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Sample records for accelerated perioperative care

  1. Perioperative Care of Prisoners: Providing Safe Care.

    Science.gov (United States)

    Smith, Francis Duval

    2016-03-01

    Correctional nurses are trained to care for prisoners in a controlled security environment; however, when a convict is transferred to a noncorrectional health care facility, the nurses there are often unfamiliar with custody requirements or how to safely care for these patients. The care of prisoners outside of prison has not been adequately investigated, and a gap exists between research and nursing education and practice. Nurses rarely have to consider how providing care for a prisoner in custody affects their practice, the potential dissonance between routine nursing care and the requirements to maintain security, or that care of prisoners in unsecured clinical areas places the nurse and other personnel at risk for physical assault or prisoner escape. Educating perioperative nurses in the care of prisoners in a public hospital environment is important for the provision of safe care and prevention of physical and emotional repercussions to personnel.

  2. Perioperative nurses' perceptions of caring practices.

    Science.gov (United States)

    McNamara, S A

    1995-02-01

    This study was designed to determine how caring is practiced in perioperative nursing. The theory of nursing by M. Jean Watson, RN, PhD, FAAN, provided the conceptual framework for the study. The researcher used a qualitative, descriptive methodology to analyze data collected in audiotaped interviews with five perioperative nurses and used standard qualitative research procedures for transcribing and analyzing the interview data. The five study participants identified their perceptions of caring behaviors with conscious and unconscious patients in the preoperative, intraoperative, and postoperative periods. They described the essential structure of caring as the establishment of a human care relationship and provision of a supportive, protective, and/or corrective psychological, physical, and spiritual environment.

  3. Perioperative Care of the Liver Transplant Patient.

    Science.gov (United States)

    Keegan, Mark T; Kramer, David J

    2016-07-01

    With the evolution of surgical and anesthetic techniques, liver transplantation has become "routine," allowing for modifications of practice to decrease perioperative complications and costs. There is debate over the necessity for intensive care unit admission for patients with satisfactory preoperative status and a smooth intraoperative course. Postoperative care is made easier when the liver graft performs optimally. Assessment of graft function, vigilance for complications after the major surgical insult, and optimization of multiple systems affected by liver disease are essential aspects of postoperative care. The intensivist plays a vital role in an integrated multidisciplinary transplant team. PMID:27339683

  4. Evidence for the perioperative care of mastectomized women

    Directory of Open Access Journals (Sweden)

    Carla Monique Lopes Mourão

    2014-01-01

    Full Text Available This study aimed to evaluate the evidence available in the literature about the perioperative care provided to women submitted to mastectomy. An integrative review of scientific literature conducted in MEDLINE, CINAHL, LILACS, and SciELO databases, published from 2000 to 2011, using the controlled descriptors: preoperative care; preoperative period; intraoperative care; intraoperative period; postoperative care; postoperative period; perioperative care; perioperative period; and mastectomy. The sample of this review consisted of seven articles. The evidence pointed as perioperative care of mastectomy the pharmacological management of pain in different surgical periods. Despite the difficulty in presenting a consensus of evidence for perioperative care of mastectomy, there was concern on the part of professionals to minimize/prevent pre-, intra- and post-operative pain. Nursing should be aware, both of the update of pharmacological treatments in pain management and the development of future research related to nursing care in the perioperative period of mastectomy.

  5. Effective Perioperative Communication to Enhance Patient Care.

    Science.gov (United States)

    Garrett, J Hudson

    2016-08-01

    Breakdowns in health care communication are a significant cause of sentinel events and associated patient morbidity and mortality. Effective communication is a necessary component of a patient safety program, which enables all members of the interdisciplinary health care team to effectively manage their individual roles and responsibilities in the perioperative setting; set expectations for safe, high-reliability care; and measure and assess outcomes. To sustain a culture of safety, effective communication should be standardized, complete, clear, brief, and timely. Executive leadership and support helps remove institutional barriers and address challenges to support the engagement of patients in health care communication, which has been shown to improve outcomes, reduce costs, and improve the patient experience. PMID:27472971

  6. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach

    Science.gov (United States)

