Perioperative Care and Operating Room Management最新文献_第2页

Effects of low-dose ketamine versus dexmedetomidine on qCON and qNOX monitoring during spinal surgery under general anesthesia: A randomized controlled trial 低剂量氯胺酮与右美托咪定对全身麻醉下脊柱手术qCON和qNOX监测的影响：一项随机对照试验

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2026-01-16 DOI: 10.1016/j.pcorm.2026.100617

Rr Sinta Irina , Prasetyo Tri Nugroho , John Frans Sitepu , Juliandi Harahap

Background

Depth of sedation and nociception monitoring during general anesthesia (GA) may improve outcomes during spine surgery. This study aimed to compare the effects of low-dose ketamine versus dexmedetomidine on qCON (quantitative consciousness index) and qNOX (nociception index) during spinal surgery.

Methods

A prospective randomized controlled trial included patients undergoing elective spinal surgery under GA. Subjects were assigned to ketamine (Group K) or dexmedetomidine (Group D). Anesthesia was induced with propofol, fentanyl, and rocuronium, and maintained with sevoflurane. qCON and qNOX were monitored at five key intraoperative timepoints. Postoperative pain was assessed using the Numeric Rating Scale (NRS) at 2 h.

Results

A total of 36 patients (18 per group) completed the study. Group D demonstrated lower qNOX values post-incision and at extubation (p < 0.05). Group D required less fentanyl and sevoflurane intraoperatively (p < 0.05). No significant difference in qCON values was observed. NRS scores at 2 h were lower in Group D (p < 0.05).

Conclusions

Dexmedetomidine provided better intraoperative nociception control with reduced anesthetic requirement and lower early postoperative pain scores compared to low-dose ketamine. Compared to qCON, differences in qNOX values may reflect greater sensitivity in detecting nociceptive differences

背景：在全身麻醉（GA）期间，镇静深度和伤害感觉监测可能改善脊柱手术的预后。本研究旨在比较低剂量氯胺酮与右美托咪定对脊柱手术中qCON（定量意识指数）和qNOX（伤害感觉指数）的影响。方法前瞻性随机对照试验纳入GA下择期脊柱手术患者。受试者被分配使用氯胺酮（K组）或右美托咪定（D组）。麻醉由异丙酚、芬太尼和罗库溴铵诱导，并用七氟醚维持。在术中5个关键时间点监测qCON和qNOX。术后2 h采用数字评定量表（NRS）评估疼痛。结果共36例患者（每组18例）完成研究。D组切开后和拔管时qNOX值较低（p < 0.05）。D组术中较少使用芬太尼和七氟醚（p < 0.05）。qCON值无显著差异。D组2 h NRS评分较低（p < 0.05）。结论与低剂量氯胺酮相比，右美托咪定能更好地控制术中疼痛，减少麻醉需求，降低术后早期疼痛评分。与qCON相比，qNOX值的差异可能反映出在检测伤害性差异方面更敏感

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引用次数: 0

Impact of risk treatment on the quality of care and safety of patients in the process of TIVAD for chemotherapy treatment in developing countries: case of Moroccan oncologic university hospital 发展中国家TIVAD化疗过程中风险治疗对患者护理质量和安全的影响：以摩洛哥肿瘤大学医院为例

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2026-01-16 DOI: 10.1016/j.pcorm.2026.100616

Kawtar Matrab , Banacer Himmi , Amine En-Naaoui , Hind Bouita , Saber Boutayeb

Devices for administering cytotoxic drugs are indispensable in oncology. Among them, the Totally Implantable Venous Access Device (TIVAD) is widely used to ensure safe and reliable drug delivery. However, TIVADs are associated with significant risks that may lead to severe or even fatal complications. Consequently, implementing a dynamic risk management system in their perioperative handling and maintenance is essential to monitor risks and improve patient safety. This study describes the extension and implementation of a risk management system using Failure Mode and Effects Analysis (FMEA) and evaluates its effectiveness.

