Perioperative Care and Operating Room Management最新文献_第6页

Thermal decay of pre-warmed intravenous fluids prior to infusion: An experimental study 输注前预热静脉输液的热衰减：一项实验研究

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-17 DOI: 10.1016/j.pcorm.2025.100578

Kanta Hattori , Mitsuru Ida , Masahiko Kawaguchi

引用次数: 0

Evaluation of the perfusion index as a determinant of the depth of anesthesia; an observational study 评价灌注指数作为麻醉深度的决定因素；观察性研究

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-17 DOI: 10.1016/j.pcorm.2025.100577

Sooraj D. Desai, Anju R. Bhalotra, Keshav Gaur, Rahil Singh, Shweta Dhiman

Background

Reliable monitoring of nociception and depth of anesthesia remains limited. Most nociception monitors assess sympathetic and parasympathetic nervous system activity. Minimum Alveolar Concentration (MAC) reflects anesthetic potency, while Bispectral Index (BIS) assesses the level of unconsciousness. Perfusion Index (PI), derived from pulse plethysmography, decreases during sympathetic activation. Light anesthesia and nociceptive stimuli trigger sympathetic responses, leading to reduced PI.

Methods

This double-blinded observational study included 35 adult patients undergoing elective surgery under standardized general anesthesia (GA). PI, MAC, BIS, heart rate (HR), and mean arterial pressure (MAP) were recorded during induction, maintenance, and recovery. The primary objective was to assess changes in PI and its correlation with MAC. Secondary outcomes included correlations of PI with BIS, HR, and MAP.

Results

PI showed significant variation across all time points. It increased after induction of GA and decreased during surgical stimulation and recovery. No significant correlation was found between changes in PI and MAC (r² = 0.394, p = 0.052) or BIS (r² = 0.392, p = 0.053). A strong negative correlation was observed between PI and HR (r = –0.888, r² = 0.789, p < 0.001), and a strong positive correlation between PI and MAP (r = 0.795, r² = 0.631, p = 0.006).

Conclusions

PI was a sensitive early indicator of inadequate anesthesia or analgesia, preceding traditional signs of sympathetic activation. Although not correlated with MAC or BIS, its strong association with HR supports its potential role as a simple, noninvasive adjunct in intraoperative monitoring.

背景：对伤害感觉和麻醉深度的可靠监测仍然有限。大多数伤害感觉监测器评估交感和副交感神经系统的活动。最低肺泡浓度（MAC）反映麻醉效力，而双谱指数（BIS）评估无意识水平。在交感神经激活过程中，由脉搏体积描记得出的灌注指数（PI）下降。轻度麻醉和伤害性刺激触发交感神经反应，导致PI降低。方法采用双盲观察方法，对35例在标准化全身麻醉（GA）下择期手术的成人患者进行研究。在诱导、维持和恢复期间记录PI、MAC、BIS、心率（HR）和平均动脉压（MAP）。主要目的是评估PI的变化及其与MAC的相关性。次要结果包括PI与BIS、HR和MAP的相关性。结果spi在各时间点均有显著差异。它在GA诱导后增加，在手术刺激和恢复期间减少。PI与MAC （r²= 0.394,p = 0.052）、BIS （r²= 0.392,p = 0.053）无显著相关。PI与HR呈显著负相关（r = -0.888, r²= 0.789,p < 0.001）， PI与MAP呈显著正相关（r = 0.795, r²= 0.631,p = 0.006）。结论spi是麻醉或镇痛不充分的早期敏感指标，比传统的交感神经激活迹象更早。虽然与MAC或BIS无关，但其与HR的强相关性支持其在术中监测中作为简单、无创辅助手段的潜在作用。

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引用次数: 0

Intravenous Dexmedetomidine vs. Meperidine for managing shivering after spinal anesthesia in cesarean deliveries: a randomized trial 静脉注射右美托咪定与哌哌啶治疗剖宫产脊髓麻醉后的寒战：一项随机试验

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-15 DOI: 10.1016/j.pcorm.2025.100575

Nahid Manouchehrian , Alireza Mortazavi , Mohammad Nima Mehrabani

Background

Post-spinal anesthesia shivering is a common complication during cesarean delivery, causing patient discomfort and interfering with vital sign monitoring.

