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Surgical and Anaesthesia Care: From Preparing to Recovering
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Surgical and Anaesthesia Care: From Preparing to Recovering

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (25 June 2023) | Viewed by 8161

Special Issue Editors

Dr. Fernando J. Abelha

E-Mail Website
Guest Editor
1. Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
2. Department of Anesthesiology, Surgery and Physiology, Centro Hospitalar de São João, Porto, Portugal
Interests: anesthesiology; physiology
Special Issues, Collections and Topics in MDPI journals
Dr. Joana Mourão

E-Mail Website
Guest Editor
1. Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
2. Department of Anesthesiology, Surgery and Physiology, Centro Hospitalar de São João, Porto, Portugal
Interests: perioperative management; outcome after surgery; risk factors for surgery; simulation for teaching; outcome prediction

Special Issue Information

Dear Colleagues,

Perioperative care includes every stage of a patient’s journey from when they are identified for an operation to when they are discharged from the hospital.

Each procedure carries its specific set of management issues and potential complications and has its own unique needs in preoperative preparation.

In addition to the risks of surgery and anesthesia, each patient presents with their own characteristics, risk factors, and comorbidities. Morbidity and perioperative mortality related to surgery involve these multiple factors.

Risk stratification tools can be used to better determine the risk of complications and mortality in the surgical context, allowing for the identification of patients requiring a different preoperative evaluation, and may help guide better postoperative care.

We believe that our contribution as perioperative actors in identifying risk and preparing patients for surgery is important and that our attitudes can make a difference in the outcome of our patients, not only in the short term but also in longer periods of time.

In this Special Issue, we welcome authors to submit papers on the perioperative care surgical patients. We are willing to cover preoperative care and the preparation of the patient for surgery and to discuss the recognition of the risk of complications associated with perioperative care and with different outcomes.

Dr. Fernando J Abelha
Dr. Joana Mourão
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • perioperative care
  • outcome
  • preparation for surgery
  • risk factors
  • postoperative complications
  • surgical procedures
  • operative/adverse effects

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Published Papers (4 papers)

