Objective: In this study of patients presenting for non-cardiac, emergency surgery in a resource limited setting, we aimed to evaluate the impact of routine preoperative transthoracic echocardiography on perioperative management. Design: A prospective before- and after-study of adult patients presenting for emergency, non-cardiac, non-obstetric surgery. Setting: The study was performed at an academic hospital in Cape Town, South Africa. Participants: Consenting patients over 18 years of age presenting for emergency surgery enrolled via convenience sampling during working hours over a 10 day period. Interventions: Basic and advanced Focused Assessment Transthoracic Echocardiography (FATE) was performed to evaluate ventricular function, valvular pathology and fluid status. After completing an assessment and treatment plan, the FATE findings were disclosed to the treating anesthetist. A post FATE plan was subsequently completed. Measurements and Main Results: A total of 67 patients were scanned with a change in management detected in 55% of cases. Thirty-nine percent of these alterations were in response to fluid management strategies with 31% of patients scanned being assessed as hypovolemic. There was a statistically significant link between patient volume status and change in perioperative management (p=0.0003). The presence or absence of valvular pathology also led to a significant association with change in management (p=0.020), most commonly in relation to the decision to proceed with surgery or the use of additional monitoring. Conclusion: This observational study of adult patients presenting for emergency surgery in an upper middle-income country demonstrates that routine preoperative transthoracic echocardiography has an impact on perioperative anesthetic management.

This thesis is concerned with the issue of smoking in the surgical population. Globally, over 300 million adults undergo surgery annually and around 60 million are smokers. The population impact of this is enormous. Moreover, smoking increases postoperative complications and is a leading cause of morbidity and mortality. Smoking rates are declining in the general population; but remains higher among surgical populations. Despite being an important modifiable risk factor, and the availability of treatments for smoking, many patients presenting for surgery still smoke and many resume smoking after surgery. Importantly, unfortunately in surgical settings, the implementation of evidence-based cessation interventions is still suboptimal. The time around surgery is a “teachable moment” and surgical guidelines recommend that all patients who smoke should be provided with evidence-based smoking cessation assistance. This thesis seeks to answers the following questions: What are the factors that determine abstinence from smoking after surgery? What is (are) the best smoking cessation intervention(s) in the surgical setting? What factors constitute barriers and facilitators to the implementation of effective smoking cessation interventions? Is cytisine effective for smoking cessation? Will the use of cytisine and behavioral counselling delivered via personalized video messaging increase abstinence from smoking at 6 months post-randomization among surgical patients? Using a variety of research methodologies, the data provided across the 5 papers in this thesis inform these knowledge gaps. Chapter 1 is an introduction providing the rationale for conducting each of the included studies. Chapter 2 is a secondary analysis from the Vascular events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study that evaluated the determinants of smoking abstinence in a representative sample of patients undergoing major non-cardiac surgery. Chapter 3 is a systematic review, pairwise meta-analysis, and network meta-analysis of randomized controlled trials evaluating preoperative smoking cessation interventions. Chapter 4 is a scoping review that explores the barriers and facilitators to smoking cessation in the surgical setting. Chapter 5 is a systematic review and meta-analysis of cytisine for smoking cessation Chapter 6 reports on the rationale and design of the PeRiopEratiVE smokiNg CessaTion (PREVENT) randomized controlled trial evaluating the efficacy and safety of cytisine versus placebo, and in a 2x2 factorial, personalized video messaging versus standard care for smoking cessation among adults undergoing surgery. Chapter 7 is the conclusion chapter wherein I discuss the key findings, limitations, and implications of the research presented in this PhD thesis. / Thesis / Doctor of Philosophy (PhD) / Up to 1 in 7 adults having surgery are cigarette smokers. Smoking increases the risk of complications after surgery and negatively impacts patient’s health and survival in the long term. Patients who are smokers have to stop smoking while in hospital for their surgery but majority of them resume smoking right after surgery. This is a missed opportunity to turn enforced temporary abstinence from smoking to permanent abstinence. It is informative to understand the factors that determine this resumption of smoking after temporary abstinence, determine the most effective interventions to help smokers quit smoking permanently and importantly, understand the barriers and facilitators to smoking cessation in surgical settings. Additionally, the current methods for smoking cessation are sub-optimally utilized in surgical settings. We need further research to evaluate new interventions, and ways of delivering smoking cessation care for smokers undergoing surgery. The studies in this thesis inform on these knowledge gaps.

