Perioperative Care and Operating Room Management最新文献

Background and Aims

Hypotension and other complications following spinal anaesthesia, such as nausea, vomiting, and poor uterine contractions during caesarean section, are common. There is no tool to predict the possibility of hypotension, nausea and vomiting, and poor uterine contractions to make proper anticipations. Peripheral Perfusion Index (PPI) is a noninvasive monitoring tool using an oximeter and can be used to indicate a patient's Systemic Vascular Resistance (SVR). This study aimed to find the correlation between pre-anaesthesia PPI and total vasopressor administration, nausea and vomiting, and uterine contraction using Linear Analogue Scale (LAS) after spinal anaesthesia for caesarean section.

Methods

The research subjects were 65 pregnant patients with the American Society of anaesthesiology II (ASA II) who underwent caesarean section at Hasan Sadikin General Hospital, Bandung, from November 2022 to April 2023. PPI was measured before spinal anaesthesia, and monitoring of nausea and vomiting, vasopressor administration, and LAS was performed intraoperatively.

Results

The results of this study showed that PPI had a strong positive correlation (r = 0.795) with total vasopressor administration, a moderate positive correlation (r = 0.506) with nausea and vomiting, and a moderate negative correlation (r = 0.574) with LAS. The AUC analysis revealed an excellent hypotension prediction with a cut-off value of 3.5 (AUC 0.868; CI 95%).

Conclusion

We conclude that PPI can be used as a predictor of vasopressor administration, nausea and vomiting, and uterine contractions.

Introduction

TeamSTEPPS® aims to create an environment where all members feel comfortable to speak about patient safety concerns. The aim of this research was to determine the effect of TeamSTEPPS® mobile-based training on the perceptions of teamwork and team performance of operating room staff.

Methods

This study was a quasi-experimental method with measurements at baseline and after 2 months of intervention. The research samples included 105 OR staff (operating room technologists, anesthesia technologists, and nurses) working in 6 teaching hospitals of Iran University of Medical Sciences in 2022, which were selected by stratified random method and proportional allocation. The research tools included the demographic form, the Persian version of the ‘TeamSTEPPS® Teamwork Perception Questionnaire’ (T-TPQ) and the Persian version of the ‘Team Performance Observation Tool’ (TPOT). The intervention was carried out with sending the link of the TeamSTEPPS® 2.0 course files to participants by mobile messengers so that they could study them during five sessions, with an interval of one week between each session. Data analysis was done by calculating descriptive statistics and paired t-test.

Results

The results showed that TeamSTEPPS® mobile-based training significantly improved the perception of teamwork (P < 0.011) and team performance of operating room staff (P < 0.001).

Conclusion

With the determination of the effect of TeamSTEPPS® mobile-based training on the perception of teamwork and team performance of operating room staff, it is suggested to present this training program to this group.

Background

Chest tube removal (CTR) is perceived as a distressing experience by patients due to moderate or severe pain. Pain management is considered to be the primary nursing role. Relaxation takes the patient away from the thought of pain and increases the release of endorphins, further reducing pain

Purpose

The aim of this study is to provide evidence of the effectiveness of breathing relaxation exercises in reducing pain during chest tube removal.

Design

A meta-analysis.

Methods

Database searches were carried out in Pub med, Complementary Index, MEDLINE, Academic Search Ultimate, CINAHL Complete, OpenAIRE, Directory of Open Access Journals, Supplemental Index, Science Direct without restriction of year up to September 2023. The study was carried out in accordance with PRISMA 2020 and Cochrane 2021 recommendations. The intervention effects were pooled using the random effects model. The Risk of Bias 2 tool was' used to assess the risk of bias.

Heterogeneity and publication bias were also assessed.

Findings

A total of 6 randomised controlled trials were included. Breathing relaxation exercises was determined to have an excellent and negative effect on pain intensity assessed immediately after chest tube removal (Hedge's g=-1,557,%95 GA=-1,841- -1,274, 280 hasta (n_egzersiz=139; n_kontrol=141), p = 0.000). Breathing relaxation exercises was determined to have a high and negative impact on pain intensity assessed 15 min after chest tube removal ((Hedge's g=-0.816, 95 % CI=-1.299–0.333, 320 patients (n_exercise=159; n_control=161). , p = 0.000).

Conclusions

Breathing relaxation exercises were found to be effective in reducing pain immediately after chest tube removal and 15 min after chest tube removal.

Background

At the start of the COVID-19 pandemic, new recommendations to evacuate surgical smoke were made due to unknown viral hazards. We evaluated perioperative registered nurses’ and surgical technicians/technologists’ knowledge of surgical smoke and determined smoke evacuation practices before and after the onset of COVID.

