Journal of Perianesthesia Nursing最新文献

Purpose: Examine the prone cardiopulmonary resuscitation techniques in patients undergoing surgery.

Design: Systematic review.

Methods: Using the preferred reporting items for systematic reviews and meta-analysis guidelines, PubMed, CINAHL, Cochrane Library, Google Scholar, and gray literature databases were searched to obtain eligible studies. The methodological quality of the case studies was assessed using the tool proposed by Murad and colleagues. Case reports involving surgical patients in a prone position were included.

Findings: A total of 21 patients undergoing neurologic or spinal surgeries were evaluated. The most common cardiac rhythms observed before arrest were pulseless electrical activity, asystole, ventricular tachycardia, ventricular fibrillation, and sudden bradycardia. The etiologies of the cardiac arrests included venous air embolism, hemorrhagic shock, and hypovolemia. Posterior compressions at T7 to T9 vertebral segment, with or without counterpressure, were immediately instituted. Return of spontaneous circulation was achieved in each instance, with an average time to return of spontaneous circulation of 5.60 minutes. Using a quality assessment tool, we determined that all case reports were of high quality and exhibited a low risk of bias.

Conclusions: Prone resuscitation during neurosurgical or spinal surgeries has demonstrated promising outcomes. Additionally, the findings of this review further emphasize the need to train health care personnel in the techniques of prone cardiopulmonary resuscitation.

Purpose: To determine the effectiveness of virtual reality (VR) on preoperative anxiety in adult patients.

Design: A systematic review and meta-analysis of randomized controlled trials.

Methods: A systematic search was carried out using PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, Scopus, PsycINFO, China National Knowledge Infrastructure (CNKI), WANFANG DATA, Chinese Science and Technology Periodical Database (VIP), and Sino-Med from inception to December 18, 2022. All eligible randomized controlled trials published were included (published in English and Chinese). The Cochrane Collaboration "Risk of Bias" tool was used to assess the methodological quality of the included studies. Review Manager software 5.4 was used for data analysis.

Findings: Nine studies with sample sizes ranging from 72 to 255 and 1,046 participants were identified. The results of the meta-analysis showed that VR significantly reduced preoperative anxiety in adults (standardized mean difference = -0.48, 95% CI: -0.93 to -0.03, P = .04). Our results suggested that VR improved postoperative satisfaction scores more effectively compared with control care (mean difference = 15.29, 95% CI: 6.25 to 24.33, P = .0009).

Conclusions: Study results support that VR has a positive effect in reducing preoperative anxiety in adults. VR can also significantly improve patients' satisfaction after surgery. However, the results need to be further assessed due to the small sample sizes and high heterogeneity.

Purpose: To explore what matters to patients on the day of surgery, to describe how a flash mob study was conducted in a perioperative setting and to provide recommendations for future studies adopting the flash mob design.

Design: Flash mob study.

Methods: On June 6 to June 7, 2023, a 24-hour flash mob study was carried out in eight Danish perioperative units. Eligible for inclusion were adult patients scheduled for elective or acute surgery. After giving informed consent, patients answered two qualitative questions: what mattered to them on the day of surgery, and whether the staff were aware of this. Data were analyzed using content analysis. Patient characteristics were presented using descriptive statistics.

Findings: Patients expressed a need to feel safe and cared for, be informed, and to receive proper anesthesia and postoperative care. Twenty-nine percent had not told health care staff, most often because they had not been asked about what mattered to them and because they did not want to be a nuisance.

Conclusions: The flash mob study was feasible and provided insight into patients' perspectives on the day of surgery. To gain insight into what matters on the day of surgery, health care professionals must actively ask patients. Furthermore, the flash mob proved to be an opportunity to create attention to what matters to patients on the day of surgery.

Purpose: Surgical patients frequently experience symptoms such as preoperative anxiety, postoperative pain, and nausea and vomiting. The aim of this study was to determine the effects of acupressure on preoperative anxiety, postoperative pain, and nausea and vomiting in otolaryngology patients.

Design: The study was designed as a prospective, assessor-blinded, parallel, 2-armed (1:1), randomized controlled trial.

Methods: The sample of this study consisted of 60 otolaryngology patients. Patients were assigned to the acupressure (n = 30) or control (n = 30) groups (1:1) through randomization. During the preoperative period, participants in the acupressure group received a 15-minute treatment involving pressure applied to the HT7, LI4, and EX-HN3 points. No intervention was administered to participants in the control group. Preoperative anxiety levels were evaluated using the State Anxiety Scale both before and 15 minutes after the acupressure application. Postoperative pain was assessed using the Numeric Pain Rating Scale at 4 hours postoperatively, at 10:00 p.m., at 08:00 a.m., and upon discharge. Postoperative nausea and vomiting were assessed at discharge using the Rhodes Index of Nausea, Vomiting, and Retching.