The dynamic nature of the system was maintained through the Plan-Do-Check-Act (PDCA) cycle, which was applied to corrective actions targeting intolerable risks under limited resource constraints. The planning, execution, evaluation, and adjustment of these actions were conducted using a structured methodology and performance indicators to assess practical effectiveness. Results show that corrective actions achieved an 86% reduction in intolerable risks, with 36% of actions classified as highly effective and 50% as effective. These results are considered very satisfactory in the context of a hospital in a developing country. The remaining 14% require readjustment, currently under analysis, which will trigger a new PDCA cycle for further improvement. This study demonstrates that integrating FMEA with a PDCA-driven approach is effective in mitigating high-risk failures associated with TIVADs. Such a system significantly enhances patient safety and perioperative care quality, while ensuring continuous improvement in resource-limited settings.

给药细胞毒性药物的装置在肿瘤学中是不可缺少的。其中，全植入式静脉通路装置（TIVAD）被广泛使用，以确保安全可靠的给药。然而，tivad与可能导致严重甚至致命并发症的重大风险相关。因此，在围手术期处理和维护中实施动态风险管理系统对于监测风险和提高患者安全至关重要。本研究描述了使用失效模式和影响分析（FMEA）的风险管理系统的扩展和实施，并评估其有效性。通过计划-执行-检查-行动（PDCA）循环来保持系统的动态性，该循环应用于在有限资源约束下针对不可容忍风险的纠正措施。这些行动的计划、执行、评估和调整是使用结构化的方法和绩效指标来评估实际效果的。结果表明，纠正措施使无法忍受的风险降低了86%，其中36%的措施被列为非常有效，50%的措施被列为有效。在发展中国家的医院中，这些结果被认为是非常令人满意的。其余14%需要重新调整，目前正在分析中，这将触发新的PDCA循环以进一步改进。这项研究表明，将FMEA与pdca驱动的方法相结合，可以有效地减轻与tivad相关的高风险失败。该系统显著提高了患者安全和围手术期护理质量，同时确保在资源有限的情况下持续改进。

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引用次数: 0

A case of delayed emergence from anesthesia in a patient with organophosphorus poisoning following use of a depolarizing muscle relaxant 有机磷中毒患者在使用去极化肌肉松弛剂后出现麻醉延迟苏醒的病例

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2026-01-16 DOI: 10.1016/j.pcorm.2026.100618

Shital A Dharamkhele , Ashish H Nasre , Shalendra Singh , Shibu Sasidharan

引用次数: 0

Unseen risks in the operating room: A study of environmental and system-related intraoperative adverse events 手术室中看不见的风险：与环境和系统相关的术中不良事件研究

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2026-01-10 DOI: 10.1016/j.pcorm.2026.100613

Sergio Susmallian , Martine Szyper-Kravitz

Background

The operating room (OR) is a highly complex environment where human, technical, and system interactions can generate intraoperative adverse events (IAEs) unrelated to direct surgical errors. This study aimed to evaluate IAEs arising from environmental, human, and system-related factors and to assess their impact on patients, staff, and surgical specialties.

Material and Methods

A retrospective observational study was conducted at a tertiary hospital between 2014 and 2020. Eighty-two cases of IAEs were identified from 559,910 surgical procedures through institutional Safety and Risk Management investigations, excluding “never events” and direct surgical errors. Data on incident type, surgical specialty, affected party, causative classification (human, system, or patient-related), and demographics were analyzed. Statistical analysis was performed using IBM SPSS Statistics, with significance set at p < 0.05.

Results

The mean age of the cohort was 61.22 ± 18.52 years, and 46 (51.1%) were male. Of all incidents, 67 (81.7%) affected patients and 15 (18.3%) involved OR personnel. General surgery accounted for 35.4% of cases. Human-related causes predominated (54.9 %), followed by system-related (29. %) and patient-related (15. %) factors (p < 0.001). System-related incidents occurred more often among older patients (mean 68.3 vs. 56.0 years; p = 0.013). No significant association was observed between incident type and surgical specialty (p = 0.188).