Objectives

This study compared the efficacy and safety of intravenous dexmedetomidine and meperidine for controlling post-spinal anesthesia shivering in cesarean deliveries.

Methods

In this randomized clinical trial, 246 parturients who developed shivering after spinal anesthesia were allocated to two groups. Group A received intravenous meperidine (0.5 mg/kg), and Group B received dexmedetomidine (0.5 µg/kg), both administered over 10 min after umbilical cord clamping. Shivering intensity, vital signs, and adverse effects were recorded and analyzed.

Results

The onset time of shivering was similar between groups (P = 0.081). The time to cessation of shivering was significantly shorter in the meperidine group (7.6 ± 4.6 min) compared to the dexmedetomidine group (9.7 ± 5.5 min) (P = 0.003). Shivering scores at 5- and 10-minute post-injection were significantly lower in the meperidine group (P < 0.05). Blood pressure was lower and heart rate higher in the meperidine group at early time points (P < 0.05), but these changes were transient and not clinically significant. Dexmedetomidine was associated with higher rates of bradycardia and hypertension (P = 0.001 and P = 0.005), while nausea and vomiting were more frequent with meperidine (P = 0.166). Meperidine demonstrated a faster time to shivering cessation, while dexmedetomidine had lower rates of nausea and vomiting.

Conclusion

Both drugs effectively controlled post-spinal anesthesia shivering. Meperidine demonstrated a faster time to shivering cessation, while dexmedetomidine had lower rates of nausea and vomiting. Further studies are needed to optimize dosing and assess long-term outcomes

脊髓麻醉后寒战是剖宫产术中常见的并发症，可引起患者不适并干扰生命体征监测。目的比较右美托咪定和哌哌啶静脉注射控制剖宫产脊髓麻醉后寒战的疗效和安全性。方法将246例脊髓麻醉后出现寒战的产妇随机分为两组。A组静脉滴注哌哌啶（0.5 mg/kg）， B组静脉滴注右美托咪定（0.5µg/kg），均在脐带夹紧后10 min内给药。记录和分析寒战强度、生命体征和不良反应。结果两组患者寒战发作时间相近（P = 0.081）。与右美托咪定组（9.7±5.5 min）相比，哌嗪组（7.6±4.6 min）停止颤抖的时间明显缩短（P = 0.003）。注射后5分钟和10分钟，哌啶组的寒颤评分明显降低（P < 0.05）。哌哌啶组在早期时间点血压较低、心率较高（P < 0.05），但这些变化是短暂的，无临床意义。右美托咪定与较高的心动过缓和高血压发生率相关（P = 0.001和P = 0.005），而恶心和呕吐更频繁使用哌嗪（P = 0.166）。哌嗪能更快地停止颤抖，而右美托咪定的恶心和呕吐率较低。结论两种药物均能有效控制脊髓麻醉后寒战。哌嗪能更快地停止颤抖，而右美托咪定的恶心和呕吐率较低。需要进一步的研究来优化剂量和评估长期结果

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引用次数: 0

Characterizing periods for rapid testing of bacterial pathogens at ends of surgical cases for interventions in the post-anesthesia care unit or hospital wards using discharge times of patients with and without postoperative healthcare-associated infections 在麻醉后护理单位或医院病房进行干预的手术病例结束时，使用有和没有术后医疗保健相关感染的患者的出院时间来描述细菌病原体快速检测的周期

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-15 DOI: 10.1016/j.pcorm.2025.100576

Franklin Dexter , Paul Cover , Randy W. Loftus

Background

Earlier studies showed that prevention of Staphylococcus aureus transmission through the anesthesia work area (e.g., from hands of the anesthesiologist to intravenous lumen) resulted in fewer postoperative healthcare-associated infections, specifically surgical site infections. Test results for contamination (e.g., of the anesthesia machine) guide anesthesia clinicians’ efforts. In the studies, a single national laboratory was used, providing such information at least several days later. Future clinical trials could use rapid assays to test reservoirs (e.g., intravenous lumen) at the end of the case for prompt treatment. Study designs depend on knowing how quickly results would be needed.