    Borden, Timothy C; Bellaire, Laura L; Fletcher, Nicholas D

    2016-01-01

    The complex nature of the surgical treatment of adolescent idiopathic scoliosis (AIS) requires a wide variety of health care providers. A well-coordinated, multidisciplinary team approach to the care of these patients is essential for providing high-quality care. This review offers an up-to-date overview of the numerous interventions and safety measures for improving outcomes after AIS surgery throughout the perioperative phases of care. Reducing the risk of potentially devastating and costly complications after AIS surgery is the responsibility of every single member of the health care team. Specifically, this review will focus on the perioperative measures for preventing surgical site infections, reducing the risk of neurologic injury, minimizing surgical blood loss, and preventing postoperative complications. Also, the review will highlight the postoperative protocols that emphasize early mobilization and accelerated discharge. PMID:27695340

  7. Quality and safety in anesthesia and perioperative care

    CERN Document Server

    Ruskin, Keith J; Rosenbaum, Stanley H

    2016-01-01

    Quality and Safety in Anesthesia and Perioperative Care offers practical suggestions for improving quality of care and patient safety in the perioperative setting. The book highlights concepts such as situation awareness, staff resource management, threat and error management, checklists, explicit practices for monitoring, and safety culture. Quality and Safety in Anesthesia and Perioperative Care is a must-have resource for those preparing for the quality and safety questions on the American Board of Anesthesiology certification examinations and clinicians and trainees in all practice setting

  8. Electrodermal activity: Applications in perioperative care

    Directory of Open Access Journals (Sweden)

    Aslanidis Theodoros

    2014-07-01

    Full Text Available Background: Electrodermal activity is originated from the activation of sweat glands in the skin in response to stress or other stimuli and thought to reflect the activity of the sympathetic nervous system, or physiological arousal. Though it has been studied since the late 19th century, it still does not make the transition into everyday clinical application. Improvement of recording and analyzing measurement data has recently increased the interest for possible applications in various clinical settings- operation room, recovery and intensive care unit- where monitoring of autonomous nervous system activity is vital. Aims: This paper presents the applications of electrodermal activity measurements, in both adult and pediatric patients. Materials-methods: It especially reviews the results of studies carried out in perioperative setting and reviews their results. Conclusion: Although no final conclusion can be drawn safely, it seems that in adult populations electrodermal activity monitoring has the role of stress detector, while in pediatric populations it works more efficiently as algesimeter. Possible future applications in intensive care are also discussed.

  9. Perioperative care of the older patient

    NARCIS (Netherlands)

    E. Blommers; M. Klimek (Markus); K.A. Hartholt (Klaas); T.J.M. van der Cammen (Tischa); J. Klein (Jan); P. Noordzij (Peter)

    2011-01-01

    textabstractNearly 60% of the Dutch population undergoing surgery is aged 65 years and over. Older patients are at increased risk of developing perioperative complications (e.g., myocardial infarction, pneumonia, or delirium), which may lead to a prolonged hospital stay or death. Preoperative risk s

  10. Perioperative care of an adolescent with postural orthostatic tachycardia syndrome

    Directory of Open Access Journals (Sweden)

    Kernan Scott

    2010-01-01

    Full Text Available Postural orthostatic tachycardia syndrome (POTS is a disorder characterized by postural tachycardia in combination with orthostatic symptoms without associated hypotension. Symptoms include light-headedness, palpitations, fatigue, confusion, and anxiety, which are brought on by assuming the upright position and usually relieved by sitting or lying down. Given the associated autonomic dysfunction that occurs with POTS, various perioperative concerns must be considered when providing anesthetic care for such patients. We present an adolescent with POTS who required anesthetic care during posterior spinal fusion for the treatment of scoliosis. The potential perioperative implications of this syndrome are discussed.

  11. Study of Problems Arising during Perioperative Care of Postoperative Endophthalmitis

    Institute of Scientific and Technical Information of China (English)

    Jingyi Lin; Yue Cai; Jiehui Huang; Ronghua Ye

    2014-01-01

    Purpose:.To discuss the problems in perioperative nursing care for patients with postoperative infectious endophthalmitis. Methods: The medical records of 34 patients (35 eyes) pre-senting with infectious endophthalmitis at Zhongshan Oph-thalmic Center,.Sun Yat-sen University between April 2002 and December 2013 were collected to analyze preoperative and postoperative nursing care for endophthalmitis after ocular surgery. Results:Thirty-four patients (35 eyes) developed complications of infectious endophthalmitis after surgery..Thirty-three cases were successfully cured and only one patient (1 eye) was un-treated due to Pseudomonas aeruginosa infection. Conclusion: Perioperative nursing care plays a pivotal role in preventing and controlling the incidence and development of postoperative infectious endophthalmitis.