Conclusion

Environmental and system-related IAEs constitute an underrecognized yet preventable source of harm in surgical care. Human factors remain the leading cause, underscoring the need for standardized safety protocols, routine equipment maintenance, and multidisciplinary team training to strengthen OR safety culture.

手术室（OR）是一个高度复杂的环境，其中人员、技术和系统的相互作用可能产生与直接手术错误无关的术中不良事件（iae）。本研究旨在评估由环境、人为和系统相关因素引起的肠内感染，并评估其对患者、工作人员和外科专业的影响。材料与方法2014 - 2020年在某三级医院进行回顾性观察性研究。通过机构安全和风险管理调查，从559,910例外科手术中确定了82例iae，排除了“从未发生的事件”和直接手术错误。分析了事件类型、外科专科、受影响方、病因分类（人、系统或患者相关）和人口统计学数据。采用IBM SPSS Statistics进行统计学分析，p <； 0.05为显著性。结果患者平均年龄为61.22±18.52岁，男性46例（51.1%）。在所有事件中，67例（81.7%）影响患者，15例（18.3%）涉及手术室人员。普通外科占35.4%。人为原因占多数（54.9%），其次是系统原因（29.9%）。%)和患者相关（15%）。%)因素（p < 0.001）。系统相关事件在老年患者中更常见（平均68.3岁vs. 56.0岁；p = 0.013）。事件类型与手术专科无显著相关性（p = 0.188）。结论环境和系统相关的iae是外科护理中一个未被充分认识但可预防的危害来源。人为因素仍然是主要原因，因此需要标准化的安全协议、日常设备维护和多学科团队培训来加强手术室的安全文化。

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引用次数: 0

Anaesthetic management in a child with hunter syndrome and multivalvular involvement 儿童亨特综合征伴多瓣膜受累的麻醉处理

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2026-01-09 DOI: 10.1016/j.pcorm.2026.100615

Dr Shivam Banerjee , Prof Bhavna Hooda , Prof Shalendra Singh , Saurabh Khurana

引用次数: 0

Intraoperative handover, beyond checklists, towards culture and safety a scoping review 术中交接，超越检查清单，向文化和安全进行范围审查

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2026-01-08 DOI: 10.1016/j.pcorm.2026.100614

Susanne Friis Søndergaard , Ann-Cartin Blomberg , Tove K. Vassbø

Objectives

Intraoperative handovers among operating room (OR) nurses are critical high-risk transitions in which incomplete communication can compromise patient safety. Despite international safety goals and structured protocols, practice remains inconsistent. This scoping review aimed to identify and conceptually map the existing literature on OR nurses’ practices and experiences of intraoperative handovers.

Methods

The review followed the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR guidelines. Using the Population, Concept, Context (PCC) framework (Population: OR nurses; Concept: handover communication; Context: intraoperative care), we conducted systematic searches in MEDLINE, CINAHL and Web of Science, supplemented by grey literature. Eligible sources included qualitative, quantitative and mixed-methods studies published in English or Scandinavian languages. The data were analysed using narrative conceptual mapping supported by NVivo.

Results

Nineteen sources were included, predominantly qualitative studies and field reports. Three conceptual themes emerged: (1) risk management as an implicit practice – nurses safeguard patient safety through vigilance and compensatory strategies, (2) standardisation as a procedural anchor – structured tools and checklists improve clarity but may constrain adaptability and (3) relational complexity as a contextual determinant – hierarchical norms and psychological safety shape communication quality. Evidence highlights that handovers are socially negotiated processes rather than routine technical exchanges.

Conclusion

Intraoperative handovers are complex high-risk transitions influenced by procedural, relational and systemic factors. While structured tools reduce omissions, rigid application risks undermining clinical judgment. Future strategies should integrate flexible standardisation with cultural and organisational reforms that foster psychological safety and shared accountability.