Methods

The retrospective cohort study was performed using data from 13,512 elective cases performed at a teaching hospital’s inpatient adult surgical suite over 12 months in 2023–2024. Postoperative healthcare-associated infections were obtained from International Classification of Diseases, Tenth Revision, Clinical Modification codes listed <91 days postoperatively, when diagnosed by a surgical team. Different periods from operating room exit were studied (e.g., 1.0, 2.0, and 4.0 h). For each endpoint, 99 % lower one-sided confidence limits for proportions were calculated using intercept-only logistic regression, with robust clustered variance estimation by day.

Results

After 1.0 and 2.0 h, there were 98.9 % (≥97.7 %) and 90.6 % (≥87.3 %) of patients who developed postoperative healthcare-associated infection who had not yet been discharged from the hospital, respectively. There were 89.0 % (≥84.9 %) and 44.2 % (≥38.2 %) who had not yet been discharged from the phase I post-anesthesia care unit. In contrast, at 4.0 h, the lower confidence limits were 76.1 % and 16.5 %, respectively.

Conclusions

Clinical trial designs to evaluate the use of rapid bacterial pathogen tests from anesthesia work areas should plan on results being obtained and used for treatment no greater than 2.0 h after patients exit operating rooms, but <1.0 h is not needed. Medical/surgical nurses throughout the hospital who care for surgical patients would need to be involved, not only post-anesthesia care unit teams.

早期的研究表明，预防金黄色葡萄球菌通过麻醉工作区域传播（例如，从麻醉师的手到静脉管腔）可减少术后医疗保健相关感染，特别是手术部位感染。污染（如麻醉机）的测试结果指导麻醉临床医生的工作。在这些研究中，使用了一个国家实验室，至少在几天后提供这些信息。未来的临床试验可以在病例结束时使用快速测定法来检测储存库（例如静脉内管腔），以便及时治疗。研究设计取决于了解需要多快得出结果。方法回顾性队列研究采用2023-2024年在某教学医院成人外科病房住院12个月的13512例选择性病例数据。术后医疗保健相关感染数据来自《国际疾病分类第十版临床修改代码》，列出了术后91天由外科团队诊断的病例。研究了从手术室出口开始的不同时间（如1.0、2.0和4.0 h）。对于每个终点，使用仅截距逻辑回归计算比例的99%较低的单侧置信限，并按天进行稳健的聚类方差估计。结果术后1.0 h和2.0 h未出院的患者分别为98.9%（≥97.7%）和90.6%（≥87.3%）。89.0%（≥84.9%）和44.2%（≥38.2%）的患者尚未从I期麻醉后护理病房出院。相比之下，在4.0 h时，下限分别为76.1%和16.5%。结论评价麻醉工作区域快速病原菌检测应用的临床试验设计应计划在患者离开手术室后不超过2.0 h内获得和用于治疗的结果，但不需要1.0 h。整个医院负责手术病人的内科/外科护士都需要参与，而不仅仅是麻醉后护理小组。

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引用次数: 0

Surgical time-outs: Ritual or real safety practice? 手术暂停：仪式还是真正的安全实践？

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-14 DOI: 10.1016/j.pcorm.2025.100573

Seyed Abolfazl Hosseini , Bahador Pourdel , Erfan Rajabi , Amirali Alizadeh

The surgical time-out, a core component of the WHO Surgical Safety Checklist, was introduced to prevent wrong-site surgery, patient misidentification, and other critical perioperative errors. While its theoretical effectiveness is supported by global data, recent evidence suggests that in many operating rooms, the practice has devolved into a symbolic and perfunctory routine. This commentary explores the gap between intention and real-world implementation, and offers practical, evidence-based strategies to reestablish the time-out as a meaningful safeguard in surgical care.