  12. Perioperative Care of the Transgender Patient.

    Science.gov (United States)

    Smith, Francis Duval

    2016-02-01

    Transgender patients are individuals whose gender identity is not related to their biological sex. Assuming a new gender identity that does not conform to societal norms often results in discrimination and barriers to health care. The exact number of transgender patients is unknown; however, these patients are increasingly seen in health care. Transgender individuals may experience provider-generated discrimination in health care facilities, including refusal of service, disrespect, and abuse, which contribute to depression and low self-esteem. Transgender therapies include mental health counseling for depression and low self-esteem, hormone therapy, and sex reassignment surgery. Health care professionals require cultural competence, an understanding of the different forms of patient identification, and adaptive approaches to care for transgender patients. VA (Veterans Affairs) hospitals provide a model for the care for transgender patients and staff. PMID:26849981

  13. Perioperative care following complex laryngotracheal reconstruction in infants and children

    Directory of Open Access Journals (Sweden)

    Gupta Punkaj

    2010-01-01

    Full Text Available Laryngotracheal reconstruction (LTR involves surgical correction of a stenotic airway with cartilage interpositional grafting, followed by either placement of a tracheostomy and an intraluminal stent (two-stage LTR or placement of an endotracheal tube with postoperative sedation and mechanical ventilation for an extended period of time (single-stage LTR. With single-stage repair, there may be several perioperative challenges including the provision of adequate sedation, avoidance of the development of tolerance to sedative and analgesia agents, the need to use neuromuscular blocking agents, the maintenance of adequate pulmonary toilet to avoid perioperative nosocomial infections, and optimization of postoperative respiratory function to facilitate successful tracheal extubation. We review the perioperative management of these patients, discuss the challenges during the postoperative period, and propose recommendations for the prevention of reversible causes of extubation failure in this article. Optimization to ensure a timely tracheal extubation and successful weaning of mechanical ventilator, remains the primary key to success in these surgeries as extubation failure or the need for prolonged postoperative mechanical ventilation can lead to failure of the graft site, the need for prolonged Pediatric Intensive Care Unit care, and in some cases, the need for a tracheostomy to maintain an adequate airway.

  14. PERIOPERATIVE CARE OF A CHILD WITH CRISPONI SYNDROME.

    Science.gov (United States)

    Rafiq, Mahmood; Almasry, Shadi; Abdulrahman, Anas; Al-Sohabani, Mazen; Tobias, Joseph D

    2016-06-01

    Crisponi syndrome is an autosomal recessive disorder characterized by intermittent episodes of muscular contraction of the facial muscles with trismus and excessive salivation simulating a tetanic spasm. These episodes occur in response to tactile stimulation or during crying. Associated physical and constitutional findings include characteristic facial anomalies, camptodactyly, intermittent hyperthermia, and feeding difficulties. We present a 15-month-old girl who required anesthetic care during laparoscopic fundoplication and gastric tube insertion. The perioperative implications of the disorder are reviewed and suggestions for anesthetic management provided. PMID:27487643

  15. Perioperative Care Coordination Measurement: A Tool to Support Care Integration of Pediatric Surgical Patients.

    Science.gov (United States)