目的手术室护士的术中交接是高危交接，不完整的沟通会危及患者安全。尽管国际安全目标和结构化协议，实践仍然不一致。本综述旨在识别和概念性地绘制关于手术室护士的实践和术中交接经验的现有文献。方法采用Joanna Briggs Institute （JBI）的方法和PRISMA-ScR指南。采用人口、概念、背景（PCC）框架（人口：手术室护士；概念：交接沟通；背景：术中护理），我们在MEDLINE、CINAHL和Web of Science中进行了系统的检索，并辅以灰色文献。合格的来源包括以英语或斯堪的纳维亚语言发表的定性、定量和混合方法研究。使用NVivo支持的叙事概念映射对数据进行分析。结果纳入19个来源，主要是定性研究和实地报告。出现了三个概念主题：(1)风险管理作为一种隐性实践-护士通过警惕和补偿策略保护患者安全；(2)标准化作为程序锚点-结构化工具和检查表提高清晰度，但可能限制适应性；(3)关系复杂性作为上下文决定因素-等级规范和心理安全塑造沟通质量。有证据表明，移交是社会协商的过程，而不是例行的技术交流。结论术中交接是一种复杂的高危交接，受程序性、关系性和全身性因素的影响。虽然结构化工具减少了遗漏，但严格的应用可能会破坏临床判断。未来的战略应将灵活的标准化与文化和组织改革结合起来，以促进心理安全和共同承担责任。

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引用次数: 0

Opioid-sparing pain management in urologic surgery: A comprehensive narrative review of ERAS protocols and multimodal strategies 阿片类药物在泌尿外科疼痛管理：ERAS方案和多模式策略的综合叙述综述

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2026-01-05 DOI: 10.1016/j.pcorm.2026.100609

Sina Samenezhad , Dorna Rafighi

The ongoing opioid crisis has underscored the urgent need to reconsider traditional postoperative pain management, particularly in urologic surgery where opioid prescribing remains common despite associated risks. This narrative review synthesizes current literature on opioid-sparing and opioid-free approaches within urologic surgery, emphasizing the role of Enhanced Recovery After Surgery (ERAS) protocols and multimodal analgesia strategies. We explore pharmacologic alternatives, including NSAIDs, acetaminophen, gabapentinoids, ketamine, dexmedetomidine, and lidocaine, alongside regional anesthesia techniques such as TAP and pudendal nerve blocks. Evidence supports these strategies in effectively reducing opioid consumption, minimizing adverse effects, and enhancing patient recovery without compromising pain control. However, widespread implementation faces barriers including institutional inertia, provider hesitancy, and lack of standardized protocols. Future directions include refining procedure-specific ERAS pathways, integrating patient-centered outcomes, and generating robust clinical trial evidence. Adoption of opioid-sparing pain management offers a promising pathway to improve postoperative outcomes while addressing the public health imperative to reduce opioid overuse in urologic surgical care.

持续的阿片类药物危机强调了迫切需要重新考虑传统的术后疼痛管理，特别是在泌尿外科手术中，尽管存在相关风险，阿片类药物处方仍然很常见。本文综述了泌尿外科手术中阿片类药物节约和无阿片类药物入路的最新文献，强调了术后增强恢复（ERAS）方案和多模式镇痛策略的作用。我们探索了药物替代方案，包括非甾体抗炎药、对乙酰氨基酚、加巴喷丁类、氯胺酮、右美托咪定和利多卡因，以及区域麻醉技术，如TAP和阴部神经阻滞。证据支持这些策略有效地减少阿片类药物的消耗，最大限度地减少不良反应，并在不影响疼痛控制的情况下促进患者康复。然而，广泛实施面临着包括制度惰性、提供者犹豫和缺乏标准化协议在内的障碍。未来的方向包括细化特定手术的ERAS途径，整合以患者为中心的结果，并产生强有力的临床试验证据。采用不使用阿片类药物的疼痛管理为改善术后结果提供了一条有希望的途径，同时解决了减少泌尿外科护理中阿片类药物过度使用的公共卫生要求。

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引用次数: 0

Use of allowable blood loss in cesarean timeouts to improve transfusion stewardship and reduce costs 在剖宫产暂停时使用允许失血量以改善输血管理并降低成本

