Journal of Perianesthesia Nursing最新文献

Purpose: Evaluate the effectiveness of various drugs in preventing postdischarge nausea and vomiting (PDNV).

Design: Systematic review.

Methods: A search for evidence was conducted in PubMed, CINAHL, Cochrane Collaboration, and Google Scholar and gray literature. Only randomized controlled trials examining a pharmacological agent to prevent PDNV were included in the study. The quality appraisal of the literature was conducted using the proposed algorithm described in the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide.

Findings: A total of 8 randomized controlled trials involving 1,441 patients were analyzed. The efficacy of pharmacological agents, including dexamethasone, olanzapine, ondansetron, palonosetron, ramosetron, promethazine, and casopitant in the prevention of PDNV, varied. Additionally, a combination of two or more drugs is a more effective therapy than using a single drug in mitigating PDNV. The review also underscored the individual patient factors that can play a significant role in identifying appropriate prevention and treatment modalities.

Conclusions: There is limited evidence on the efficacy of pharmacological agents in preventing PDNV. The scarcity of large-scale, clinical trials specifically focusing on PDNV restricts the ability to recommend prophylactic drug therapy for reducing its incidence.

Purpose: Laryngeal microsurgery is a challenging surgery because of the risk of airway complications. Therefore, extubation is of significant importance. We aimed to investigate the effect of magnesium sulfate on extubation quality, recovery features, and complications.

Design: A prospective, randomized, controlled clinical trial.

Methods: Ninety-eight adult patients scheduled for larynx laser microsurgery were included and randomly allocated to two groups to receive magnesium sulfate 30 mg/kg in 100 mL saline infusion (maximum 2 g) (group M) or saline 100 mL (group S) before induction of anesthesia. Anesthesia induction was performed with propofol 2 mg/kg, rocuronium 0.6 mg/kg, remifentanil 0.5 mcg/kg, and general anesthesia maintained with total intravenous anesthesia (propofol 3 to 7 mg/kg, remifentanil 0.05 to 0.1 mcg/kg/min, and O₂/air 30/70 mixture). A train of four was used for neuromuscular monitoring. Extubation quality score, extubation time, postanesthesia care unit time, numerical rating scale, and complications were recorded.

Findings: Extubation quality scores were better in group M than group S (46 patients compared to 28 patients who had mild or no cough, P < .001, respectively). Extubation time was similar between groups. Postanesthesia care unit time was 15.7 ± 2.9 minutes in group M and 13.4 ± 4.6 minutes in group S, respectively (P = .01). Numerical rating scale scores were lower in group M than in group S (1 (1 to 2), 3 (2 to 3.5), respectively, P < .001).

Conclusions: Magnesium sulfate before induction of anesthesia resulted in better extubation quality scores without delayed recovery and positively affected postoperative analgesia.

Purpose: To develop the Safe Use of Technology in the Operating Room Scale (SUTORS) and evaluation of its psychometric properties.

Design: The study was a scale development study including the validity and reliability analyses.

Methods: The study was conducted in training and research hospitals located in Istanbul, Turkey. The sample population comprised all health care professionals working in the operating rooms of the relevant hospitals. A total of 54 health care professionals were recruited for the preliminary implementation, and those who participated were excluded from the final sample. The sample size consisted of 437 health care professionals. The study collected data using the Healthcare Professional Identification Form and the SUTORS. The scope, content, and language appropriateness were evaluated. The data were then analyzed using various statistical methods, including Cronbach's α, halving, principal component analysis, confirmatory factor analysis, discriminative item analysis, cumulative explained variance, and composite reliability values.

Findings: The health care professionals had an average age of 30.69 ± 6.64 years and had been working in the operating room for an average of 5.94 ± 5.86 years, and 39.6% of them were nurses. The scale draft consisted of 134 items and 3 sections in total, and a 53-item scale was constructed as a result of content and linguistic validity. On completion of the explanatory and confirmatory factor analyses, the SUTORS, consisting of 45 items and 3 separate scale sections, was finalized. The scale comprises 45 items and 3 distinct sections for general applications, surgical team, and anesthesia team. Cronbach's α values were calculated for each section, resulting in 0.928, 0.906, and 0.946, respectively.

Conclusions: All three sections of the SUTORS are valid and reliable measures that can be used to assess the safe use of technology in the operating room.

Purpose: This study aimed to compare the effect of povidone iodine (PI) and chlorhexidine gluconate (CG) shower groups on the healing process in cesarean section operations.

Design: Randomized controlled trial.

Methods: Patients were recruited from Gynecology and Obstetrics Hospital in Turkey between February and May 2021. In total, 102 pregnant women were scheduled for elective cesareans. They were randomly divided into PI group (A), CG group (B), and CG shower group (C) operated by three gynecology and obstetrics physicians. During the data collection, a demographics form, an incision site evaluation form, a visual analog scale (VAS), and a postpartum comfort questionnaire (PPCQ) were used. Data from the in-house blinding study to avoid bias and follow-up of the women were done for 7-day duration following postnatal to assess postoperative comfort, pain, and wound complications.

Findings: The VAS, pain, erythema, warm, edema, discharge, and wound opening were statistically evaluated at the incision site with 3 measurements for each of the groups. There was a significant difference in the CG groups (2 and 3) (VAS P < .000, erythema P < .05, and edema P < .05). The mean PPCQ score was higher in the CG groups (2 and 3) and showed a significant difference compared with the PI group (P < .000).

