Perioperative Care and Operating Room Management最新文献

Background

Medication errors (MEs) frequently occur during the execution and administration of anesthesia and are influenced by several factors, such as the experience of the anesthesia staff, the severity of comorbidities, and the technique used. Without pharmacy approval or referral to other staff, anesthesia staff prepare, administer, and monitor powerful anesthetic drugs. This study aimed to evaluate medication errors made by anesthesia staff members working in government hospitals in Sana'a City, Yemen. Methods: A total of 102 anesthesia staff members in government hospitals participated in a descriptive cross-sectional study consistent with the STROBE guidelines was used. The data were collected through a self-administered questionnaire administered during a previous study from March 26th to April 9th, 2022.

Results

A total of 83.3% of the participants were males. A total of 37.3% were aged 25–30 years, 58.8% had 1–5 years of experience, 52.0% had a diploma, and 80.4% were anesthesia technology specialists. In relation to medication errors, 56.9% of them experienced administration errors in their anesthesia practice. There were statistically significant differences in the opinions of preventive measures between anesthesiologists and anesthesia technology specialists.

Conclusion

There was a high occurrence of anesthetic medication errors in Sana'a government hospitals. Syringe labeling practices need to be standardized by policymakers, and future studies should concentrate on the factors that encourage reporting errors in nonpunitive cultures.

Purpose

Since the hospital stay of patients after ambulatory surgery is short, it is important to determine the factors that may cause problems in the early postoperative period. Among these factors, the effects of which are not fully known are active smoking and secondhand smoke exposure. This study aimed to elucidate how active smoking and secondhand smoke exposure effect early outcomes of ambulatory surgery.

Methods

A prospective observational study was conducted with 124 patients (42 active smokers, 40 nonsmokers exposed to secondhand smoke and 42 nonsmokers) who underwent ambulatory general surgery. Patients were closely monitored for cardiac and respiratory complications, as well as pain, opioid use, and nausea and vomiting until discharge from the hospital.

Results

Postoperative complications were observed in 50.8 % of the patients. Hypotension was more common in active smokers compared with nonsmokers and nonsmokers exposed to secondhand smoke. Smokers were more likely to require postoperative supplemental oxygen therapy. Pain intensity at 1st and 4th hours after surgery was significantly higher in smokers (p <  0.005). In addition, nonsmokers exposed to secondhand smoke exhibited more severe pain than nonsmokers (p = 0.001). There were no statistically significant differences between the groups with regard to opioid consumption.

Conclusion

Although smoking and secondhand smoke exposure are not associated with serious complications after ambulatory surgery, patients' comfort and the success of ambulatory surgery may be negatively affected due to severe pain associated with smoking and secondhand smoke exposure.

Objectives

The subcostal transversus abdominis plane (STAP) block has recently been included in the enhanced recovery after surgery (ERAS) protocol for laparoscopic cholecystectomy (LC). In our study on STAP for LC, we compared the effectiveness of adding low-dose magnesium sulphate (MgSO₄) to bupivacaine versus using bupivacaine alone. MgSO₄ was hypothesized to enhance the analgesic effects of bupivacaine and therefore aid in the recovery process.

Methods

Sixty patients, aged 18–65 years, ASA I–II, undergoing LC, were randomly assigned to receive bilateral STAP 15 min before skin incision with 20 ml bupivacaine 0.25 % and either 150 mg MgSO₄ (BM group) or 1.5 ml normal saline (B group). Pain scores, time to initial analgesic demand, overall analgesic requirement, sedation, emetic episodes, time to get out of bed, and patient satisfaction were recorded for the first 24 h following surgery. The Mann-Whitney U test was used to analyze the non-normally distributed data between groups, while the Chi-square test or Fisher^’s exact test was used to test categorical data.

Results

The BM group had statistically significant but clinically insignificant lower pain scores at rest and during coughing in the post-anesthesia care unit (PACU) (P = 0.005 and P = 0.003), at 1 h (P = 0.005 and P = 0.015), 6 h (P = 0.009 and P = 0.003), 12 h (P = 0.017 and P = 0.001), and 24 h (P = 0.001 and P = 0.001) after surgery compared to the B group. Kaplan–Meier curves for times to the first paracetamol and morphine doses showed significant differences (log-rank test) between the groups (P = 0.001 and P = 0.003, respectively). Additionally, the total doses of paracetamol (P = 0.001) and morphine (P = 0.001) in the BM group were significantly lower than those in the B group during the first 24 h after surgery. Sedation and emetic episodes were identical between the groups. The Patient in the BM group ambulated faster (P = 0.001) and were more satisfied (P = 0.026) than those in the B group.

