Perioperative Care and Operating Room Management最新文献

Background

The study aims to assess efficacy of superficial cervical plexus (SCP) block on Postoperative nausea and vomiting (PONV) incidence and severity in adults undergoing tympanomastoid operations.

Methods

Adult Patients American Society of Anesthesiologists (ASA) I-II in the age group 20–45 years, of both sex undergoing tympanomastoid operation under General Anesthesia (GA) scheduled for operation time from 30 min to 4 h. Ninety consenting patients were randomly allocated to two groups; saline or control group (n = 45) and SCP block (n = 45) received GA with SCP block. The primary outcome is incidence and severity of PONV over 24 h. other outcomes include number of patients required rescue antiemetic, hemodynamics, postoperative pain, first analgesic request, side effects of drugs used and incidence of complications related to the block.

Results

PONV incidence was lower in block group compared to control group {9 (20%) versus 17 (37.8%)}, p value 0.063, odds ratio (95% confidence interval 0.78 (0.59–1.01)). Need for rescue antiemetic was significantly lower in block group 14 patients (31.1%) compared to control group 34 patients (75.6%) (pvalue <0.001). Total intra operative opoids consumption was significantly lower in block group compared to control group (p value 0.002).There was no significant statistical difference between groups regarding need for postoperative analgesia and pain assessment times using visual analogue scale (VAS) score.There were no recorded complications related to the blocks in both groups.

Conclusion

Among adult patients undergoing tympanomastoid operations, the use of ultrasound (US) guided SCP block reduced the severity of PONV in early postoperative period. The overall incidence of PONV during 24 h was slightly lower in SCP block group however it was not statistically significant.

Non-analgesic properties of regional nerve blocks aid in the management of symptoms or diseases which are difficult to cure by conventional methods. Nerve blocks are one of the major analgesic modalities in the management of surgical patients. The non-analgesic effects of nerve block effects has been being explored in recent times. We have postulated systematically the non-analgesic benefits of different nerve block techniques and their mechanism of nerve block in management of multisystem diseases or symptoms. Diseases that are managed by non-analgesic effects of nerve blocks include postoperative cognitive dysfunction, posttraumatic stress disorder, postoperative nausea and vomiting, refractory arrhythmias, heart failure, hypertension, pulmonary hypertension, postoperative pulmonary complications and immune function.

Background

Surgery accounts for 30 % of the global disease burden, but healthcare systems struggle with managing surgical waitlists, optimising operations, and minimising cancellations, leading to poor patient outcomes and financial strain. E-health technologies offer promising solutions to enhance perioperative care and improve surgical outcomes, yet their integration faces significant organisational and structural challenges. This paper aims to explore and analyse the perspectives of decision-making personnel regarding the challenges and opportunities of implementing a surgery support e-health application.

Methods

This study utilised an explorative qualitative approach, employing a rapid cycle qualitative evaluation informed by the NASSS framework. Data were collected through individual semi-structured interviews with decision-making personnel conducted. Framework analysis guided by the NASSS framework was used to analyse the interview transcripts.

Results

A total of 15 participants from public health and external organisations participated in the study. The analysis, framed by the seven domains of the NASSS framework, critical challenges in integrating new health technologies, emphasising the need for compatibility, cybersecurity, and demonstrating clear benefits. Key factors for successful adoption included early and continuous stakeholder engagement, organisational readiness, and ongoing support. Additionally, participants highlighted the importance of centralised information systems and continuous adaptation of health IT solutions to meet evolving needs.

Conclusion

This paper reveals that implementing surgical e-health interventions is a complex process fraught with organisational, technical, financial, and political challenges, particularly due to insufficient end-user involvement and the intricate healthcare landscape. Despite the recognised benefits, successful implementation necessitates comprehensive stakeholder engagement and co-design approaches. Additionally, while a partnership between commercial vendors and public health developers presents an attractive solution, significant obstacles such as intellectual property disputes and resource allocation must be overcome.

Background

The operating room (OR) is a pivotal financial hub in modern healthcare, accounting for up to 40 % of hospital costs and generating 60–70 % of revenue. Optimizing OR efficiency is crucial for financial sustainability, patient safety, OR throughput, and satisfaction among patients, surgeons, and staff.

Objective

This Quality Improvement (QI) project aims to evaluate whether pre-procedure neuraxial ultrasound can enhance obstetric OR efficiency by reducing the time and attempts needed for epidural placement. The secondary objective is to assess improvements in patient comfort, safety, and satisfaction.