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2026-01-05 DOI: 10.1016/j.pcorm.2026.100610

Giselle De La Rua , Anthony Rios , Jean-Paul Russo , Michael French , Michelle Fletcher , YanYun Wu , Paloma Toledo

Introduction

Blood transfusions occur in ∼2 % of U.S. cesarean deliveries. Despite established guidelines, obstetric patients are often over-transfused, leading to unnecessary risk and inefficient use of limited blood products. Allowable blood loss (ABL) offers an individualized transfusion threshold that may reduce avoidable intraoperative transfusions and associated costs. This study explores the clinical and economic impact of ABL reporting during cesarean timeouts at a quaternary care safety-net hospital.

Study Design and Methods

A retrospective cohort study compared transfusion practices before (Sept 2022–Jan 2023) and after (Aug 2024–Dec 2024) ABL reporting was introduced. Patients with preoperative hemoglobin (Hgb) <7 g/dL or only autologous cell-salvaged blood were excluded. Descriptive and nonparametric tests were employed, with significance set at p < .05. Holm-Bonferroni corrections were applied for correlated variables.

Results

87 patients met inclusion criteria (pre n = 76; post n = 11). Post-intervention patients had lower preoperative Hb (p = .027) and ABL (p = .020), but similar blood loss, PPH risk, and postoperative outcomes. Data showed reductions in avoidable intraoperative transfusions and unused units of pRBCs per patient with no statistically reliable trend. (p = 1.000; p = 1.000).

Discussion

The modest trend towards improved stewardship following ABL reporting during cesarean timeouts may yield economic benefits through reduced crossmatching, fewer unused units, and monthly reductions in total and avoidable transfusions. This simple intervention may enhance transfusion stewardship, reduce inefficient use of scarce resources, and decrease costs. Larger studies are needed to confirm these preliminary findings and assess long-term outcomes.

在美国，约2%的剖宫产发生输血。尽管有既定的指导方针，但产科患者经常输血过多，导致不必要的风险和有限血液制品的低效使用。允许失血量（ABL）提供了一个个性化的输血阈值，可以减少术中可避免的输血和相关费用。本研究探讨了第四护理安全网医院剖宫产暂停期间ABL报告的临床和经济影响。研究设计与方法介绍了一项回顾性队列研究，比较ABL报告前（2022年9月- 2023年1月）和报告后（2024年8月- 2024年12月）的输血实践。排除术前血红蛋白(Hgb)≥7 g/dL或仅保留自体细胞的患者。采用描述性和非参数检验，显著性为p <； 0.05。对相关变量采用Holm-Bonferroni校正。结果87例患者符合纳入标准（术前76例，术后11例）。干预后患者术前Hb （p = 0.027）和ABL （p = 0.020）较低，但出血量、PPH风险和术后结果相似。数据显示术中可避免的输血和每位患者未使用的红细胞单位减少，没有统计学上可靠的趋势。（p = 1.000; p = 1.000）。剖宫产暂停期间ABL报告后，改善管理的适度趋势可能通过减少交叉匹配、减少未使用单位和每月减少总输血量和可避免输血量而产生经济效益。这种简单的干预措施可以加强输血管理，减少稀缺资源的低效使用，并降低成本。需要更大规模的研究来证实这些初步发现并评估长期结果。

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引用次数: 0

“Eyes wide open”: A consciousness-based cultural model for infection control in the operating room “睁大眼睛”：手术室感染控制的意识文化模式

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2026-01-05 DOI: 10.1016/j.pcorm.2026.100612

Saeid Amini Rarani , Mohsen Torabikhah

Surgical site infections (SSIs) are among the most preventable yet persistent complications in modern surgical care. Despite advancements in sterile techniques, antibiotics, and environmental controls, infections continue to affect patient recovery and healthcare systems. This paper proposes a novel consciousness-based cultural model The Eyes Wide Open Approach which integrates emotional intelligence, ethical responsibility, and continuous awareness into the operating room (OR) culture. Rather than replacing technical precision, this approach complements it, anchoring infection prevention in shared vigilance, team empowerment, and a deep moral connection to the patient’s safety.

