Journal of Perianesthesia Nursing最新文献

The purpose of this paper is to summarize the nursing experience of a patient who developed a tracheo-mediastinal fistula following bronchoscopic balloon dilation for severe central airway stenosis due to tuberculosis. Key nursing points include: early recognition of complications; enhanced monitoring of the patient's condition to watch for recurrence of the fistula; dynamic monitoring of the circulatory system to prevent obstructive shock; evidence-based and standardized care for indwelling catheters; meticulous management throughout the course of treatment to eliminate mediastinal and subcutaneous emphysema; monitoring thrombus detachment and appropriate anticoagulant therapy; improving discharge guidance and continuous nursing. After effective treatment and careful nursing, the patient made a full recovery and was discharged smoothly.

Purpose: Acupuncture is a potentially beneficial addition to the enhanced recovery after surgery (ERAS) strategy for improving the quality of surgical care for breast cancer. This study evaluated the advantages of acupuncture in postoperative recovery after breast cancer surgery.

Design: A prospective, blinded, randomized, case-control study.

Methods: In this single-center, parallel-group, randomized controlled trial, 144 breast cancer patients undergoing surgery were allocated to the following groups: (group A) conventional group (no acupuncture treatment); (group B) preoperative acupuncture (acupuncture treatment given 1 day before surgery); (group C) intraoperative acupuncture (acupuncture treatment given on the day of surgery); and (group D) a combination of preoperative and intraoperative acupuncture (n = 36/group). The primary outcome was the intraoperative consumption of anesthetics. The secondary outcomes included heart rate and blood pressure changes, intraoperative blood glucose level, pH, and bispectral index, recovery and extubation time, postoperative functional assessment of cancer therapy-breast score, and adverse reactions.

Findings: Intraoperative consumption of sufentanil and blood glucose level was significantly decreased in group C, and no interactive effect was found between the preoperative and intraoperative acupuncture groups. Preoperative heart rate in groups B and C showed significant changes. The 1-week postoperative functional assessment of cancer therapy-breast score was most markedly improved in group C compared with other groups. No adverse reaction occurred with acupuncture.

Conclusions: Intraoperative acupuncture alone is adequate for optimizing the intraoperative state, and preoperative acupuncture seems unnecessary. Acupuncture is safe, with potential benefits for enhanced recovery after surgery in breast cancer surgery.

Trial registration: Chinese Clinical Trial Registry, ChiCTR1800019979.

Purpose: Thirst is a high-incidence condition that causes patients to experience problems in the early postoperative period in the postanesthesia care unit (PACU). The study was conducted to determine the effect of oral water and ice application in managing early postoperative thirst.

Design: Randomized controlled trial.

Methods: The study was conducted between January and April 2017 with 150 patients who were transferred from the operating room of a university hospital to the PACU and met the research criteria. The patients were divided into treatment (water group = 50, ice group = 50) and control (n = 50) groups. Patients in the intervention group received oral water/ice application after admission to the PACU after surgery. Patients in the control group received routine treatment and care.

Findings: In intragroup comparisons before and after the application, there was a statistically significant decrease in thirst, dry mouth, dry throat, and difficulty in swallowing in the water and ice groups (P < .001); ice application was more effective than water application, and there was no significant difference in the control group (P > .05).

Conclusions: Postoperative oral water/ice application was an effective and safe nursing intervention to reduce thirst, dry mouth, dry throat, and difficulty in swallowing. Ice application was more effective.

Purpose: To investigate the effect of nonpharmacological methods on anxiety before breast surgery, using the meta-analysis method.

Design: A meta-analysis.

Methods: Nine electronic databases were searched to identify studies published up to October 2023. The study was carried out in accordance with Preferred Reporting Items for Systematic Review and Meta-analyses 2020 and Cochrane 2021 recommendations. The Risk of Bias 2 tool was used to assess the risk of bias. Heterogeneity and publication bias were also assessed.