Methods

Conducted at a tertiary hospital in Miami from January to March 2022, the study included 98 parturients undergoing elective cesarean delivery. Patients were randomized into two groups: one receiving preoperative ultrasound (n = 49) and the other not (n = 49). Key metrics recorded included patient demographics, procedural times, number of attempts, pain scores, and patient satisfaction.

Results

The ultrasound group demonstrated significant improvements in OR efficiency: shorter epidural placement times (median 9 vs. 13 min, p < 0.001), fewer attempts (median 1 vs. 2, p < 0.001), reduced anesthesia ready times (median 22 vs. 31 min, p < 0.001), and decreased total OR times (median 122 vs. 140 min, p = 0.004). Patients in the ultrasound group reported less back pain (median score 0 vs. 1, p < 0.001) and higher satisfaction (median score 10 vs. 9, p < 0.001).

Conclusion

Preoperative neuraxial ultrasound significantly improves OR case duration and enhances patient outcomes in obstetric anesthesia. While the study's single-site data and lack of blinding are limitations, the findings support larger, multi-institutional studies to confirm these benefits and explore further efficiency improvements.

Aim

This study assessed the perception, attitude and willingness of nursing undergraduates to specialise in perioperative nursing.

Background

The field of perioperative nursing is currently facing a significant shortage of trained perioperative nurses. This has great implications for patients’ care and surgical outcomes. Nursing students are the future workforce and their perception, attitude and willingness to join the perioperative nurses’ workforce will go a long way in averting this dangerous trend.

Design

The study adopted a descriptive cross-sectional research design.

Method

The study that was conducted in July, 2023, employed proportionate stratified random sampling technique to select a sample size of 271 nursing students across selected universities. Data collection was done with the aid of a structured questionnaire. Data collected was analysed using descriptive and inferential statistics, with p value set at 0.05 level of significance.

Results

Findings revealed that less than half (39.5 %) of the respondents possessed positive perception towards the specialty of perioperative nursing while the majority (60.5 %) had negative perception. Similarly, majority (51.3 %) of the respondents had a negative attitude to the field of perioperative nursing. Results further showed that majority (54.2 %) of the respondents exhibited low level of willingness to specialise in perioperative nursing. Data generated for the hypothesis showed a significant association between respondents’ attitude, willingness and their perception of perioperative nursing specialty.

Conclusion

The study concluded that nursing undergraduates are not that willing to specialise in perioperative nursing. Therefore, plans must be put in place to heighten the nursing students’ interest in perioperative nursing. This is with a view to boosting enrolment in perioperative nursing and resultant increase in recruitment and retention of perioperative nurses.

Operating room nursing and surgical technologist are two disciplines that provide perioperative care in the operating room. However, they have distinct histories, philosophies, curricula, and functions that shape their professional identities and boundaries. This paper critically analyzes the literature on these disciplines, focusing on their historical development, current situation, future directions, and the implications of paradigm shift for their evolution. The findings suggest that both fields are undergoing significant transformations due to technological advancements and changing healthcare needs, and highlight the need for interdisciplinary collaboration and continuous adaptation to ensure high-quality perioperative care for patients.

Background

Due to the equipment used in the health system, drugs, and the need for specialized health personnel, the operating rooms are the most costly, and time is the most valuable resource. From this point of view, the study was aimed to raise awareness about Value Stream Mapping, which is one of the problem-solving practices in nurses, and to practice with a sample VSM study (eliminating non-value-creating activities, creating flow in processes, and avoiding delays due to the preparation of the surgery in the pre-op period with continuous improvement).

Methods

Observational action research. The research, Value Stream Mapping, which is one of the lean methods, was carried out in a private hospital between December 2019 and March 2022. A total of 59 patient flows were observed in three stages. First, the current situation map was drawn. Value-added and non-value-added time was determined. The problems experienced in the current situation were determined and suggestions were developed for their solution, kaizen studies were carried out. Onset time and delays in minutes were monitored for all first cases on a daily basis.

Result

Non-value-added activities were reduced from 102 min to 52 min on average. In particular, the quality increased from 0 % to 36 %. "If patients were not in the operating room within 10 min of the scheduled start time, this was considered a late start". While the rate of starting the surgery on time at the first observation was 0 %, this rate increased to 70 % at the end of the study.

Conclusions

Improving the pre-op preparation process was effective in increasing the percentage of surgery that started on time in the operating room. It is thought that value stream mapping can be a useful method for improving on-time starts in the operating room.