Methods

An electronic survey was developed, validated, and distributed nationally. Means and percentages were used for analysis of descriptive data. For comparison analyses, repeated measures were conducted on continuous variables with paired t-tests and mixed factor ANOVAs.

Results

We found gaps in knowledge regarding surgical smoke hazards, low evacuation device usage, lack of smoke evacuation policies, and little to no air quality or exposure monitoring in ORs. Smoke evacuation practices did not change significantly following the onset of COVID-19.

Conclusions

Implications for leadership, education, and research may provide perioperative personnel with improved work environments without surgical smoke hazards.

Introduction

Achieving optimal anticoagulation during coronary artery bypass graft (CABG) surgery remains a challenge, with variations in heparin response attributed to differences in demographic and clinical factors. Deviations from the target activated clotting time (ACT) during CABG have been linked to adverse outcomes. This study aimed to assess the impact of different intravenous heparin doses on ACT in patients undergoing on-pump CABG.

Methods

A cross-sectional study was conducted on 54 patients scheduled for CABG surgery with cardiopulmonary bypass in 2021. ACT measurements were taken 5 min after the initial bolus dose of 200 IU/kg and a secondary dose of 100 IU/kg heparin. Demographic and clinical data, including ACT measures, hemoglobin levels, bypass time, and mortality, were collected.

Results

The study population predominantly comprised of male patients, with a mean age of 61.18 ± 8.81 years. The patients received 4 (3–4) grafts over 75 (65–80) minutes. Baseline ACT was 149.91±17.48 s, increasing to 410 (359–472) and 604 (542–679) seconds after the initial and additional heparin, respectively. Only 22.2 % of the study subjects achieved target ACT>480 s with 200 IU/kg, and the remaining 77.8 % required an additional 100 IU/kg heparin to reach the target ACT. No cases of heparin resistance, mortality, or dropouts were reported at the end of the study. Preoperative and postoperative hemoglobin levels were positively correlated (r = 0.59, p < 0.0001).

Conclusion

A 300 IU/kg heparin dose appears safer than lower doses for initiating cardiopulmonary bypass in on-pump CABG. Preoperative hemoglobin optimization may help minimize perioperative hemoglobin drop. Further research is needed to refine dosing strategies and personalize CABG management.

Introduction

Surgical patients in United States’ hospitals have grown more linguistically diverse. However, professional medical interpreter (PMI) utilization remains inconsistent at many healthcare institutions for limited-English proficient (LEP) patients. Numerous studies demonstrate that inadequate perioperative access to PMI leads to worse care and outcomes for LEP patients. The perioperative setting presents unique challenges for providers in caring for LEP patients including obtaining informed consent, a transient team of multi-disciplinary providers, and the time pressure of operating room practice.

Objective

Our study is the first to assess barriers to consistent PMI use in the immediate perioperative setting and to identify system-level approaches to improve PMI use.

Method

We surveyed a multidisciplinary team of perioperative nurses, advanced practice providers, anesthesiology and surgical trainees and faculty on their personal practices and perceived barriers to PMI use. An anonymous online 13-question survey was used. Answer options included rank order, multiple choice, Likert scale, and free text. Survey data was analyzed using univariate statistics and stratified based on providers having received information on the Title VI Civil Rights Act of 1964 and their medical training status. Pearson's chi-squared test was performed and odds ratios calculated to determine if these provider characteristics were associated with increased preference for PMI over bilingual staff and patients’ family members for interpretation and with other LEP evidence-based care practices.

Results

We received a total of 262 responses with a 28.3 % response rate. Among survey participants, 19.1 % of participants did not know where to find patients’ language preferences in the electronic health record (EHR) and 69.8 % of participants did not know how to update language preferences in the EHR. When a bilingual staff was present, 31.0 % and 24.8 % of providers would forgo using video and phone PMI, respectively. Comparatively, trainees were more likely to use PMI instead of patients’ family or bilingual staff. Providers who received training on the Title VI Civil Rights Act of 1964 were more likely to use PMI for interpretation and provide translated consent forms, and least likely to utilize patients’ families for interpretation. Barriers to PMI use included difficulty obtaining video consoles or phones, long wait times for interpreters, unavailability of language, unfamiliarity with using video consoles or accessing interpreters, poor sound quality and internet connectivity issues. As many as 26 % of respondents cited time pressure for starting a surgical case as the reason for not using an interpreter.

Discussion

Based on these survey results, we developed a framework for quality improvement initiatives to effect system-level change in similar hi