Conclusions: Due to the antiseptic and nonirritating properties of CG, showering 6 hours before the operation contributed to the wound healing process according to the incision site evaluation form and to a corresponding increased PPCQ level of the mother in the postoperative period.

Purpose: The purpose of this study was to systematically encapsulate the array of discomfort symptoms ensuing from sedative-administered colonoscopy, with the overarching objective of formulating screening criteria conducive to the identification of the core clinical symptoms characterizing postoperative fatigue syndrome (POFS).

Design: A single-center descriptive study.

Methods: We selected patients who had undergone a sedative-administered colonoscopy and conducted a telephone follow-up to examine the occurrence of postoperative discomfort symptoms.The Common Terminology Criteria for Adverse Events (Version 5.0) was used to determine the discomfort symptoms and preliminarily assess the severity by comparing the collected patient feedback information. Basic patient information was collected at the anesthesia clinic or at the endoscopy center. The initial telephone follow-ups were conducted 24 hours after the examination.

Findings: The analysis involved 542 patients who successfully completed the investigation, yielding a compilation of 19 postoperative discomfort symptoms, encompassing fatigue, lethargy, dizziness, and others. Following a meticulous screening process, the identified core clinical symptoms of POFS were narrowed down to fatigue, lethargy, dizziness, and headache.

Conclusions: The diagnostic criteria for POFS should encompass the presence of fatigue, lethargy, dizziness, and headache, as these symptoms constitute the core clinical manifestations.

Purpose: This study aimed to investigate the impact of music on preoperative fear and anxiety in patients undergoing thyroid surgery.

Design: This was a randomized controlled prospective study.

Methods: This study was conducted at the general surgery clinic of a training and research hospital from April 10, 2021 to April 1, 2022. The study included 76 patients who were scheduled for thyroid surgery and were randomized into equal-sized intervention (music) and control groups. Participants in the music group were asked to listen to music for at least 30 minutes every 3 hours until surgery. Both groups completed the Surgical Fear Questionnaire (SFQ) and Anxiety Specific to Surgery Questionnaire (ASSQ) 24 hours before surgery and 1 hour before transfer to the operating room. Descriptive statistics, χ² tests, independent and paired sample t tests, one-way analysis of variance, and Pearson's correlation were used for data analysis.

Findings: Although the post-test scores of both the music and control groups on the SFQ and ASSQ were significantly lower than the pretest scores, there was no significant difference between the two groups. Additionally, there was no significant difference between the sociodemographic characteristics and the obtained SFQ and ASSQ scores. A moderate positive correlation was found between the SFQ and ASSQ scores.

Conclusions: The findings indicate that listening to music did not reduce preoperative fear and anxiety in patients undergoing thyroid surgery.

Purpose: In response to nurse concerns of the need for additional support from unit nursing assistants (NA) at the bedside, we set a goal to improve RN satisfaction with the role of the NA in the postanesthesia care unit (PACU).

Design: Prospective pre/post design.

Methods: Using LEAN methodology, the NA role was expanded to encompass their full scope of practice at the bedside, and the responsibility of performing patient transport from the PACU was reallocated to a Centralized Transport Service over a 6-month period.

Findings: The total number of transports performed by NA decreased by approximately 20%. Time spent waiting for a Centralized Transporter decreased from an average of 56 to 11 minutes. RN satisfaction increased in the 3 areas explored, with a 12.5% increase in median overall satisfaction with the NA role. Our facility's Hospital Consumer Assessment of Healthcare Providers and Systems scores also increased from previous months after this project, alluding to more effective care delivered to patients in the PACU.

Conclusions: Realignment of roles can promote efficiency and throughput. Communication fosters teamwork and can improve staff satisfaction.

Purpose: Define the impact of the implementation of evidence-based music medicine (MM) on pain management outcomes after abdominal and pelvic surgery when combined with usual care.

Design: This quality improvement project implemented MM in a hospital postanesthesia care unit using a pretest-posttest design. The Roy Adaptation Model and Kotter's Change theory guided all project phases.

Methods: Nursing staff were educated in-person, via electronic formats and paper handouts. A convenience sample of adults who underwent abdominal or pelvic surgery was offered a preselected MM playlist (via earphones and MP3 players) in addition to usual care during the Phase I recovery period. The outcomes included administered opioids (oral morphine milligram equivalents), pain levels (numerical rating scale), heart rate, respiratory rate, and systolic blood pressure. The outcomes for those who accepted MM (music group) were compared to those for patients admitted to the postanesthesia care unit 1 month before project implementation (baseline group).

Findings: The music group data revealed highly significant reductions in heart rate (P = .008, Cohen's d = 0.57) and systolic blood pressure (P < .001, Cohen's d = 0.78) at 30 minutes compared with pretest data. In contrast, the baseline group data showed no effect on systolic blood pressure levels (P = .274). The music group showed higher clinical significance (1.8 to >2-fold higher effect size) on reducing numerical rating scale scores at 30 minutes (music group: P < .001, Cohen's d = 1.19; baseline group: P = .008, Cohen's d = 0.55) and the final period in phase I (music group: P < .001, Cohen's d = 1.71; baseline group: P < .001, Cohen's d = 0.93). The mean morphine milligram equivalents dose for the music group (29.5 ± SD 19.8) compared with the baseline group (33.0 ± SD 26.6) was not significantly different (P = .376, Cohen's d = 0.18).

Conclusions: Adding MM with usual care leads to statistically and clinically significant reductions in pain indicators in adults who had abdominal or pelvic surgeries versus usual care alone.