手术暂停是世卫组织手术安全核对表的核心组成部分，它的引入是为了防止手术部位错误、患者误诊和其他严重的围手术期错误。虽然其理论上的有效性得到了全球数据的支持，但最近的证据表明，在许多手术室，这种做法已经沦为一种象征性和敷衍的例行公事。这篇评论探讨了意图和现实世界实施之间的差距，并提供了实用的、基于证据的策略，以重建暂停作为外科护理中有意义的保障。

引用次数: 0

Proper management and execution of surgical counting: achieving consensus through a Delphi study 手术计数的正确管理和执行：通过德尔菲研究达成共识

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-14 DOI: 10.1016/j.pcorm.2025.100574

Francesco Silvestri , Caterina Cicala , Salvatore Pagliaro , Debora Formisano , Luca Ghirotto

Surgical counting is a critical, multi-professional safety practice aimed at preventing retained surgical items (RSIs), such as sponges, instruments, and sharps, during operative procedures. It is commonly defined as a rational, standardized, and replicable process designed to ensure that all items used intraoperatively are accurately accounted for at the time of wound closure. The failure of this process—retention of foreign bodies—is a rare but serious adverse event associated with significant clinical, organizational, and legal consequences, including infection, re-operation, prolonged hospitalization, increased costs, and, in severe cases, death. Despite the existence of numerous international guidelines, counting errors continue to occur, often despite a “correct count” being reported. Studies have shown that RSIs may occur in the presence of systemic factors such as time pressure, communication breakdowns, multitasking, and variable adherence to protocols. Internationally, surgical safety is guided by regularly updated, evidence-based recommendations issued by professional societies. In Italy, however, Recommendation No. 2/2008—based on WHO’s “Safe Surgery Saves Lives” initiative—remains the primary national reference document, yet it has not been updated in over 15 years and does not fully reflect evolving practices or recent literature.

Aim

this study aimed to explore current practices, perceptions, and critical issues related to surgical counting in Italy, drawing on the experience and knowledge of a multidisciplinary expert panel composed of operating room nurses, surgeons, and clinical risk managers.

Methods

to gather expert opinion, a three-round Delphi process was conducted to gather and refine expert opinions. A preliminary literature review informed the first-round questionnaire. Through iterative feedback and consensus thresholds, the study generated a set of validated statements aimed at improving surgical counting practices and informing future national guidelines.

Conclusion

the findings offer a structured, practice-informed contribution to updating Italy’s approach to surgical counting and promoting safer operative care.

手术计数是一项关键的、多专业的安全实践，旨在防止手术过程中保留手术物品（rsi），如海绵、器械和利器。它通常被定义为一个合理的、标准化的、可复制的过程，旨在确保术中使用的所有物品在伤口关闭时都被准确地计算在内。这一过程的失败——异物滞留——是一种罕见但严重的不良事件，与重大的临床、组织和法律后果相关，包括感染、再次手术、延长住院时间、增加费用，严重者甚至死亡。尽管存在许多国际指导方针，计数错误仍在继续发生，通常尽管报告了“正确计数”。研究表明，rsi可能发生在系统因素存在的情况下，如时间压力、沟通中断、多任务处理和对协议的不同遵守。在国际上，手术安全以专业协会发布的定期更新的循证建议为指导。然而，在意大利，基于世卫组织“安全手术拯救生命”倡议的第2/2008号建议仍然是主要的国家参考文件，但它在15年多的时间里没有更新，也没有充分反映不断发展的做法或最近的文献。本研究旨在探讨意大利手术计数的当前实践、观念和关键问题，借鉴由手术室护士、外科医生和临床风险管理人员组成的多学科专家小组的经验和知识。方法收集专家意见，采用三轮德尔菲法收集和提炼专家意见。初步的文献综述为第一轮问卷调查提供了依据。通过反复反馈和共识阈值，该研究产生了一套有效的声明，旨在改进手术计数实践并为未来的国家指南提供信息。结论：研究结果为更新意大利手术计数方法和促进更安全的手术护理提供了结构化的、实践知情的贡献。

