BACKGROUND: High-flow nasal oxygen (HFNO) is increasingly being used in intensive care units for management of hypoxemia and respiratory failure. However, the effectiveness of HFNO for preventing hypoxemia in the intraoperative period is unclear. The purpose of this systematic review was to compare patient oxygenation and end-tidal CO2 (Etco 2), between HFNO and conventional oxygenation, during the intraoperative period in surgical patients. METHODS: Standard databases were searched from inception to February 2020. Studies involving intraoperative use of HFNO with 1 of the 4 outcomes: (1) oxygen (O2) desaturation, (2) minimum O2 saturation, (3) safe apnea time, or (4) Etco 2 were included. Intraoperative period was divided into 2 phases: at induction with general anesthesia and during surgical procedure under sedation without tracheal intubation. RESULTS: Eight randomized controlled trials (RCTs; 4 induction, 4 procedure, 2314 patients) were included for systematic review and meta-analyses. We found the risk of intraoperative O2 desaturation was lower in HFNO versus conventional oxygenation control group; at induction with an odds ratio (OR; 95% confidence interval [CI]) of 0.06 (0.01–0.59, P = .02), and during procedure, OR (95% CI) of 0.09 (0.05–0.18; P < .001). The minimum O2 saturation was higher in HFNO versus conventional oxygenation; at induction by a mean difference (MD) (95% CI) of 5.1% (3.3–6.9; P < .001), and during procedure, by a MD (95% CI) of 4.0% (1.8–6.2; P < .001). Safe apnea time at induction was longer in HFNO versus conventional oxygenation by a MD (95% CI) of 33.4 seconds (16.8–50.1; P < .001). Etco 2 at induction was not significantly different between HFNO and conventional oxygenation groups. CONCLUSIONS: This systematic review and meta-analysis show that, in the intraoperative setting, HFNO compared to conventional oxygenation reduces the risk of O2 desaturation, increases minimum O2 saturation, and safe apnea time. HFNO should be considered for anesthesia induction and during surgical procedures under sedation without tracheal intubation in patients at higher risk of hypoxemia.

Background: Due to paucity of psychiatrists in India, psychiatric patients often present to other doctors. We aimed to study nonpsychiatric residents’ attitude and stigma toward psychiatric patients. Methods: A total of 57 postgraduate trainees participated in a cross-sectional study in a tertiary hospital in New Delhi. Attitudes to psychiatric patients were assessed using the attitude to mental illness questionnaire (AMIQ) and the perceived stigma questionnaire. This was correlated with sociodemographic information. Results: Over 70% residents accepted mentally ill patients as friends and felt they were equally employable. However, AMIQ demonstrated a negative attitude towards patients with schizophrenia. Perceived competence in dealing with psychiatric patients was associated with adequate undergraduate exposure (Chi-square = 7.270, P = 0.026) and correlated with positive attitudes ( t -test, P = 0.0008). Conclusions: While the questionnaires revealed some prejudice toward psychiatric patients with schizophrenia, the postgraduate trainees who felt competent to deal with the mentally ill had the most positive attitudes toward them.

There is a growing interest in multimodal prehabilitation programs prior to surgery. Several recent guidelines have recommended multimodal prehabilitation programs that include smoking cessation. While preoperative smoking cessation programs reduce perioperative complications and increase long-term abstinence, 1 the impact of smoking cessation interventions as part of multimodal prehabilitation programs has not been described. As such, we performed a systematic review to summarize the literature on prehabilitation programs that have included smoking cessation.A literature search was performed in April 2018 of Medline, Medline In-Process, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed-NOT-Medline, CINAHL, Web of Science, and Scopus. Studies that evaluated the effect of preoperative smoking cessation as part of surgical prehabilitation were included.The literature search identified seven studies for inclusion (Table). Five studies were observational studies and two were randomized-controlled trials. The study populations included patients undergoing elective thoracic, abdominal, and orthopedic surgeries. Interventions generally consisted of a combination of aerobic exercise, strength training, pulmonary rehabilitation, and lifestyle modification including smoking cessation.Five studies assessed the effect of their interventions on postoperative outcomes. Three studies found an improvement in outcomes, primarily a reduction in postoperative pulmonary complications and hospital length of stay; however, two other studies failed to show a reduction in postoperative pulmonary complications.Three studies examined the effect of the intervention on exercise capacity and health-related quality of life. The results show that the interventions can effectively improve exercise capacity; however, the results for quality of life were inconsistent.Three studies reported the number of current smokers undergoing the intervention that quit smoking preoperatively, with abstinence rates from 46-100%. The results show that the interventions resulted in a high smoking abstinence rate prior to surgery; however, longterm abstinence was not measured in any of the studies.Even though the evidence suggests some beneficial effects, the evidence for smoking cessation interventions in the context of multimodal prehabilitation programs is limited. Most of the studies were observational, and only two were randomized studies with small sample sizes. The studies were heterogeneous with regards to the surgical population, types of interventions, and outcomes. Most of the studies did not start the smoking cessation intervention early enough (at least four weeks before surgery-the minimum period shown to reduce postoperative complications). 1 Most importantly, as no study compared prehabilitation programs with and without smoking cessation, we are not able to identify the specific benefits