Conclusions

Adding a low-dose (150 mg) of MgSO₄ to bupivacaine in the STAP block for LC was associated with improved analgesic outcomes in the first 24 h after surgery.

Ethical approval

Medical Ethics Committee of Faculty of Medicine, IRB no: 17,100,622 on November 15, 2016.

Trial registration

ClinicalTrials.gov (NCT03612947) on August 2, 2018.

Objective

This scoping review aimed to identify and synthesise existing literature on patient-facing e-health interventions to support self-management and preparation for or recovery from surgery for adult patients.

Introduction

Patients waiting for surgery often experience distress and uncertainty, which can lead to suboptimal surgical preparation and recovery. E-health interventions may provide new models of care to address these issues and maximise value-based healthcare.

Inclusion criteria

Studies were included if adult patients utilised an e-health intervention to support self-management in preparation for and recovery from their surgery, with interventions targeting any perioperative phase.

Methods

The review followed Joanna Briggs Institute methodology and included sources from 2010 onwards in MEDLINE, Embase, PubMed, Cumulative Index for Nursing and Allied Health Literature, Google Scholar and ProQuest. Four reviewers undertook screening and data was presented in tabular and diagrammatic form with a narrative summary.

Results

From 2293 records, 48 papers with a total of 41 unique studies from 15 countries were included. Most interventions supported patients in the postoperative phase only for bowel/colorectal cancer surgery and total hip arthroplasty Quality was generally good to average, with limitations including small sample sizes, single-centre studies, and a failure to include a comparison group. Just 35 % of interventions were codesigned with input from patients during the development process. Development and evaluation methods were workshops (17 %) and unvalidated attitudinal studies (65 %), respectively. E-health interventions showed positive impacts on clinical outcomes (54 %), user satisfaction (65 %), utilisation of the interventions (46 %), and health system outcomes (24 %).

Conclusions

E-health interventions for self-management of surgery preparation and recovery were prevalent in 15 countries, but mostly focused on postoperative support and lacked input from end-users during development. Future studies should address these limitations by creating applications that support patients from all surgical specialities and involving patients and families in the development process.

Elaboration of a consensus document to address perioperative blood pressure (BP) in neurocritical patients, made with anesthesia and resuscitation, and intensive medicine specialists in Spain, by means of a modified Delphi methodology in two rounds with a questionnaire answered by 65 panelists. Consensus was reached in 126 (74.6 %) of 169 statements, with 113 agreements (66.9 %). Consensus was obtained for the use of clevidipine, urapidil, and beta-blockers for acute hypertension in head trauma patients and for brain tumor surgery, among others. The experts considered that the existing clinical studies evaluating the optimal perioperative therapy in neurocritical patients with altered BP are insufficient and that most recommendations are based on clinical experience. Therefore, treatment must be individualized regardless of absolute BP target value and based on occurrence/absence of acute organ damage and the coexistence of other diseases.

Background

Frailty is common in geriatric emergency surgery and associated with increased risk for poor postoperative outcomes. Frailty screening is challenging in emergency settings. The Edmonton Frail Scale (EFS) is a valid tool to screen for patients at high risk for poor postoperative outcomes. Recently, the EFS was modified to decrease dependence on staff to perform physical measures. This modification, the EFS-Acute Care (EFS-AC), has not been validated. We wish to assess the agreement between the EFS and the EFS-AC.

Study design

We performed a prospective cohort study from 10/2021 – 10/2022 screening 688 patients ≥ 65 years with both the EFS and EFS-AC preoperatively. We assessed the ability of the EFS-AC to discriminate frailty identified by the EFS and compared the association of both scales with loss of independence (LOI), hospital length of stay (LOS), ICU admissions, and ICU LOS. Receiver Operator Curves were used to estimate the discriminatory thresholds for LOI.