Background

Wide Awake Local Anesthesia No Tourniquet (WALANT) has been accepted safe and effective anesthesia technique for many orthopaedics procedures. Despite growing number of studies, few had described using WALANT in lower extremities with more complexity like the knee. We present a case series of patella fracture fixation using WALANT.

Methods

WALANT was used as a method of anesthesia for five patients diagnosed with patella fracture undergone tension band wiring fixation at Thammasat University hospital during 2021 - 2022. Visual analog scale (VAS) was collected throughout the surgery as primary objective and up to 48 h after the operation. We also evaluated their demographic and clinical data, range of motion, total operative time, amount of WALANT used, blood loss and hospital stay.

Results

Throughout the procedure, all patients reported no pain or discomfort except at wiring step which average VAS was 2.4 ± 1.14. The mean total operative time was 91.6 ± 18.58 min and mean WALANT solution used was 124 ± 12.94 ml. The visualization of surgical field was satisfying with minimal blood loss. All patients were able to walk with weight-bearing as tolerated right after the operation and were discharged in the same day except one due to lack of caregivers at home. Neither local nor systemic complications were found. No conversion to other anesthesia techniques due to failure of WALANT.

Conclusions

This study shows WALANT may be considered safe and effective as an alternative anesthesia technique for patella fracture fixation in ambulatory setting, offering favorable outcome without need for postoperative hospitalization.

Background

Clinical decision-making and self-efficacy levels of operating room nurses are critical for patient care quality and safety.

Objective

This study aims to examine the relationship between clinical decision-making levels and self-efficacy among operating room nurses and to identify factors influencing these two key components of nursing practice.

Methods

A cross-sectional descriptive design was used to survey 94 nurses working in surgical wards at Ankara University Medical Faculty Hospital. Data were collected using the Clinical Decision Making in Nursing Scale (CDMNS), General Self-Efficacy Scale (GSES), and a demographic information form. Data were analyzed using descriptive statistics, correlation analysis, and group comparisons.

Results

A significant positive correlation was found between clinical decision-making ability and self-efficacy (r = 0.355, p < .0001). Nurses with higher education levels demonstrated significantly greater clinical decision-making skills (p < .005). Nurse managers reported significantly higher self-efficacy levels compared to scrub/circulating nurses (p < .05). Age was positively correlated with self-efficacy (r = 0.373, p < .0001) but not with clinical decision-making ability.

Conclusion

The research indicated that self-efficacy levels correspond with clinical decision-making capabilities of the operating room nurses. Higher education levels of the practitioners enhanced their clinical decision-making abilities. Nurse managers had higher self-efficacious beliefs than the scrub or circulating nurses. Age was positively associated with self-efficacy, but not with the scores on clinical decision-making abilities. The results of this study nurse leaders have higher GSES and CDMNS scores because they are experienced nurses with higher education degrees.

Background

Ultrasound-guided supra-clavicular nerve block (SCNB) has regained interest in adults but remains underutilized in pediatrics. This case series aims to evaluate the efficacy and safety of ultrasound-guided SCNB in children undergoing upper-extremity surgery.

Methods

Prospective observational case series, the inclusion criteria were children over one year old who were scheduled for elective upper-extremity surgery. After induction of general anesthesia, an ultrasound-guided SCNB was performed. A dose of 0.2–0.5 ml/kg of bupivacaine 0.25 % or ropivacaine 0.2 % was administered all around the brachial plexus. In case of postoperative pain, 15 mg kg^-1 of paracetamol + 10 mg kg^-1 of ibuprofen were administered. The primary outcome measure was the success and safety of the block. Secondary outcomes were time to first analgesia administration and duration of motor blockade.

Results

Thirty-three patients were included. Median age and weight were 6 [2.75,9.75] years and 24 [16,35] kg, respectively with a sex ratio of 3.1. Bupivacaine 0.25 % was used in the majority of cases (N = 24). The overall duration to complete block performance was 170 [120,300] seconds. A single attempt was sufficient for the majority of children, with a block success rate of 100 %. No incidents were reported during block performance. Postoperatively, time to the first analgesic request was 10 [8,12.5] hours. Twenty-five patients developed a motor block, with a duration of 4 [0.5,5] hours. Bupivacaine 0.25 % was associated with higher incidence of motor blockade (p = 0.002).

Conclusions

Ultrasound-guided SCNB appears to be an effective and safe technique in children. Further studies using lower doses of bupivacaine could help reduce the incidence of motor block.