{"title":"Proper management and execution of surgical counting: achieving consensus through a Delphi study","authors":"Francesco Silvestri , Caterina Cicala , Salvatore Pagliaro , Debora Formisano , Luca Ghirotto","doi":"10.1016/j.pcorm.2025.100574","DOIUrl":"10.1016/j.pcorm.2025.100574","url":null,"abstract":"<div><div>Surgical counting is a critical, multi-professional safety practice aimed at preventing retained surgical items (RSIs), such as sponges, instruments, and sharps, during operative procedures. It is commonly defined as a rational, standardized, and replicable process designed to ensure that all items used intraoperatively are accurately accounted for at the time of wound closure. The failure of this process—retention of foreign bodies—is a rare but serious adverse event associated with significant clinical, organizational, and legal consequences, including infection, re-operation, prolonged hospitalization, increased costs, and, in severe cases, death. Despite the existence of numerous international guidelines, counting errors continue to occur, often despite a “correct count” being reported. Studies have shown that RSIs may occur in the presence of systemic factors such as time pressure, communication breakdowns, multitasking, and variable adherence to protocols. Internationally, surgical safety is guided by regularly updated, evidence-based recommendations issued by professional societies. In Italy, however, Recommendation No. 2/2008—based on WHO’s “Safe Surgery Saves Lives” initiative—remains the primary national reference document, yet it has not been updated in over 15 years and does not fully reflect evolving practices or recent literature.</div></div><div><h3>Aim</h3><div>this study aimed to explore current practices, perceptions, and critical issues related to surgical counting in Italy, drawing on the experience and knowledge of a multidisciplinary expert panel composed of operating room nurses, surgeons, and clinical risk managers.</div></div><div><h3>Methods</h3><div>to gather expert opinion, a three-round Delphi process was conducted to gather and refine expert opinions. A preliminary literature review informed the first-round questionnaire. Through iterative feedback and consensus thresholds, the study generated a set of validated statements aimed at improving surgical counting practices and informing future national guidelines.</div></div><div><h3>Conclusion</h3><div>the findings offer a structured, practice-informed contribution to updating Italy’s approach to surgical counting and promoting safer operative care.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"41 ","pages":"Article 100574"},"PeriodicalIF":1.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparative efficacy of greater occipital nerve radiofrequency approaches for the treatment of combined migraine and cervicogenic headache: Randomized clinical trial 枕大神经射频入路治疗合并偏头痛和颈源性头痛的比较疗效：随机临床试验

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-09 DOI: 10.1016/j.pcorm.2025.100571

Ghada Mohammad AboElfadl , Manal Hassanien , Ahmed A. Hamed , Ahmed Mohamed Aboelfadl , Gehan I. Salem , Amr Mohamed Ahmed Thabet

Background

we aimed to evaluate the efficacy of ultrasound-guided distal and proximal greater occipital nerve (GON) radiofrequency approaches in patients with combined chronic migraine and cervicogenic headaches.

Methods

We studied 60 patients with combined chronic migraine and cervicogenic headache, aged between 18 and 65 years and met the specific diagnostic criteria of the International Classification of Headache Disorders (ICHD). Patients were divided into two groups: proximal (Group A) and distal (Group B). The primary endpoint measured changes in headache frequency per month, while secondary endpoints included pain intensity, changes in the Headache Disability Index (HDI), sleep disturbances, and patient satisfaction.

Results

The proximal approach had a lower nocturnal neck and migraine pain intensity compared to the distal approach. Both groups reduced headache episodes and sleep disturbances and improved HDI. However, the proximal approach showed a greater reduction in headache episodes (p = 0.000), fewer sleep disturbances (p = 0.001), more improvement in HDI, and higher patient satisfaction (p = 0.016).

Conclusion

The proximal and distal approaches for GON radiofrequency ablation effectively reduced headache episodes, disability, and sleep disturbance. However, the proximal approach had a more sustained impact on pain intensity, indicating better long-term relief for neck pain and migraines.