Results

688 patients with a median age 73 (IQR 68, 77) were enrolled. The EFS-AC was able to discriminate individuals’ frailty status by the EFS with excellent agreement (AUC 0.971 [0.958, 0.983]). An EFS-AC threshold score of ≥ 6 points lead to 93.60 % of individuals being correctly identified (77.87 % sensitivity and 97.00 % specificity). Both EFS and EFS-AC ≥ 6 were similarly associated with a higher risk for all clinical outcomes assessed and demonstrated similar ability to predict LOI.

Conclusions

The EFS-AC is a valid preoperative frailty screen, and due to its self-reported nature, can be administered in the acute care setting, during virtual visits, or through digital health apps. Real-time screening can assist with better understanding patient needs and lead to interventions to prevent poor hospital outcomes.

Background

The sterilization of instruments is a critical process to perform the activity in the operating rooms and ensure the safety of patients. The best approach to improve the performance of the sterilization is the risk management. Nevertheless, improving the performance in sterilization units in developing countries presents a real challenge.

Purpose

Designing an effective risk management project in health sector, specifically in sterilization units, adaptable to the context of developing countries (DC).

Methods

This study uses Failure Modes and Effects Analysis (FMEA) to manage risks in healthcare in DC. Modifications to the implementation of the recommended tool mode. A case study of the sterilization unit of a tertiary Moroccan national reference university hospital was conducted to verify the effectiveness of the model.

Findings

The present study demonstrated that the proposed model is adaptable to the DC context. This model was implemented with minimal resources and was highly efficient.

Conclusions

The increase of risks in healthcare is a challenge for managers in DC. This study highlights the first successful experience of risk management in Moroccan healthcare sector.

Uvular necrosis is a known risk factor following general anesthesia due to compression of blood flow to the uvula. We report a case of uvular necrosis followed by uvular deviation in a male patient after undergoing two surgeries in four days. He had a sore throat and experienced a foreign body sensation in his throat following the second surgery. He was treated conservatively, but his uvula remained deviated four years later at follow up. Although uvular injury is a known complication of general anesthesia, it is important to understand the risk factors, recognize the conditions, and have a high index of suspicion when evaluating patients with sore throats after anesthesia.

Endotracheal intubation is the gold standard for airway management. Direct laryngoscopy is a difficult procedure with a high failure rate. A 3D printed video laryngoscope can be used as a more affordable replacement for a laryngoscope. The aim of this study was to evaluate the success rate and time of endotracheal intubation in manikins using the Alba 3D printed video laryngoscope, the C-MAC video laryngoscope and the Macintosh operated by medical students. This study was conducted using a cross sectional randomised study method involving 36 medical students. This study found that the mean endotracheal intubation time using Alba 3D Print was significantly shorter than using Macintosh, but not better than C-MAC (VL3D-25 vs LDM-50.5 vs VLC-21.5 s) with a p-value of <0.001. The success rate of endotracheal intubation using Alba 3D moulds was significantly better than using Macintosh, but not statistically significant when compared to C-MAC (VL3D-91.7% vs LDM-97.2% vs VLC-75%) with p-value <0.05). This study concluded that the use of Alba 3D prints has a better success rate and time compared to Macinctosh and can be an affordable alternative to commercial video laryngoscopes such as C-MAC for educational purposes.

When operating room (OR) allocated times are calculated, reports ideally are accompanied with attachment or link to an article describing the specific optimization method used. In addition, many stakeholders (e.g., managers and committee members) also need a background source. Our review supplies in one downloadable publication such an article. Our review covers the fundamental knowledge sufficient to read the thousands of articles on OR staffing and case scheduling, including references describing the specific method implemented, and to understand relevant studies of implementation (e.g., behavioral operations and managerial epidemiology). Inappropriate OR allocation and case scheduling can be mitigated by ensuring that when there is a case waiting to start, to be done today, the number of ORs in use for each such service is at least the number that maximizes the efficiency of use of OR time. Implementation means performing mathematical calculations using hospital data or anesthesia billing information. Physician leadership ensures that the statistical methods used are appropriate and applied for case scheduling. When done properly, there are opportunities to reduce turnover times and late first case of the day starts targeted toward reducing over-utilized time. These actions facilitate growth in surgical practices, increase OR productivity, and help prevent surgical teams from working late because of poor staffing and staff scheduling.