Findings: A search of 9 electronic databases identified 280 records. Six studies that met the inclusion criteria were eligible for meta-analysis. All the trials explained how the randomization was done. The studies selected were published between 2016 and 2022. A total of 519 female patients were included in the selected trials, 303 in the intervention group and 216 in the control group. The studies included aromatherapy, music, electro-acupuncture, and Yokukansan Kampo medicine practices. A meta-analysis was performed with anxiety levels measured immediately before surgery. In addition, a subgroup analysis was performed with trials that used anxiety-specific scales before surgery and trials that used aromatherapy.

Conclusions: The results of this meta-analysis indicated a moderate efficacy of nonpharmacological approaches, whereas aromatherapy showed a relatively lower efficacy in reducing preoperative anxiety in breast surgery patients.

Purpose: Pressure injuries can often occur in patients undergoing surgical, diagnostic, or other invasive procedures, so it is important to assess patients in the perioperative period. This study was conducted to determine the incidence and risk factors of perioperative pressure injury.

Design: A cross-sectional, prospective, and descriptive study.

Methods: This study involved 158 patients who met the study's eligibility criteria between May 2022 and July 2022. The data were collected using the Patient Information Form, Munro Scale, Braden Scale, and pressure injury staging form. The patients were monitored postoperatively or for 3 days.

Findings: Pressure injury developed in 13.9% of the patients. Perioperative risk factors were age, edema, mobilization time, parenteral nutrition, blood transfusion, and glucose level, while preoperative albumin level was lower in patients with pressure injury. In the postoperative period, the risk factors were duration of mobilization and transition to oral feeding, length of intensive care unit stay, and low Braden score. In multivariate analysis, the variables that showed significance with the risk of pressure injury were postoperative Munro score and edema.

Conclusions: It is crucial to evaluate the risk factors for pressure injury in patients who have undergone surgical procedures.

Purpose: Perioperative respiratory adverse events continue to pose significant challenges in pediatric anesthesia. Research has hinted at a lower incidence of these complications in children anesthetized with propofol than sevoflurane. This study aimed to assess and compare respiratory complications in children undergoing general anesthesia with either sevoflurane or propofol during surgery.

Design: Systematic review and meta-analysis.

Methods: We conducted comprehensive searches of the PubMed, Embase, and Cochrane Library databases and manual searches to identify pertinent randomized controlled trials (RCTs) published up to August 19, 2023. The Cochrane risk assessment tool was employed to evaluate the risk of bias in the selected studies. The pooled analysis of relevant data compared respiratory complications, vomiting, agitation, anesthesia duration, extubation time, and recovery time in pediatric patients undergoing anesthesia with sevoflurane and propofol.

Findings: A total of 17 RCTs, containing 1,758 pediatric participants, were included and analyzed. Respiratory adverse events were examined, encompassing laryngospasm, apnea, cough, and SpO2. In comparison to sevoflurane, children subjected to propofol anesthesia demonstrated a significant reduction in the risk of laryngospasm (P = .001), vomiting (P < .001), and agitation (P = .029). Especially in patients receiving laryngeal mask airway, propofol anesthesia significantly reduced the incidence of laryngospasm (P = .003) and agitation (P < .001). At the same time, they exhibited an increased risk of apnea (P = .039). Notably, no statistically significant disparities were observed between sevoflurane and propofol concerning cough, SpO2 < 95%, anesthesia time, extubation time, and recovery time. Administration of propofol following sevoflurane anesthesia did not significantly impact the occurrence of vomiting or the recovery time.

Conclusions: While propofol presents an elevated risk of apnea, it concurrently yields a significant reduction in laryngospasm, vomiting, and agitation. Consequently, propofol emerges as a favorable anesthetic option for pediatric patients.

Purpose: Enhanced Recovery After Surgery (ERAS) is a concept that covers evidence-based practices and requires multidisciplinary teamwork, and nurses play a key role in this team. This qualitative research is conducted to describe the experiences of nurses implementing ERAS and the obstacles they encounter in practice.

Design: This research was conducted using the phenomenology pattern, one of the qualitative research designs.

