxiety levels and hypertension or reduce the need for sedative medication. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02892825.

Assessing Preoperative Anxiety: Nurses Versus Health Care Assistants.

PURPOSE: Our objective was to compare the difference in anxiety levels self-reported by patients and those estimated by health care assistants and nurses in two ambulatory surgery settings. DESIGN: We performed a prospective study. METHODS: Patients' preoperative anxiety was graded using a visual analog scale. FINDINGS: Between September 1 and November 31, 2019, a total of fifteen health care assistants and fourteen nurses assessed anxiety scores of 170 patients, including 92 women and 78 men. At admission, the mean visual analog scale anxiety score declared to health care assistants and nurses was 5.3 (SD = 2.9) and 4.2 (SD = 3.1), respectively (P = .02). The correlation between health care assistants' assessment of the patients' anxiety and the declared level of anxiety was significantly higher than nurses' assessment (r = 0.83 vs r = 0.12; P < .001). CONCLUSIONS: Nurse assistants estimate patients' preoperative anxiety with more accuracy than nurses in our hospital. Nursing education curriculum should continue to include addressing preoperative patient anxiety.

Choroidal and peripapillary changes in high myopic eyes with Stickler syndrome.

BACKGROUND: To compare different clinical and Spectral-Domain Optical Coherence Tomography (SD-OCT) features of high myopic eyes with Stickler syndrome (STL) with matched controls. METHODS: Patients with genetically confirmed STL with axial length ≥ 26 mm and controls matched for axial length were included. The following data were obtained from SD-OCT scans and fundus photography: choroidal and retinal thickness (respectively, CT and RT), peripapillary atrophy area (PAA), presence of posterior staphyloma (PS). RESULTS: Twenty-six eyes of 17 patients with STL and 25 eyes of 19 controls were evaluated. Compared with controls, patients with STL showed a greater CT subfoveally, at 1000 µm from the fovea at both nasal and temporal location, and at 2000 and 3000 µm from the fovea in nasal location (respectively, 188.7±72.8 vs 126.0±88.7 µm, 172.5±77.7 vs 119.3±80.6 µm, 190.1±71.9 vs 134.9±79.7 µm, 141.3±56.0 vs 98.1±68.5 µm, and 110.9±51.0 vs 67.6±50.7 µm, always P< 0.05). Furthermore, patients with STL showed a lower prevalence of PS (11.5% vs 68%, P< 0.001) and a lower PAA (2.2±2.1 vs 5.4±5.8 mm2, P=0.03), compared with controls. CONCLUSIONS: This study shows that high myopic patients with STL show a greater CT, a lower PAA and a lower prevalence of PS, compared with controls matched for axial length. These findings could be relevant for the development and progression of myopic maculopathy in patients with STL.

Simulation in psychiatry for medical doctors: A systematic review and meta-analysis.

CONTEXT: Most medical doctors are likely to work with patients experiencing mental health conditions. However, educational opportunities for medical doctors to achieve professional development in the field of psychiatry are often limited. Simulation training in psychiatry may be a useful tool to foster this development. OBJECTIVES: The purpose of this study was to assess the effectiveness of simulation training in psychiatry for medical students, postgraduate trainees and medical doctors. METHODS: For this systematic review and meta-analysis, we searched eight electronic databases and trial registries up to 31 August 2018. We manually searched key journals and the reference lists of selected studies. We included randomised and non-randomised controlled studies and single group pre- and post-test studies. Our main outcomes were based on Kirkpatrick levels. We included data only from randomised controlled trials (RCTs) using random-effects models. RESULTS: From 46 571 studies identified, we selected 163 studies and combined 27 RCTs. Interventions included simulation by role-play (n = 69), simulated patients (n = 72), virtual reality (n = 22), manikin (n = 5) and voice simulation (n = 2). Meta-analysis found significant differences at immediate post-tests for simulation compared with active and inactive control groups for attitudes (standardised mean difference [SMD] = 0.52, 95% confidence interval [CI] 0.31-0.73 [I2  = 0.0%] and SMD = 0.28, 95% CI 0.04-0.53 [I2  = 52.0%], respectively), skills (SMD = 1.37, 95% CI 0.56-2.18 [I2  = 93.0%] and SMD = 1.49, 95% CI 0.39-2.58 [I2  = 93.0%], respectively), knowledge (SMD = 1.22, 95% CI 0.57-1.88 [I2  = 0.0%] and SMD = 0.72, 95% CI 0.14-1.30 [I2  = 80.0%], respectively), and behaviours (SMD = 1.07, 95% CI 0.49-1.65 [I2  = 68.0%] and SMD = 0.45, 95% CI 0.11-0.79 [I2  = 41.0%], respectively). Significant differences in terms of patient benefit and doctors' behaviours and skills were found at the 3-month follow-up. CONCLUSIONS: Despite heterogeneity in methods and simulation interventions, our findings demonstrate the effectiveness of simulation training in psychiatry training.