Trial registration

ClinicalTrials.gov (identifier: NCT06121037)

背景：本研究旨在评价超声引导下枕骨大神经远端和近端射频入路治疗慢性偏头痛合并颈源性头痛的疗效。方法研究60例慢性偏头痛合并颈源性头痛患者，年龄18 ~ 65岁，符合国际头痛疾病分类（ICHD）的具体诊断标准。患者分为近端组（A组）和远端组（B组）。主要终点测量每月头痛频率的变化，而次要终点包括疼痛强度、头痛残疾指数（HDI）的变化、睡眠障碍和患者满意度。结果与远端入路相比，近端入路夜间颈部和偏头痛疼痛强度较低。两组都减少了头痛发作和睡眠障碍，并提高了人类发展指数。然而，近端入路显示头痛发作更少（p = 0.000），睡眠障碍更少（p = 0.001）， HDI改善更多，患者满意度更高（p = 0.016）。结论近端和远端入路射频消融术可有效减少头痛发作、残疾和睡眠障碍。然而，近端入路对疼痛强度有更持久的影响，表明对颈部疼痛和偏头痛有更好的长期缓解。试验注册：clinicaltrials .gov（标识符：NCT06121037）

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引用次数: 0

Comparative efficacy of low-dose prothrombin complex concentrate + fresh frozen plasma combination and fresh frozen plasma in postoperative haemostasis after on-pump and off-pump coronary arterial bypass grafting surgery 低剂量凝血酶原复合物浓缩物+新鲜冷冻血浆联合与新鲜冷冻血浆在有泵和无泵冠状动脉搭桥术术后止血效果的比较

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-08 DOI: 10.1016/j.pcorm.2025.100572

Reza Widianto Sudjud, Erwin Pradian, Suwarman, Jenifer Kiem Aviani, Phillipus Andre, Dian Nuryanda

Background

Postoperative bleeding is a major cause of morbidity and mortality in CABG. While FFP is commonly used for bleeding management, high doses may increase the risk of acute lung injury and infection. PCC offers a safer alternative. This study compares low-dose PCC + FFP versus FFP alone in on-pump and off-pump CABG.

Methods

Medical records of CABG patients (2022–2023) were reviewed. Statistical analysis included Independent T-Test, Mann-Whitney U, and Chi-Square Test.

Results

The combination of low-dose PCC (500 IU) and FFP achieved significantly more rapid hemostasis within the first 3 hours postoperatively (277.00 ± 60.48 mL vs. 416.00 ± 34.00 mL; p < 0.0001), without any serious adverse events. However, no significant differences in bleeding volume were observed between the groups beyond the 3-hour mark. On-pump surgery patients had longer ICU stays (mean difference: 0.52 [0.31–0.73], p < 0.00001). In-hospital mortality was higher in the PCC group (RR 2.63 [1.25–5.59], p = 0.0149), particularly in on-pump cases, those with three anastomoses, and male patients, but 30-day mortality was similar between groups (RR 1.53 [0.90–2.63], p = 0.1681).

Conclusion

Low-dose PCC provides rapid hemostasis within 3 hours in CABG but should be used cautiously in male patients, multiple anastomoses, and on-pump surgeries.

背景：术后出血是冠状动脉搭桥术发病和死亡的主要原因。虽然FFP通常用于出血治疗，但高剂量可能会增加急性肺损伤和感染的风险。PCC提供了一个更安全的选择。本研究比较了低剂量PCC + FFP与单独FFP在有泵和无泵CABG中的作用。方法回顾我院2022-2023年冠脉搭桥患者的医疗记录。统计分析采用独立t检验、Mann-Whitney U检验和卡方检验。结果低剂量PCC （500 IU）联合FFP在术后前3小时内止血速度明显加快（277.00±60.48 mL vs. 416.00±34.00 mL; p < 0.0001），无严重不良事件发生。然而，3小时后各组之间的出血量没有显著差异。非泵手术患者的ICU住院时间更长（平均差异：0.52 [0.31-0.73],p < 0.00001）。PCC组住院死亡率较高（RR为2.63 [1.25-5.59],p = 0.0149），特别是非泵送组、三吻合口组和男性患者，但两组间30天死亡率相似（RR为1.53 [0.90-2.63],p = 0.1681）。结论小剂量PCC可在冠脉搭桥术后3小时内快速止血，但在男性患者、多处吻合口及无泵手术中应谨慎使用。

