Melatonin shows potential for reducing delirium among older people after surgery
Taking melatonin around the time of surgery is linked with lower odds of delirium onset in older people, compared with placebo or no treatment. In a systematic review and meta-analysis, around 15% of the melatonin group developed delirium after surgery compared with around 20% of the comparison group.
Delirium is an acute state of mental confusion associated with longer hospital stays and increased mortality. UK clinical guidelines do not recommend specific medications to prevent this condition...
People leave hospital after surgery sooner if hospitals follow ‘enhanced recovery protocols’
Strategies to improve or enhance recovery after planned surgery can reduce the amount of time people over 60 spend in hospital, compared with standard care. These strategies include minimising fasting before operations, targeted anaesthesia, getting people up and about quickly after surgery and an early return to eating.
In this review, hospital stay could be reduced by up to five days with the use of enhanced recovery protocols. Exercises and nutritional programmes to prepare for surgery (&lsq...
High-flow nasal oxygen reduces reintubation after major surgery compared with conventional oxygen therapy
In adults after major surgery, high-flow nasal oxygen decreases by about two-thirds the need for reintubation compared with conventional oxygen therapy. In this study, only about four in every 100 patients needed reintubation with high-flow nasal oxygen, compared with about 11 in every 100 patients receiving conventional oxygen therapy.
This review evaluated seven randomised and three non-randomised studies in 1,327 adult patients recovering from surgery under a general anaesthetic. Most of the...
Intravenous magnesium can reduce shivering in patients after surgery
An infusion of magnesium, given during or immediately after surgery, reduces the proportion of patients who experience shivering in the operating theatre or in recovery from 23% to 9.9%.
Shivering is unpleasant for the patient and may place strain on the cardiovascular system, as it increases oxygen use. A review of 64 trials found that intravenous magnesium was effective compared to placebo without any reported adverse effects.
In the UK, frequent temperature checks and active warming are rou...
Better pain relief for women in labour
Women in labour, who had the short acting strong painkiller remifentanil, rather than pethidine, had less need for further pain relief. Only 19% of women given remifentanil received a subsequent epidural compared with 41% given pethidine. Remifentanil was given intravenously, using a patient-controlled delivery device, and pethidine given by intramuscular injection.
This NIHR-funded study is the first large trial to compare intravenous remifentanil (administered via a patient-controlled deliver...
Music can reduce pain and anxiety following surgery
Recorded music played before, during or after surgery in adults reduces self-reported post-operative pain and anxiety, compared with usual care. The average effect is equivalent to a reduction in anxiety of 21 percentage points and a 10 percentage point reduction in pain within a few days of surgery.
It is thought that placebo and distraction effects probably play a role, but in this review music still improved pain when used for patients under a general anaesthetic.
Nearly two-thirds of patie...
Enhanced recovery programmes after stomach cancer surgery reduce hospital stay without increasing complications
Enhanced recovery programmes reduce length of hospital stay and associated healthcare costs after stomach cancer surgery, with no impact on short-term mortality or post-operative complications. They also improvepost-operative quality of life.
The enhanced recovery approach includes a range of components designed to help people to recover more quickly and have better outcomes after surgery. These include optimising people's health preoperatively, attention to detail during anaesthesia and su...
Cell salvage during caesarean section doesn’t reduce blood transfusions
In a large UK trial, cell salvage for women at risk of blood loss during caesarean did not reduce the need for donor blood transfusion, though few needed transfusion (2.5% compared with 3.5% among controls).
More babies are being born by caesarean section and if blood loss is excessive, transfusions may be required, probably by about one in 20 women. Collecting the mother’s own lost blood during the procedure, filtering and returning it to her (cell salvage) is a potential alternative tha...
Dexamethasone before bowel surgery reduces postoperative nausea and vomiting
A single dose of dexamethasone given at the time of anaesthesia for bowel surgery reduced vomiting in the next 24 hours, with no increase in complications. Thirteen people need to be treated to prevent one extra episode of vomiting.
Dexamethasone (a steroid) is one of several drugs recommended for patients at moderate and high risk of postoperative nausea and vomiting. It isn’t widely used in bowel surgery.
In this large UK-based trial, treating eight people also prevented one person re...
Laminar airflow in surgery might not reduce surgical site infections
The type of theatre ventilation system used during hip and knee replacement, abdominal or vascular surgery has no effect on the rate of surgical site infections. Prevention of surgical site infection is a complex area with many potential targets for action. So decisions relating to commissioning or decommissioning these systems will need to consider the totality of the evidence alongside the costs.
This systematic review included 12 observational studies comparing wound infection rates followin...