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Research

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23 pages, 340 KiB  
Article
Opioid-Free Anaesthesia Reduces Complications in Head and Neck Microvascular Free-Flap Reconstruction
by Paulo-Roberto Cardoso Ferreira, Rita Isabel Pinheiro De Oliveira, Marta Dias Vaz, Carla Bentes and Horácio Costa
J. Clin. Med. 2023, 12(20), 6445; https://doi.org/10.3390/jcm12206445 - 10 Oct 2023
Viewed by 1082
Abstract
Head and neck free-flap microvascular surgeries are complex and resource-intensive procedures where proper conduct of anaesthesia plays a crucial role in the outcome. Flap failure and postoperative complications can be attributed to multiple factors, whether surgical- or anaesthesia-related. The anesthesiologist should ensure optimised [...] Read more.
Head and neck free-flap microvascular surgeries are complex and resource-intensive procedures where proper conduct of anaesthesia plays a crucial role in the outcome. Flap failure and postoperative complications can be attributed to multiple factors, whether surgical- or anaesthesia-related. The anesthesiologist should ensure optimised physiological conditions to guarantee the survival of the flap and simultaneously decrease perioperative morbidity. Institutions employ different anaesthetic techniques and results vary across centres. In our institution, two different total intravenous approaches have been in use: a remifentanil-based approach and a multimodal opioid-sparing approach, which is further divided into an opioid-free anaesthesia (OFA) subgroup. We studied every consecutive case performed between 2015 and 2022, including 107 patients. Our results show a significant reduction in overall complications (53.3 vs. 78.9%, p = 0.012), length of stay in the intensive care unit (3.43 ± 5.51 vs. 5.16 ± 4.23 days, p = 0.046), duration of postoperative mechanical ventilation (67 ± 107 vs. 9 ± 38 h, p = 0.029), and the need for postoperative vasopressors (10% vs. 46.6%, p = 0.001) in the OFA group (vs. all other patients). The multimodal and OFA strategies have multiple differences regarding the fluid therapy, intraoperative type of vasopressor used, perioperative pathways, and various drug choices compared to the opioid-based technique. Due to the small number of cases in our study, we could not isolate any attitude, as an independent factor, from the success of the OFA strategy as a whole. Large randomised controlled trials are needed to improve knowledge and help define the ideal anaesthetic management of these patients. Full article
(This article belongs to the Special Issue Surgical and Anaesthesia Care: From Preparing to Recovering)
15 pages, 1150 KiB  
Article
One-Year Survival after Cardiac Surgery in Frail Older People—Social Support Matters: A Prospective Cohort Study
by Maria de Lurdes Castro, Marta Alves, Ana Luisa Papoila, Amália Botelho and José Fragata
J. Clin. Med. 2023, 12(14), 4702; https://doi.org/10.3390/jcm12144702 - 15 Jul 2023
Cited by 2 | Viewed by 1465
Abstract
There are increasing rates of cardiac surgery in the elderly. Frailty, depression, and social vulnerability are frequently present in older people, and should be considered while assessing risk and providing treatment options. We aimed to analyse the impact of clinically relevant variables on [...] Read more.
There are increasing rates of cardiac surgery in the elderly. Frailty, depression, and social vulnerability are frequently present in older people, and should be considered while assessing risk and providing treatment options. We aimed to analyse the impact of clinically relevant variables on survival at one year, and identify areas of future intervention. We performed a prospective cohort study at a University Hospital, with a sample of 309 elective cardiac surgery patients 65 years old and over. Their socio-demographic and clinical variables were collected. Frailty prevalence was 61.3%, while depression was absent in the majority of patients. Mortality was 1.6% and 7.8% at 30 days and 12 months, respectively. After Kaplan–Meier analysis, severe frailty (p = 0.003), severe depression (p = 0.027), pneumonia until 30 days (p = 0.014), and re-operation until 12 months (p = 0.003) significantly reduced survival, while social support increased survival (p = 0.004). In the adjusted multivariable Cox regression model, EuroSCORE II (HR = 1.27 [95% CI 1.069–1.499] p = 0.006), pneumonia until 30 days (HR = 4.19 [95% CI 1.169–15.034] p = 0.028), re-intervention until 12 months (HR = 3.14 [95% CI 1.091–9.056] p = 0.034), and social support (HR = 0.24 [95% CI 0.079–0.727] p = 0.012) explained time until death. Regular screening for social support, depression, and frailty adds relevant information regarding risk stratification, perioperative interventions, and decision-making in older people considered for cardiac surgery. Full article
(This article belongs to the Special Issue Surgical and Anaesthesia Care: From Preparing to Recovering)
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13 pages, 1397 KiB  
Article
Stair-Climbing Tests or Self-Reported Functional Capacity for Preoperative Pulmonary Risk Assessment in Patients with Known or Suspected COPD—A Prospective Observational Study
by André Dankert, Benedikt Neumann-Schirmbeck, Thorsten Dohrmann, Lili Plümer, Viktor Alexander Wünsch, Phillip Brenya Sasu, Susanne Sehner, Christian Zöllner and Martin Petzoldt
J. Clin. Med. 2023, 12(13), 4180; https://doi.org/10.3390/jcm12134180 - 21 Jun 2023
Viewed by 1465
Abstract
Background: This prospective study aims to determine whether preoperative stair-climbing tests (SCT) predict postoperative pulmonary complications (PPC) better than self-reported poor functional capacity (SRPFC) in patients with known or suspected COPD. Methods: A total of 320 patients undergoing scheduled for major [...] Read more.
Background: This prospective study aims to determine whether preoperative stair-climbing tests (SCT) predict postoperative pulmonary complications (PPC) better than self-reported poor functional capacity (SRPFC) in patients with known or suspected COPD. Methods: A total of 320 patients undergoing scheduled for major non-cardiac surgery, 240 with verified COPD and 80 with GOLD key indicators but disproved COPD, underwent preoperative SRPFC and SCT and were analyzed. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection. Two multivariable regression models were fitted, the SRPFC model (baseline variables such as sociodemographic, surgical and procedural characteristics, medical preconditions, and GOLD key indicators plus SRPFC) and the SCT model (baseline variables plus SCTPFC). Results: Within all stair-climbing variables, LASSO exclusively selected self-reported poor functional capacity. The cross-validated area under the receiver operating characteristic curve with bias-corrected bootstrapping 95% confidence interval (95% CI) did not differ between the SRPFC and SCT models (0.71; 0.65–0.77 for both models). SRPFC was an independent risk factor (adjusted odds ratio (OR) 5.45; 95% CI 1.04–28.60; p = 0.045 in the SRPFC model) but SCTPFC was not (adjusted OR 3.78; 95% CI 0.87–16.34; p = 0.075 in the SCT model). Conclusions: Our findings indicate that preoperative SRPFC adequately predicts PPC while additional preoperative SCTs are dispensable in patients with known or suspected COPD. Full article
(This article belongs to the Special Issue Surgical and Anaesthesia Care: From Preparing to Recovering)
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Review

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18 pages, 1350 KiB  
Review
New Perspective for Drug–Drug Interaction in Perioperative Period
by Abigail Silva, Bárbara Costa, Irene Castro, Joana Mourão and Nuno Vale
J. Clin. Med. 2023, 12(14), 4810; https://doi.org/10.3390/jcm12144810 - 21 Jul 2023
Cited by 2 | Viewed by 3644
Abstract
In this review, we aim to discuss current information on drug interactions in the perioperative period. During this period, patients receive several drugs that may interact with each other and affect the efficacy and safety of the treatment. There are three types of [...] Read more.
In this review, we aim to discuss current information on drug interactions in the perioperative period. During this period, patients receive several drugs that may interact with each other and affect the efficacy and safety of the treatment. There are three types of drug interactions: pharmacodynamic, pharmacokinetic, and pharmaceutical. It is important to recognize that drug interactions may increase the toxicity of the drug or reduce its efficacy, increasing the risk of complications in the perioperative period. This review describes the most commonly used perioperative drugs approved by the FDA and some of the described interactions between them. Thoroughly reviewing a patient’s medication list and identifying potential interactions are essential steps in minimizing risks. Additionally, vigilant monitoring of patients during and after surgery plays a pivotal role in early detection of any signs of drug interactions. This article emphasizes the significance of addressing DDIs in the perioperative period to ensure patient well-being and advocates for the implementation of careful monitoring protocols to promptly identify and manage potential interactions. Full article
(This article belongs to the Special Issue Surgical and Anaesthesia Care: From Preparing to Recovering)
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