The effectiveness of BIS monitoring during electro-convulsive therapy: A systematic review and meta-analysis.

STUDY OBJECTIVE: Electroconvulsive therapy (ECT) has been shown to be highly effective in patients suffering from treatment-resistant depression. ECT procedure is performed under general anesthesia but the impact of anesthesia depth on seizure characteristics and clinical outcome remains unclear. We aimed to study the effects of BIS monitoring on electric and clinical response to ECT treatment. DESIGN: Meta-analysis searching PubMed, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO database, and Google Scholar. PATIENTS/INTERVENTIONS: Studies comparing different BIS levels during ECT. MEASUREMENT: The primary outcome measured the electrical seizure duration. Secondary outcomes measured the clinical seizure duration, and correlation between pre-ictal BIS level and awakening time. Difference in means (MD) was used for effect size. MAIN RESULTS: Among 38 eligible studies, 7 were analyzed including 260 patients, aged from 16 to 80 years old, benefiting from 1283 ECT sessions. Higher BIS levels were associated with longer electric seizures duration (correlation 0.61, 95% CI [0.39-0.75], 7 studies) and longer motor seizures duration (correlation 0.72, 95% CI [0.29-0.91], 6 studies). CONCLUSIONS: High values of pre-ictal BIS are associated with improved seizure duration. The usefulness of systematic BIS monitoring during all ECT procedures should be further studied to better identify adequate BIS levels according to patient's characteristics.

Choosing appropriate size of I-Gel® for initial success insertion: a prospective comparative study.

PURPOSE: The optimal size of the I-Gel® remains unclear since the manufacturer's weight-based formula (size 3 for weight < 50 kg, size 4 for weight 50-90 kg, and size 5 for weight > 90 kg) for the laryngeal mask airway I-Gel® is not evidence-based. We hypothesised that sex may also guide the choice of I-Gel® size. METHODS: Insertion success rates of the I-Gel® chosen according to the weight-based formula were prospectively recorded and compared with those of a patients' cohort ventilated with an I-Gel® chosen according to the sex-based formula recorded. Two periods of 18 months were randomised in three independent hospitals in France to study each choice strategy. Patients requiring I-Gel® size change were compared with those who where successfully ventilated with the initially chosen device. Complications linked to the I-Gel® and factors for changing the size of the I-Gel® were also recorded and analysed. RESULTS: Data from 900 patients were prospectively collected in the three participating centres. The overall initial ventilation was inadequate in 80 cases, including 7% (n = 31) in the weight-based group and 3% (n = 13) in the sex-based group (P = 0.01). In the weight-based group, changing size of I-Gel® was successful in 28 (90%) cases. In the sex-based group, changing size of I-Gel® was useful in 1 case only. Endotracheal tube insertion was necessary in 15 cases despite changing I-Gel® size, including 3 cases in the weight-based group and 12 cases in the sex-based group. Ease of insertion and postoperative pharyngo-laryngeal problems were similar between groups with or without changing size of I-Gel®. CONCLUSION: Adequate ventilation is achieved most of the time using size selection for the I-Gel® laryngeal mask airway according to the manufacturer's weight-based formula. However, our results suggest that the sex-based formula in healthy, anaesthetised, adult patients may also be appropriate for I-Gel® size choice.