Methods: The research study group was determined by criterion sampling, one of the purposeful sampling methods.The criterion for participation in this study is to follow at least one of the steps of the ERAS protocol and volunteer to participate in the study. In this context, 12 nurses who met the inclusion criteria participated in the study. Data were obtained from May 1 to May 31, 2023 using an introductory information form and a semistructured interview form. The introductory information form asked questions such as age, gender, marital status, working year, ERAS application time, and total working year. The semistructured interview form, developed by the authors based on the related literature, consisted of four open-ended questions 1The obtained data were analyzed using the seven-step Colaizzi method.

Findings: The study identified three themes: the importance of the ERAS protocol, the obstacles to the ERAS protocol, compliance with the ERAS protocol and applicability. Nine subthemes were found: reducing complications and accelerating the healing process, increasing the level of satisfaction, lack of knowledge, leader confusion, resistance to change, lack of team cooperation, policy, leadership, and education.

Conclusions: This study revealed the experiences of nurses who implement at least one component of ERAS protocols regarding the obstacles to the implementation of the protocol. As a result, nurses stated that lack of information and team cooperation, leader complexity, and resistance to change were obstacles to the protocol. Identifying the obstacles encountered in the implementation of the protocols is important for producing solution suggestions.

Purpose: In 2019, approximately 5% of blood draws in the postanesthesia care unit (PACU) were hemolyzed compared to 1.1% across other hospital units. A preliminary review showed almost 60% of patients sampled blood employing arterial lines in the unit. The purpose of this quality improvement study was to improve blood drawing practices and reduce the occurrence of hemolysis. A secondary aim was for PACU nurses to lead this unit-based initiative.

Design: Team members led by PACU nurses used the Deming model of quality improvement as a framework to better the process of specimen collection.

Methods: The team employed the Plan-Do-Check-Act procedure to organize their improvement efforts. Specimen collection protocol was modified to include manual aspiration from arterial lines and hemolysis data was retrieved from laboratory generated reports and electronic medical records.

Findings: By changing blood drawing practices, the hemolysis rate was significantly reduced from 5.2% to 3.6%. Two years postimplementation, rates continue to decline with the current rate at 1.97%.

Conclusion: This nurse-led interdisciplinary improvement initiative identified and trialed evidence-based solutions to reduce blood specimen hemolysis.

Argininemia is a rare autosomal recessive metabolic disorder characterized by a deficiency of arginase, a vital enzyme in the urea cycle. This metabolic defect results in the accumulation of arginine and its metabolites, leading to hyperammonemia and associated neurological symptoms. We present a case detailing the perioperative management of an 11-year-old male child diagnosed with argininemia undergoing circumcision. The perioperative management of patients with argininemia presents unique challenges due to the risk of hyperammonemia and neurological decompensation triggered by physiological stress, fasting, and the catabolic state associated with surgery. This case report highlights the importance of individualized anesthetic strategies for patients with rare metabolic disorders like argininemia. A multidisciplinary approach involving collaboration among anesthesiologists, endocrinologists, dietitians, and surgeons is essential to ensuring a safe perioperative experience for these patients. Further research is essential to refine perioperative protocols and optimal anesthetic interventions for individuals with argininemia undergoing surgical procedures.

Purpose: The purpose of the telehealth preanesthesia clinic (PAC) is to reduce the number of day-of-surgery (DOS) cancellations through the implementation of an algorithm-based standardized protocol.

Design: A prospective quality improvement project with pre and post assessment.

Methods: One hundred and fifty preoperative and postoperative surgical chart reviews using the Focus, Analyze, Develop, Execute, and Evaluate model. Retrospective chart reviews were conducted via the electronic health record to collect DOS cancellation counts along with reason for cancellation for a 6-week period prior to implementation, and a 6-week period postimplementation based on inclusion and exclusion criteria.

Findings: The implementation of a telehealth PAC using TEMPO (transition and action, evaluation and significant history, medications, procedure and condition, and overall plan) protocols resulted in a statistically significant reduction in DOS cancellations from 3.38% to 1.72%.

Conclusions: Postimplementation findings support the use of a telehealth PAC to reduce DOS cancellations.