This project represents the ever-changing methods surrounding Enhanced Recovery after Surgery and the protocols that compose it. The purpose of this study is to expand education of ERAS guidelines and improve patient outcomes through furthering staff education. Enhanced Recovery After Surgery has been a part of perioperative departments worldwide after being introduced in the 1990s by Northern European general surgeons and has been adapted and modified since its introduction (ERAS Society History, 2022). The preoperative and postoperative process is ever-changing and is difficult for staff to keep up with. Many staff members find it difficult to stay on top of the most recent protocols. From clerical staff to nurses to surgeons there is a breakdown in the process of ensuring patients receive the optimal benefits if ERAS. This presentation will serve to both educate viewers on the latest ERAS recommendations as well as help develop and define a workflow for ensuring staff members have the most updated guidelines available to streamline the process and provide the best recovery experience for patients.

Zugl.: Giessen, Universiẗat, Diss., 2007.

Zugl.: Giessen, Univ., Diss., 2007

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2004. / Also held in print (114 leaves, 30 cm.) in North Shore Theses Collection (T 610.730690993 MCC).

Universiẗat, Diss., 2004--München.

Universiẗat, Diss., 2007--Giessen.

The purpose of this study was to determine if obese patients have a different sensory regression time from subarachnoid block than non-obese patients using hyperbaric 0.75% bupivacaine. A quasi-experimental design was used. Twenty patients were separated into two groups; one group was classified as obese, and the other group was classified as non-obese. The data consisting of age, height, weight, sex, and surgical procedure were recorded preoperatively. All the patients received hyperbaric 0.75% bupivacaine via subarachnoid puncture. The levels of spinal anesthesia were recorded at the highest level achieved. The injection time was also recorded. When the surgery was completed, the patient was transferred to the recovery room and levels of sensory blockade were checked by pin-prick with an 18-gauge needle every 10 minutes until complete recovery from the spinal anesthesia had been achieved. The hypothesis, there will be no difference in sensory regression time from SAB with hyperbaric 0.75% bupivacaine between obese and non-obese patients, failed to be rejected. No statistically significant difference, using linear regression analysis, was found in mean regression time between groups (obese versus non-obese).

Seven orthopedic surgery patients requiring the use of a tourniquet were studied. The hypothesis stated that tourniquet application does not affect coagulation. A total of 5 blood samples were drawn perioperatively (preoperative, 5 minutes after induction of anesthesia, 30 minutes after tourniquet inflation, 2 - 5 minutes after tourniquet deflation, and 30 minutes after tourniquet deflation. For each sample, TEG parameters (R, R + k, MA and α) were measured. The value for each TEG parameter was compared by analysis of variance (ANOVA), then the samples were contrasted and examined by repeated measures ANOVA. None of the TEG parameters showed a statistically significant difference in the blood samples before, during or after tourniquet application. The hypothesis could not be rejected at the α = .05 level of significance. A t test was used to examine the effect of anesthesia on coagulation. The TEG parameters indicated a significant relationship between the TEG values R and R + k, and a near significant relationship between TEG values MA and a and the administration of anesthesia. It was concluded that tourniquet use does not effect coagulation when applied 2 hours or less. However, anesthesia had a significant effect on TEG parameters R and R + k. The clinical significance of this effect was questionable since the type of anesthesia varied in some patients, and none of the patients in the study demonstrated symptoms of coagulopathy.