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引用次数: 0

The perceived influence of burnout on quality of perioperative care among surgical team in teaching hospitals in a peri-urban city in southwestern Nigeria 尼日利亚西南部一个近郊城市教学医院外科团队的倦怠感对围手术期护理质量的影响

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-03 DOI: 10.1016/j.pcorm.2025.100567

Rafiat Omotayo ISHOLA , Olufemi Oyebanji OYEDIRAN , Iyanuoluwa Oreofe OJO , Johnson Adewale AKINOSO , Emmanuel Olufemi AYANDIRAN

Aim

This study assessed the perceived influence of burnout on the quality of perioperative care provided by surgical teams in selected teaching hospitals in Nigeria.

Background

Burnout among surgical teams is a significant issue that can negatively impact patient safety, team performance and the overall quality of perioperative care.

Design

This study adopted a descriptive cross-sectional design.

Methods

Conducted in January 2025, the study assessed the level of burnout among surgical teams and its perceived influence on the quality of perioperative care in selected teaching hospitals in Nigeria. A stratified random sampling technique was used to select 229 respondents from surgical teams. A structured questionnaire was used to collect the data, which was analysed using the Statistical Package for the Social Sciences (SPSS) version 27. Descriptive and inferential statistics were used to present the data at a significance level of p = 0.05.

Results

The results of this study revealed that more than two-thirds of respondents (62.6%) experienced a high level of burnout. Contributing factors included a lack of effective equipment, an imbalance in work-life experience, unmet job expectations, poor working relationships within the surgical team and an increased workload. Additionally, slightly more than half of the respondents (51.2%) perceived the quality of perioperative care to be good, while 48.8% reported poor quality. The results also showed that age, educational background, area of specialisation, and years of experience were predictors of burnout among the surgical team (P = 0.001, 0.009, 0.014, and 0.000, respectively). Additionally, no significant relationship was found between burnout and quality of perioperative care (t/f = 1.981, p = 0.161).

Conclusion

This study concluded that burnout levels among surgical teams are high. Therefore, there is a need to provide a support system and adequate equipment to ease the workload and reduce burnout among surgical team members in Nigeria.

目的本研究评估了尼日利亚选定教学医院外科团队提供围手术期护理质量的倦怠感影响。手术团队的职业倦怠是一个重要的问题，它会对患者安全、团队绩效和围手术期护理的整体质量产生负面影响。设计本研究采用描述性横断面设计。方法本研究于2025年1月在尼日利亚选定的教学医院进行，评估了外科团队的职业倦怠水平及其对围手术期护理质量的影响。采用分层随机抽样的方法，从外科团队中抽取229名受访者。使用结构化问卷来收集数据，并使用社会科学统计软件包（SPSS）第27版进行分析。采用描述性统计和推断性统计，p = 0.05为显著性水平。结果本研究结果显示，超过三分之二（62.6%）的受访者经历了高度的倦怠。造成这种情况的因素包括缺乏有效的设备、工作与生活经验的不平衡、无法满足工作期望、外科团队内部的工作关系不佳以及工作量增加。此外，略多于一半（51.2%）的受访者认为围手术期护理质量良好，48.8%的受访者认为质量较差。结果还显示，年龄、学历、专业领域和工作年限是外科团队倦怠的预测因素（P分别为0.001、0.009、0.014和0.000）。倦怠与围手术期护理质量无显著相关（t/f = 1.981, p = 0.161）。结论外科团队存在较高的职业倦怠水平。因此，有必要提供一个支持系统和足够的设备，以减轻尼日利亚外科团队成员的工作量和减少倦怠。

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引用次数: 0

Remimazolam versus propofol for gastrointestinal endoscopic sedation: A systematic review and meta-analysis of randomized controlled trials with GRADE assessment 雷马唑仑与异丙酚用于胃肠道内窥镜镇静：随机对照试验GRADE评估的系统回顾和荟萃分析