Findings: Although the preoperative anxiety of the control group increased in the operating room waiting area, that of the acupressure group decreased significantly (P = .033). The postoperative pain severity levels of the 2 groups were similar at the fourth hour after surgery and at 10:00 p.m. (P > .05), whereas they were significantly lower at 08:00 a.m. (P = .04) and discharge (P = .048) in the acupressure group. No significant difference was found between the groups in postoperative nausea and vomiting symptoms (P > .05).

Conclusions: Acupressure was effective in reducing the severity of preoperative anxiety and postoperative pain in otolaryngology patients, but the same effect was not observed in postoperative nausea and vomiting.

Purpose: To determine if language-based disparities in postoperative pain management exist in women undergoing gynecologic surgery.

Design: A retrospective cohort study was performed.

Methods: The electronic medical records were reviewed of individuals, aged 18 to 80, who underwent an abdominal hysterectomy between 2016 and 2021 at the University of Colorado Anschutz Medical Center. A random sample of 100 patients, 50 categorized as English proficient and 50 categorized as having limited English proficiency (LEP), were compared. The primary outcomes were the number of quantitative pain assessments and the total dose of opioid given in oral morphine milligram equivalents. The secondary outcomes were the average pain scores, the number of qualitative pain assessments, postanesthesia care unit length of stay, regional block use, patient-controlled analgesia, or opioid use after the first 24 hours. Linear and generalized linear modeling was used to assess the relationship between English proficiency and the outcomes of interest.

Findings: All patients received at least 1 pain assessment while in the postanesthesia care unit (range 2 to 25). There was no significant difference in the number of objective pain assessments or the total dose of opioid given between the groups. There were no significant differences in any of the secondary outcomes between the groups. On subgroup analysis, the presence of a documented bedside interpreter did not result in a significant difference in endpoints. Fewer LEP patients received patient-controlled analgesia (34% LEP vs 58% English proficient), though the difference did not reach statistical significance.

Conclusions: Language barriers may complicate care and impact postoperative recovery. In our population of women in a high-volume, urban, level I, trauma center, there were no observed differences in postoperative pain management practices in patients with LEP compared with English-proficient patients. Standardized nursing protocols may contribute to more equitable care. Ongoing investigations in the identification and prevention of language-related disparities in perioperative care are warranted.

Purpose: Intradermal injection of local anesthetic has been reported to have greater analgesic effect for peripheral venous catheter (PVC) insertion than topical application in adult surgical patients. However, the injection of local anesthetic itself is a painful procedure compared to topical application. We compared the analgesic effect of a lidocaine-prilocaine patch with intradermal injection of 2 % lidocaine on pain intensity at the time of analgesia and PVC insertion as assessed by a visual analog scale (VAS) in adult patients.

Design: A prospective observational study.

Methods: After institutional review board (IRB) approval, we studied 70 patients scheduled for surgery and expected to have peripheral venous cannulation in the operating room. Patients who presented in the operating room with a topical anesthetic patch were assigned to the patch group, and patients who presented without a topical anesthetic patch were assigned to the injection group. The injection group received a 2 % lidocaine injection with a 26-gauge (G) needle just before PVC insertion by anesthetists. The patch group received a lidocaine-prilocaine patch on the dorsal hand 1 to 2 hours before the scheduled surgery time by ward nurses. The primary endpoints were pain using the VAS score at the time of PVC insertion and pain associated with the local anesthetic procedure.

Findings: The patch group included 34 patients (21 male, 13 female, age 61 [median], interquartile range [IQR] 45 to 69), and the intradermal injection group included 31 patients (22 male, 9 female, age 60 [median], IQR 52 to 73). All patients analyzed had a 20-G catheter in the dorsal hand. The median VAS score for PVC insertion was 4 in the intradermal injection group (IQR 0 to 14) and 2 in the patch group (IQR 0 to 16) (P = .707). Median VAS scores for the local anesthetic procedure were 16 in the intradermal injection group (IQR 10 to 32) and 0 in the patch group (IQR 0 to 0) (P < .001).

Conclusions: We found no difference in the pain intensity for PVC insertion between topical application of local anesthetic by lidocaine-prilocaine patch and intradermal injection of 2 % lidocaine. VAS scores for anesthetic application were significantly lower in the patch group. The lidocaine-prilocaine patch provided analgesia equivalent to intradermal injection with 2 % lidocaine for PVC but without the pain associated with injection of local anesthetic.

Purpose: To explore the analgesic characteristics of ultrasound-guided great auricular nerve (GAN) block to further improve pain management.

