Background: Implementation of Enhanced Recovery After Surgery requires coordinated multidisciplinary practice change and remains challenging in resource-constrained health care settings because implementation barriers often extend beyond knowledge deficits. This article describes the development, implementation and implementation-focused evaluation of a multidisciplinary perioperative education programme designed to support Enhanced Recovery After Surgery implementation across two public-sector hospitals in India. Methods: The programme was developed through a sequential, evidence-informed process. Findings from a prospective observational evaluation and a sequential explanatory mixed-methods study were synthesised and mapped to the Enhanced Recovery After Surgery Society Guideline for Perioperative Care in Elective Colorectal Surgery and overarching Enhanced Recovery After Surgery principles. This informed the development of a workflow-integrated educational programme incorporating orientation sessions, micro-training, bedside coaching, structured communication, nursing and clinician champions, bedside checklists, visual reminders and audit-feedback. Results: The programme was implemented across a tertiary teaching hospital and a district hospital. Educational activities were embedded within routine perioperative workflows, promoting multidisciplinary engagement, behavioural reinforcement, workflow integration and adoption of standardised recovery practices. Conclusions: A structured, evidence-informed educational strategy integrated within routine clinical workflows provides a practical approach to supporting sustainable Enhanced Recovery After Surgery implementation in resource-constrained public-sector hospitals.
We aimed to identify and categorise the timing and methods of warming interventions in recent literature and describe the landscape of perioperative warming practices. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, six databases were searched, targeting randomised controlled trials published between 2015 and 2025. Studies were selected using predefined inclusion and exclusion criteria to identify current practices for perioperative temperature management. Methodological quality of the included studies was evaluated. Overall, 22 studies were reviewed; 17 reported significant improvements in clinical outcomes. Active prewarming was highly effective. Multimodal strategies demonstrated superior efficacy, with a reduction in hypothermia incidence. Although multimodal approaches were effective in seven of nine studies, only four specifically involved structured procedures, such as the use of checklists. Active prewarming and multimodal approaches effectively prevent perioperative hypothermia, and having established protocols is important. Specific procedures for managing temperature perioperatively are essential for improving patient safety.
Background: Malignant hyperthermia is a rare but life-threatening perioperative emergency requiring prompt recognition and coordinated management. This national cross-sectional study evaluated operating room nurses’ knowledge of malignant hyperthermia and its management in Türkiye and examined factors associated with knowledge. Methods: Operating room nurses working in public, training and research, university and private hospitals completed an online questionnaire comprising demographic and professional characteristics and a 20-item knowledge test. Results: Knowledge was stronger for clinical manifestations, treatment principles, post-dantrolene monitoring and the importance of written protocols, whereas gaps were concentrated in crisis management, cooling measures and multidisciplinary team responsibilities. Previous malignant hyperthermia education was associated with greater knowledge, while professional experience alone was not. Conclusion: Targeted continuing education, multidisciplinary simulation and accessible institutional protocols may strengthen preparedness for malignant hyperthermia crises.
Cannula detachment during intraocular surgery is an uncommon but potentially blinding complication. When it happens, attention commonly turns to whether the scrub practitioner tightened the connection adequately. This article explains why a well-made connection can still fail under hydraulic load once the junction has been lubricated, why incomplete tightening, where it occurs, is better understood as a foreseeable human factor than as an individual failing, why the cause cannot be established from the outcome alone and what theatre teams can do to reduce the risk and limit the harm.
Introduction: Patients undergoing total knee arthroplasty under neuraxial anaesthesia remain awake within a stressful operative environment. Music listening is a low-cost, non-pharmacological intervention that may reduce anxiety and pain. Methods: We searched PubMed, MEDLINE, Embase and Cochrane Central Register of Controlled Trials from inception to April 2026. Standardised mean differences were pooled using random-effects models; risk of bias was assessed with Cochrane Risk of Bias 2. Results: Eight randomised controlled trials (440 participants) were included. Music listening significantly reduced postoperative anxiety (standardised mean difference = −0.95; 95% confidence intervals: −1.34 to −0.55) and postoperative pain at 24 h (standardised mean difference = −0.81; 95% confidence interval: −1.23 to −0.39) and was associated with reduced opioid consumption, lower intraoperative sedation requirements, fewer conversions from neuraxial to general anaesthesia and higher patient satisfaction. Subgroup analysis suggests that a proportion of the benefit may be attributable to noise isolation from headphones alone rather than to music. Conclusion: Low-certainty evidence suggests music may be an optional, low-cost adjunct within enhanced recovery after surgery pathways for total knee arthroplasty. Further research is needed to refine optimal intervention protocols and validate benefits in larger multicentre trials.