IF 1 Q2 Nursing

Perioperative Care and Operating Room Management

Pub Date : 2025-10-02 DOI: 10.1016/j.pcorm.2025.100569

Abdallfatah Abdallfatah , Bishoy Beshay , Mark Nasseem , Imad Samman Tahhan , Mohammad Kloub , Riddhi Machchhar , Samaa Daoud , Mohamed Hamed , Hazem Abosheaishaa

Background

Gastrointestinal endoscopy is one of the most performed procedures worldwide, and sedation is often necessary to enhance patient satisfaction and improve procedural outcomes. Although propofol is the preferred sedative due to its rapid onset and recovery, it is associated with adverse effects such as hypotension and respiratory depression. Recently, remimazolam has emerged as a promising alternative sedative. Our aim is to evaluate the efficacy and safety of remimazolam compared to propofol.

Methods

We performed a systematic review and meta-analysis following PRISMA guidelines, and our study was registered in the PROSPERO database (CRD42025635440). We performed a literature search across multiple databases up to January 2025. Two independent reviewers carried out data extraction and quality assessment, with a third author resolving any conflicts. We conducted the SRMA using RevMan version 5.4. The primary outcome was hypotension.

Results

We included 29 Randomized controlled trials; the overall risk of bias was low to moderate. Remimazolam significantly reduced the risk of hypotension (27 studies, OR: 0.26, 95 % CI: 0.21–0.33; P < 0.00001). Additionally, remimazolam was associated with lower rates of respiratory depression (OR: 0.33; P < 0.00001) and bradycardia (OR: 0.36; P < 0.00001), and reduced injection site pain (OR: 0.09; P < 0.00001. There was no significant difference in the sedation success rate for remimazolam and propofol (13 studies, OR: 0.44, 95 % CI: 0.28–0.69; P = 0.0004; I² 0 %). Moreover, patients reported higher satisfaction with remimazolam (8 studies; MD: 0.43, 95 % CI: 0.16–0.70; P < 0.00001).

Conclusion

Our systematic review and meta-analysis demonstrated that remimazolam is clinically comparable to propofol for sedation in gastrointestinal endoscopy, offering superior hemodynamic stability, greater safety, and higher patient satisfaction. However, caution is advised in interpreting these findings.

背景胃肠内窥镜检查是世界范围内执行次数最多的手术之一，镇静通常是提高患者满意度和改善手术结果所必需的。虽然异丙酚因其起效快、恢复快而成为首选的镇静剂，但它与低血压和呼吸抑制等不良反应有关。最近，雷马唑仑已成为一种有前途的替代镇静剂。我们的目的是比较雷马唑仑与异丙酚的疗效和安全性。方法我们按照PRISMA指南进行了系统评价和荟萃分析，我们的研究在PROSPERO数据库中注册（CRD42025635440）。我们对截至2025年1月的多个数据库进行了文献检索。两名独立审稿人进行数据提取和质量评估，第三作者解决任何冲突。我们使用RevMan 5.4版本进行SRMA。主要结局是低血压。结果纳入29项随机对照试验；总体偏倚风险为低至中等。雷马唑仑显著降低低血压的风险（27项研究，OR: 0.26, 95% CI: 0.21-0.33; P < 0.00001）。此外，雷马唑仑与较低的呼吸抑制（OR: 0.33; P < 0.00001）和心动过缓（OR: 0.36; P < 0.00001）发生率相关，并减少注射部位疼痛（OR: 0.09; P < 0.00001）。雷马唑仑和异丙酚的镇静成功率无显著差异（13项研究，OR: 0.44, 95% CI: 0.28-0.69; P = 0.0004; I²0 %）。此外，患者对雷马唑仑的满意度更高（8项研究；MD: 0.43, 95% CI: 0.16-0.70; P < 0.00001）。我们的系统回顾和荟萃分析表明，雷马唑仑在胃肠内镜镇静方面的临床效果与异丙酚相当，具有更好的血流动力学稳定性、更高的安全性和更高的患者满意度。然而，在解释这些发现时建议谨慎。

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