Journal of Perianesthesia Nursing最新文献

Purpose: The use of handoff communication tools, such as checklists, has been shown to improve communication and decrease the omission of critical patient care information. However, the effect these tools have on patient outcomes has not been investigated. After successfully implementing a handoff checklist in an adult postanesthesia care unit, patient outcomes were retrospectively measured before and after the implementation.

Design: Retrospective chart review.

Methods: Seven hundred and ninety-one prechecklist patients in September 2017 were compared to 828 postchecklist patients in September 2018. Pain scores, oxygen saturation, and end-tidal CO₂ readings were collected for postanesthesia care unit patients in both groups.

Findings: Postchecklist patients exhibited less severe pain (30.8% vs 42.4%) and fewer desaturation episodes (36.4% vs 44.8%). Time to rescue for both did not show a significant difference.

Conclusions: This retrospective comparison showed an improvement in measurable patient outcomes in the immediate postoperative period after the implementation of a handoff communication tool. More research is needed to determine the direct correlation between handoff tool use and measurable patient outcomes.

Purpose: The purpose of the study was to examine the level of compassion satisfaction and compassion fatigue in surgical nurses.

Design: A descriptive and relationship-seeking study.

Methods: The study sample consisted of 200 surgical nurses working in surgical units. Data were collected using the "Nurse Introduction Form," "Compassion Scale," and "Professional Quality of Life Scale." The data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. (Armonk, NY: IBM Corp).

Findings: According to this study, surgical nurses had a high level of compassion satisfaction and a moderate level of compassion fatigue. There is a statistically significant correlation between compassion satisfaction and compassion fatigue (P = .002, r = 0.220).

Conclusions: Among surgical nurses, the moderating variables that influenced levels of compassion satisfaction were gender, educational level, professional experience, and overall job satisfaction. Concurrently, age and professional experience were identified as significant factors affecting compassion fatigue.

Purpose: Compare nebulized dexmedetomidine to other sedatives while assessing the level of sedation, mask acceptance, and parental separation anxiety in the pediatric population undergoing surgery.

Design: Systematic review and meta-analysis.

Methods: MEDLINE (PubMed), Google Scholar, CINAHL, the Cochrane Review Database, Google Scholar, and gray literature were searched for evidence. Risk ratio (RR) and standardized mean difference (SMD) were used to estimate outcomes with suitable effect models. The quality of evidence was rated using the Risk of Bias and the Grades of Recommendation, Assessment, Development, and Evaluation approach.

Findings: Eight studies (n = 615) were included in the review. Over 30 minutes following premedication, nebulized dexmedetomidine yielded comparable sedation scores to other nebulized treatments (SMD, -0.09; 95% confidence interval [CI], -0.45 to 0.28; P = .64). Subgroup analyses revealed that nebulized dexmedetomidine provided more satisfactory sedation levels compared with midazolam (SMD, -0.82; 95% CI, -1.37 to -0.26; P = .004), although it did not provide a satisfactory sedation level as ketamine (SMD, 0.34; 95% CI, 0.01 to 0.67; P = .04). Furthermore, patients receiving nebulized dexmedetomidine showed higher rates of satisfactory mask acceptance (RR, 1.32; 95% CI, 1.08 to 1.59; P = .007) and favorable parental separation outcomes (RR, 1.17; 95% CI, 1.04 to 1.32; P = .01).

Conclusions: Nebulized dexmedetomidine is efficacious versus nebulized midazolam but not nebulized ketamine for preprocedural sedation for pediatric patients undergoing general anesthesia. Nonetheless, it demonstrated superior results in facilitating parental separation and mask acceptance.

Purpose: Postoperative nausea and vomiting (PONV) is common among females undergoing gynecological surgeries. PONV not only causes patients discomfort but also leads to serious complications, affecting their health outcomes. This study aimed to evaluate the effectiveness of applying auricular acupressure to alleviate PONV and postoperative anxiety and to improve satisfaction with anesthesia care in patients undergoing gynecological laparoscopic surgery (GLS).

Design: A randomized control trial was conducted for this study.

Methods: Eighty patients who received general anesthesia for GLS were recruited at a medical center in northern Taiwan and randomly assigned to the control and experimental groups. Both groups had pellets taped onto different auricular points after the surgery: the stomach (CO4), cardia (CO3), liver (CO12), occiput (AT3), shenmen (TF4), and subcortex (AT4) for the experimental group and the knee (AH4) and thoracic vertebrae (AH11) for the control group. The pellets were removed 24 hours after surgery. The severity of PONV was assessed as the primary outcome. Secondary outcomes included levels of anxiety and satisfaction with postanesthesia care.

