Association of Perioperative Registered Nurses

Postoperative opioid and benzodiazepine use often extends beyond recovery, yet research on surgical prescribing tends to focus on opioid-naive patients. Less is known about those already using these medications preoperatively, who face different risks and care needs. Using a national US claims database (PearlDiver, 2010 to 2022), we identified insured adults receiving 1 of 18 common surgeries. We examined patterns of filled prescriptions for opioids and benzodiazepines before and after surgery, including (1) opioids without benzodiazepines (opioid monotherapy), (2) benzodiazepines without opioids (benzodiazepine monotherapy), (3) exposure to both, and (4) exposure to neither. Preoperative prescriptions were assessed between 6 months and 1 week before surgery. Postoperative prescriptions between 1 and 3 months after surgery were assessed. Using multivariable logistic regression, we analyzed relationships between preoperative and postoperative opioid and benzodiazepine medication fills. Among 14.9 million adults, 62% and 80% were opioid- and benzodiazepine-naive preoperatively. Among opioid and benzodiazepine-naive patients, 21.4% initiated these medications postoperatively. In contrast, 51% of preoperative opioid and benzodiazepine users filled prescriptions after surgery. Although >80% of patients on preoperative benzodiazepine monotherapy no longer received benzodiazepines postoperatively, benzodiazepine monotherapy strongly predicted exposure to benzodiazepine monotherapy (adjusted odds ratio 24.10 [23.88 to 24.32]) and both opioid and BZDs (adjusted odds ratio 15.59 [15.51 to 15.88]). Postoperative prescribing may reflect patients' preexisting opioid and benzodiazepine use more than new surgical indications. Understanding these trajectories is key for developing surgery-specific interventions, especially for patients with preoperative opioid and benzodiazepine exposure.

ABSTRACTBackground and AimCentral venous catheters are vital in the peri‐ and postoperative period for patients undergoing abdominal surgery but are associated with risks such as catheter related infections. Signs of infection, like tenderness and induration at the insertion site, are important to recognize, as they may precede catheter‐related infections, but are often neglected. The aim was to compare surgical patients' experience of central venous catheter with the nursing documentation.MethodsData was collected from short patient interviews and by reviewing electronic health record documentation.ResultsIn total, 106 patients were included, 103 of whom had a central venous catheter located in the internal jugular vein. The median (interquartile range) number of days with a catheter was 10 (8–16). There were no catheter related infections, but potential risks were identified. In 56% of the patients, central venous catheters were removed within the last 2 days before discharge. The most common reason for keeping the catheter was blood sampling. The results from the interviews indicate that 37 of the patients experienced considerable discomfort, such as persistent sensations of constriction, restricted mobility and pain, however, these symptoms were documented in the electronic health record for only three patients.ConclusionThe findings emphasize the necessity of systematically addressing patients' symptoms and individual needs in the postoperative care of the central venous catheter. Incorporating these aspects as a mandatory element in the standardized documentation template within the electronic health record will constitute an important first step toward enhancing patient‐centred care. There is a need for clearly defined guidelines outlining the indications for retention or removal of central venous catheters to minimize catheter‐days during postoperative care in surgical wards.Trial RegistrationAs this was a descriptive, qualitative observational study that did not involve testing a new intervention, compare interventions, or randomize participants, we did not find trial registration necessary under commonly accepted guidelines for clinical trial registration.

Jo Dawson discusses the state of children's oral health across the UK.

Biological rhythms control gene expression, but effects on central nervous system (CNS) cells and structures remain undefined. While circadian (24-hour) rhythms are most studied, many genes have periods of greater and less than 24-hours; these fluctuations can be both site- and cell-specific. Identifying patterns of gene rhythmicity across the CNS is necessary for both the study of chronobiology and to make sense of data obtained in the laboratory. We now identify cycling mRNAs, miRNAs, gene networks and novel mRNA-miRNA co-expression pairs in the cortex, hypothalamus, and corpus striatum using high-dimensional datasets. A searchable catalogue (https://www.ghasemloulab.ca/chronoCNS) was created to help refine the analysis of cellular/molecular rhythmicity across the CNS. Immunofluorescence was also used to confirm the rhythmicity of key targets across cells in these structures, with strong cycling signatures in resting oligodendrocytes. Our study sheds light on the contribution of circadian, ultradian, and infradian rhythms and mRNA-miRNA interactions to CNS function.

Epidural blood patch (EBP) is frequently used for the treatment of spontaneous intracranial hypotension (SIH) and anesthesiologists are often involved in performing such procedures. However, the optimal technique and approach of EBP remains uncertain. This case series included adult patients with SIH who underwent EBPs at London Health Science Centre, Ontario, Canada between 2010 and 2022. Demographics, clinical presentations, investigations, and EBP treatment details were collected and analyzed. Univariate analysis was used to investigate the association of the variables with the likelihood of EBP 1-month efficacy and the efficacy duration of EBP. The study included 36 patients with SIH who received at least 1 EBP. EBPs provided immediate relief in almost all patients, albeit with diminishing effects over time. The 1-month efficacy improved with increasing number of EBP attempts ( P =0.032, Fisher exact test), though no particular EBP technique or volume of injectate was associated with better efficacy ( P =0.38, Fisher exact test). Though permanent resolution of symptoms was observed in only 24 of 82 EBPs (29%), 24 of 36 patients (67%) had permanent symptom resolution following repeated EBPs. EBP is a promising treatment and symptomatic relief option in patients suffering from the debilitating symptoms of SIH. Tailored EBP techniques, including use of targeted higher volume EBP and a multi-level catheter guided technique for refractory cases, showed efficacy in our institutional setting. Despite its limitations, this study contributes valuable insights and experiences into the use of EBP for treatment of SIH.

"Cumulative excess oxygen exposure" (CEOE)-previously defined as the mean hourly administered Fio2 above 0.21 when the corresponding hourly Spo2 was 95% or above-was previously shown to be associated with mortality. The objective of this study was to examine the relationship among Fio2, Spo2, and mortality in an independent cohort of mechanically ventilated children. Retrospective cross-sectional study. Quaternary-care PICU. All patients admitted to the PICU between 2012 and 2021 and mechanically ventilated via endotracheal tube for at least 24 hours. None. Among 3,354 patients, 260 (8%) died. Higher CEOE quartile was associated with increased mortality (p = 0.001). The highest CEOE quartile had an 87% increased risk of mortality (95% CI, 7-236) compared with the first CEOE quartile. The hazard ratio for extended CEOE exposure, which included mechanical ventilation data from throughout the patients' mechanical ventilation time rather than only from the first 24 hours of mechanical ventilation, was 1.03 (95% CI, 1.02-1.03). Potentially excess oxygen exposure in patients whose oxygen saturation was at least 95% was associated with increased mortality.