Design: Single-center, prospective, randomized, controlled, and double-blind preliminary clinical trial.

Methods: Thirty-seven patients who underwent middle ear surgery were included in this study: 15 in the GAN block group (the large ear nerve block [NB] group) and 22 in the traditional anesthesia group (control [CON] group). After induction of anesthesia, the NB group was given an ultrasound-guided GAN block (0.25 % Ropivacaine 2 mL), while the CON group was exempt from the GAN block. The patient's basic information, perioperative information, the region, and numeric rating scale of postoperative pain (at 1 hour, 6 hours, 12 hours, and 24 hours), and adverse reactions were recorded. Repeated measurement analysis, t test, and Fisher exact probability method were used for statistical analysis.

Findings: Compared with the CON group, the numeric rating scale in the NB group was lower after surgery (1 hour: 1.18 ± 0.35 vs 0.27 ± 0.20, P = .023; 6 hours: 1.82 ± 0.37 vs 1.13 ± 0.39, P = .203; 12 hours: 1.05 ± 0.19 vs 0.20 ± 0.10, P < .001; 24 hours: 0.55 ± 0.17 vs 0.13 ± 0.09, P = .029). In the NB group, the region of pain was merely concentrated in the ear canal. In the CON group, the pain extended to areas outside the ear canal, such as tragus and mastoid (at 12 hours, P = .006). There was no significant difference in the risk of postoperative adverse reactions between the two groups.

Conclusions: Ultrasound-guided GAN block can relieve patients' pain after middle ear surgery, especially in the area outside the ear canal.

Purpose: To determine the prewarming effect on body temperature in the perioperative period of patients undergoing conventional abdominal surgery and the level of thermal comfort.

Design: A randomized controlled clinical trial.

Methods: A Brazilian oncology hospital located in São Paulo. A total of 99 patients aged 18 years or over undergoing elective conventional abdominal surgeries, with a minimum duration of 1 hour of anesthesia. The study was carried out from 2019 to 2021. Patients were randomized into 3 groups: prewarming with a blanket and cotton sheet (control; n = 33); prewarming with a forced-air warming system for 20 minutes (intervention 1; n = 33); prewarming with a forced-air warming system for 30 minutes (intervention 2; n = 33). Central temperature was measured by a zero-heat-flux temperature sensor every 20 minutes from the preoperative period until the surgery end time. The level of thermal comfort was determined through self-report during the preanesthetic and postanesthetic periods.

Findings: There was a significant difference between the temperatures between the groups (P = .048), with evidence of greater benefit in maintaining the temperature in the group that received the prewarming intervention for 20 minutes. There was no significant difference between the percentage of temperatures below 36 °C among the groups (P = .135). Patients in the intervention groups were more comfortable during the postanesthetic recovery period than those in the control group (P = .048). Only 7 (8.24%) patients had postoperative chills (P = .399) and more than half of these incidents occurred in the control group (4; 13.3%).

Conclusions: Prewarming for 20 minutes obtained the best results, showing the lowest average of temperature episodes below 36 °C during the intraoperative period and greater thermal comfort as reported by patients.

Purpose: The present study aimed to evaluate the effects of three different doses of ropivacaine in Shang Ring circumcision in school-aged children.

Design: This is a prospective, randomized, controlled study.

Methods: A total of 148 American Society of Anesthesiologists I to II children were enrolled and randomly assigned into the R0.2%, R0.25%, and R0.3% groups. These groups received 0.2%, 0.25%, and 0.3% of ropivacaine (0.5 mL/kg) for caudal block, respectively. The perioperative data on anesthesia quality (including adequate analgesia rate, analgesic duration, lower extremity numbness duration, and postoperative first urination time), and adverse events were collected. Hemodynamic variables were also measured perioperatively.

Findings: The adequate analgesia rate of caudal block in the R0.2% group (75.5%) was significantly lower than that in the R0.25% (94.0%) and R0.3% groups (98.0%) (P = .001). The analgesic duration of the R0.2% and R0.25% groups was significantly less than that of the R0.3% group (P < .001). The duration of lower extremity numbness in R0.2% group was significantly shorter than that in R0.25% (P < .05) and R0.3% groups (P < .01), and there was no significant difference between the R0.25% and R0.3% groups. The first urination time of R0.2% was significantly shorter than the R0.3% group (P < .05). There was no significant difference between the R0.2% and R0.25% or the R0.25% and R0.3% groups. No significant difference was found in adverse effects among groups (P > .05).

Conclusions: Caudal block with 0.3% ropivacaine can provide more satisfactory intraoperative analgesia quality for school-aged children receiving Shang Ring circumcision, without increasing the risk of adverse effects.