Findings: After 24 hours of follow-up, patients in the experimental group reported significantly less PONV and a higher level of satisfaction with anesthesia care compared to patients in the control group. However, the levels of postoperative anxiety between the control and experimental groups were statistically insignificant.

Conclusions: The study demonstrates that the six auricular points, including CO4, CO3, CO12, AT3, TF4, and AT4, can effectively alleviate PONV and improve the quality of anesthesia care after GLS. Auricular acupressure is a nonpharmacologic treatment for PONV that takes cost and patient satisfaction into consideration.

Point-of-care test (POCT) of blood viscoelasticity can reflect the coagulation status of patients accurately and timely. POCT can be used to monitor the effect of preoperative antithrombotic drugs on coagulation function, which will inform the selection of appropriate surgical timing. It can also be applied to analyze the reasons of intraoperative bleeding and guide the transfusion of blood products. Also, it is useful to assess the risk of postoperative thromboembolism and hint the need for prophylactic anticoagulation. This article mainly introduces the principles and clinical application of several frequently used POCTs for blood viscoelasticity, with a focus on their role in special types of diseases in which coagulation function changes significantly, such as cardiac disease, trauma, pathological obstetrics, and liver disease. Furthermore, we describe the role of microparticle in coagulation, which is a novel potential biomarker for diagnosing thrombotic disorders and possesses potential to be applied in POCTs of blood viscoelasticity.

Purpose: With increasingly complex care, monitor alarms, and high patient traffic, the postanesthesia care unit (PACU) is one of the loudest patient care areas in the hospital. High noise levels lead to worse outcomes and impede recovery. The objective of this study is to measure the sound levels in the PACU and identify potential causes for increased sound levels.

Design: An observational study in the 24-unit PACU in the Ghent University Hospital was conducted.

Methods: Sound levels were measured every second continuously at 3 separate locations using noise dosimeters over a period of 11 days. During the sound measurements, the patient and nurse census in the PACU was measured.

Findings: The mean A weighted equivalent sound level pressure (LAeq) was 59.0 A-weighted decibel (dBA) (standard deviation 6.5), exceeded the noise levels recommended by the World Health Organization (40 dBA LAEQ). With an average LAEQ of 62.4 dBA (6.1), the morning shift is the noisiest. We evaluated the effect of patient census and nurse census on LAEQ. The overall regression was statistically significant (P < .001). Nurse census and patient census significantly predicted noise levels (P < .001).

Conclusions: Noise levels in the PACU were consistently above the levels recommended by the World Health Organization. Nurse census and patient census seemed to significantly impact the mean noise levels. Our results suggest that the most important sources of ambient noise are consistently present sources such as computers, ventilation systems, air-conditioning. These factors, along with the architectural design and nurse and patient census, might play a very important role in noise control.

Purpose: Duloxetine, a serotonin and norepinephrine reuptake inhibitor primarily used for chronic neuropathic pain, has been debated for its efficacy in total joint arthroplasty contexts.

Design: Umbrella review.

Methods: A comprehensive search spanning PubMed, CINAHL, OVID, Embase, MEDLINE, CENTRAL, Google Scholar, and Cochrane, with no language restrictions up to January 2024, was conducted. Two independent reviewers performed data extraction and quality assessment. Primary outcomes focused on pain scores, with secondary outcomes including morphine consumption.

Findings: This review encompasses 8 randomized controlled trials involving 740 patients and 6 meta-analyses. Moderate-certainty evidence from both individual studies and meta-analyses suggests that duloxetine administration correlates with reduced ambulation (-0.73, 95% confidence interval [CI] -0.95 to -0.51 for central sensitization; -0.36, 95% CI -0.47 to -0.25 for noncentral sensitization) and decreased rest pain scores (-0.81, 95% CI -1.07 to -0.55 for central sensitization; -0.22, 95% CI -0.36 to -0.09 for noncentral sensitization), along with lower morphine consumption (-0.52, 95% CI -0.65 to -0.38). Systematic reviews indicate a consistent trend of duloxetine reducing ambulatory (ranging from -1.45 to 0.13) and resting (ranging from -13.46 to 0.16) pain scores, as well as opioid consumption (ranging from -12.72 to -0.71).

Conclusions: Despite controversies surrounding its efficacy in total joint arthroplasty, duloxetine demonstrates potential in reducing perioperative pain scores and opioid consumption, even in cases of central sensitization. Further trials with larger cohorts are necessary to strengthen the validity of these findings.