手术部位感染（ssi）是现代外科护理中最容易预防但又持久的并发症之一。尽管在无菌技术、抗生素和环境控制方面取得了进步，但感染继续影响患者的康复和医疗保健系统。本文提出了一种新的基于意识的文化模型——睁大眼睛方法，该方法将情商、伦理责任和持续意识融入手术室文化。这种方法不是取代技术精确性，而是对其进行补充，将感染预防固定在共同警惕、团队授权以及与患者安全的深刻道德联系中。

引用次数: 0

A study of preoperative triggers to prospectively identify cases at risk of adverse events in non-operating room anesthesia 一项术前触发因素的研究，以前瞻性地识别非手术室麻醉中有不良事件风险的病例

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2026-01-04 DOI: 10.1016/j.pcorm.2026.100611

Karen L. Posner , Adam Claessens , Richard D. Urman , Shawn Mincer , Karen B. Domino

Traditional methods to investigate adverse events incompletely identify events that may cause patient harm. Trigger tool methodology uses surveillance algorithms of patient-level data to flag patterns consistent with adverse events. This methodology can be adapted to non-operating room anesthesia (NORA) and the need for prospective action to prevent patient harm. The first step is to use retrospective data to develop a trigger tool for use in preoperative case planning. This case control study used NORA gastroenterology (GI) cases from the Anesthesia Closed Claims Project as cases with adverse events and from the National Anesthesia Clinical Outcomes Registry as controls (procedures not associated with adverse events). Structured analysis of detailed narrative information from cases was used to identify additional triggers. Cases were more likely to be American Society of Anesthesiologists Physical Status 3–5 (71 %) than controls (43 %, OR 3.17, p < 0.001), conducted on an emergency basis (12 % cases vs. 0.4 % controls, OR 30.3, p < 0.001), involved monitored anesthesia care (88 % cases vs. 49 % controls, OR 7.55, p < 0.001), and more commonly performed on inpatients (OR 1.725, p = 0.042). Structured narrative analysis identified triggers in 84 % of cases. The most common triggers were ASA PS 3–5 (69 %), cardiovascular comorbidities (46 %), gastrointestinal conditions (37 %), and morbid obesity (30 %). Injuries were more severe in cases with triggers than cases without triggers (p = 0.003). Reducing the risk of severe complications with use of a pre-procedure trigger tool for NORA with resultant change in anesthetic plan could potentially reduce preventable harm in thousands of patients per year in the United States.

调查不良事件的传统方法不能完全识别可能对患者造成伤害的事件。触发工具方法使用患者级数据的监测算法来标记与不良事件一致的模式。这种方法可以适用于非手术室麻醉（NORA）和预防患者伤害的前瞻性行动的需要。第一步是使用回顾性数据开发用于术前病例规划的触发工具。本病例对照研究使用来自麻醉封闭索赔项目的NORA胃肠病学（GI）病例作为不良事件的病例，并将来自国家麻醉临床结果登记处的病例作为对照（与不良事件无关的程序）。对病例的详细叙述信息进行结构化分析，以确定其他触发因素。病例更有可能是美国麻醉医师协会身体状态3-5(71%)，而不是对照组（43%,OR 3.17, p < 0.001），在急诊基础上进行（12%病例对0.4%对照，OR 30.3, p < 0.001），涉及麻醉监护（88%病例对49%对照，OR 7.55, p < 0.001），更常在住院患者中进行（OR 1.725, p = 0.042）。结构化叙事分析确定了84%的病例的诱因。最常见的诱发因素是ASA PS 3-5（69%）、心血管合并症（46%）、胃肠道疾病（37%）和病态肥胖（30%）。有触发器组损伤较无触发器组严重（p = 0.003）。使用手术前触发工具降低NORA严重并发症的风险，从而改变麻醉计划，可以潜在地减少美国每年数千名患者的可预防伤害。

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引用次数: 0