Purpose: This study aimed to compare the effects of lavender and rosemary extracts on sore throat and hoarseness after endotracheal intubation in patients undergoing percutaneous nephrolithotomy.

Design: Randomized clinical trial.

Methods: This study was conducted on 90 patients undergoing percutaneous nephrolithotomy at Bahonar Hospital in Kerman in 2021. The patients were selected by convenience sampling method and randomly assigned to three groups: lavender, rosemary, and control. After general anesthesia with endotracheal intubation, an anesthesiologist put sterile gauzes impregnated with 3 cc of rosemary and lavender extracts into patients' throats in the intervention groups, while the control group received 3 cc of distilled water. After the surgery, the gauzes and tracheal tubes were removed and the patients were transferred to the postanesthesia care unit (PACU), their sore throat and hoarseness were measured and recorded during and 2 to 6 to 24 hours after recovery. A significance level of < .05 was considered.

Findings: The study results showed a significant difference in the severity of sore throat between the 3 groups 2, 6, and 24 hours after surgery; sore throat in the rosemary group and then in the lavender group was lower than that in the control group (P < .05). The results also indicated a significant difference in hoarseness intensity between the three groups 2 and 6 hours after surgery; hoarseness intensity in the rosemary and lavender groups was lower than that in the control group, but it was not different between 3 groups 24 hours after surgery (P < .05).

Conclusions: Rosemary and lavender extracts had a positive effect on sore throat and hoarseness. As these herbs cause no complications in patients and are available and inexpensive, further studies are necessary to confirm the use of these herbs during intubation.

Purpose: The purpose of this research was to determine the effect of virtual reality (VR) on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia.

Design: This was a randomized controlled experimental trial.

Methods: The research was conducted in the operating room unit of the state hospital in Hakkari-Şemdinli District Center between May 2021 and June 2022. Data were collected using the Descriptive Information Form, visual analog scale (VAS), verbal category scale (VCS), State-Trait Anxiety Inventory, and the Application Registration Form to record preoperative and postoperative oxygen saturation and heart rate.

Findings: When the groups' VAS and VCS mean scores were compared for head and incision site pain, the mean scores of headache and incision site pain in both groups were found to be significantly lower in the experimental group patients (P < .001). In addition, the difference between the groups in headache VAS and VCS mean scores at all hours was statistically significant; incision site pain VAS and VCS mean scores were significantly lower between the groups at all hours, except the 1st and 2nd hours (P < .001). While there was no significant difference in the State-Trait Anxiety Inventory (SAS) pretest mean scores between the groups (P > .05), the SAS post-test mean scores of the experimental group were significantly lower (P < .05). The mean heart rate in the intraoperative and postoperative periods and the mean saturation in the postoperative period differed significantly between the groups (P < .05). The difference between the blood pressure averages before, during, and after the operation was not statistically significant in both groups (P > .05). While nausea and vomiting was significant in the experimental group only at the 2nd hour (P < .05), it was not statistically significant at the other hours (P > .05).

Conclusions: VR was found to effectively reduce pain, anxiety, postspinal headache, and increase the oxygen saturation level in the postoperative period in patients who underwent spinal anesthesia. Hence, VR is an effective treatment for patients who have undergone surgery under spinal anesthesia.

Purpose: The purpose of this quality improvement project was to implement an evidence-based intraoperative protocol to reduce the incidence of spinal-induced hypotension during elective cesarean sections.

Design: A quality improvement project.

Methods: After receiving education, anesthesia providers implemented the intraoperative protocol for 6 weeks on elective cesarean sections. Intraoperative anesthesia records were retrospectively reviewed and evaluated preimplementation and postimplementation to determine the impact of the project on the incidence of spinal-induced hypotension.

Findings: The final sample included 134 patient charts (64 preimplementation and 72 postimplementation). The incidence of hypotension 10 minutes after spinal placement was not significantly different before (n = 9) or after implementation (n = 13; χ² = 0.4, P = .554). After project implementation, the rate of hypotension was 22% (n = 13) in patients not treated per the protocol and 0% (n = 0, χ² = 3.5, P = .062) in patients treated per the protocol. There was a 39.4% (P < .001) reduction in the need for rescue doses of phenylephrine and a 27.8% (P = .001) reduction in the need for rescue doses of ephedrine after protocol implementation.

Conclusions: Hypotension was not significantly decreased for all patients after project implementation but was eliminated for patients in whom the protocol was used. Provider utilization of the intraoperative protocol was only 18%. It is recommended to pursue additional interventions to increase protocol utilization, accessibility of protocol components, and staff training. Future studies can investigate the impact of this protocol on maternal nausea and vomiting incidence during elective cesarean sections.