    Ferrari, Lynne R; Ziniel, Sonja I; Antonelli, Richard C

    2016-03-01

    The relationship of care coordination activities and outcomes to resource utilization and personnel costs has been evaluated for a number of pediatric medical home practices. One of the first tools designed to evaluate the activities and outcomes for pediatric care coordination is the Care Coordination Measurement Tool (CCMT). It has become widely used as an instrument for health care providers in both primary and subspecialty care settings. This tool enables the user to stratify patients based on acuity and complexity while documenting the activities and outcomes of care coordination. We tested the feasibility of adapting the CCMT to a pediatric surgical population at Boston Children's Hospital. The tool was used to assess the preoperative care coordination activities. Care coordination activities were tracked during the interval from the date the patient was scheduled for a surgical or interventional procedure through the day of the procedure. A care coordination encounter was defined as any task, whether face to face or not, supporting the development or implementation of a plan of care. Data were collected to enable analysis of 5675 care coordination encounters supporting the care provided to 3406 individual surgical cases (patients). The outcomes of care coordination, as documented by the preoperative nursing staff, included the elaboration of the care plan through patient-focused communication among specialist, facilities, perioperative team, and primary care physicians in 80.5% of cases. The average time spent on care coordination activities increased incrementally by 30 minutes with each additional care coordination encounter for a surgical case. Surgical cases with 1 care coordination encounter took an average of 35.7 minutes of preoperative care coordination, whereas those with ≥4 care coordination encounters reported an average of 121.6 minutes. We successfully adapted and implemented the CCMT for a pediatric surgical population and measured nonface

  16. Transforming Perioperative Care: The Case for a Novel Curriculum for Anesthesiology Resident Training.

    Science.gov (United States)

    Alem, Navid; Cohen, Neal; Cannesson, Maxime; Kain, Zeev

    2016-06-15

    Currently, perioperative health care is undergoing transformative changes. One prospect for the specialty of anesthesiology is a reorientation of resident education to focus more on the entire spectrum of perioperative care as exemplified by the perioperative surgical home (PSH). To advance this novel paradigm for patients and anesthesiologists, one must also consider further incorporating the competencies fundamental to the PSH during residency training. As such, the purpose of this case report is to outline the successful implementation of a comprehensive PSH curriculum for anesthesiology residents. PMID:27166744

  17. Incorporating Age-Specific Plans of Care to Achieve Optimal Perioperative Outcomes.

    Science.gov (United States)

    Mower, Juliana

    2015-10-01

    When developing a nursing plan of care, a perioperative nurse identifies nursing diagnoses during the preoperative patient assessment. The ability to identify age-specific outcomes (ie, infant/child, adolescent, adult, elderly adult) in addition to those that are universally applicable is a major responsibility of the perioperative RN. Having an individualized plan of care is one of the best ways to determine whether desired patient outcomes have been successfully attained. Nursing care plans address intraoperative and postoperative risks and allow for a smooth transfer of care throughout the perioperative experience. A good nursing care plan also includes education for the patient and his or her caregiver. Within an overall plan of care, the use of methods such as a concept or mind map can visually demonstrate the relationships between systems, nursing diagnoses, nursing interventions, and desirable outcomes.

  18. Orthopedic Perioperative Care: viewpoint of the patient, nursing staff and medical residents

    Directory of Open Access Journals (Sweden)

    Josilaine Porfírio da Silva

    2015-03-01

    Full Text Available The aim of this study was to identify the actions of perioperative care taken with the orthopedic surgical patient in view of the surgical team and the patient. Qualitative descriptive and exploratory research, conducted with 20 professionals, in the period from October 2009 to July 2011. Data collection took place by means of a semi-structured interview addressing issues related to care and self-care to patients undergoing orthopedic surgery. Results were arranged into three categories: (a Meanings of perioperative care: covered integral assistance, prevention of damage and care subjective; (b patients' needs perceived by health team: evidenced basic and specific human needs; (c Actions of care: surgical indication, evaluation revealed the wait, use of special materials and surgical risk. From the perceived needs is that care happens, its meaning is dynamic and timeless. This study showed that the meaning of care remained related to the health-disease process.

  19. Nursing care in the perioperative period for patients undergoing bariatric surgery

    OpenAIRE

    Maria Beatriz Guimarães Ferreira; Márcia Marques dos Santos Felix; Cristina Maria Galvão

    2014-01-01

    This integrative review aimed to analyze the available evidence in the literature regarding nursing care in the perioperative period for patients who underwent bariatric surgery. The search for primary studies was carried out in the US National Library of Medicine National Institutes of Health, Cumulative Index to Nursing and Allied Health Literature and Latin American and Caribbean Health Sciences Literature databases. The sample was comprised of 11 primary studies, published between January...

  20. Kaizen: a process improvement model for the business of health care and perioperative nursing professionals.

    Science.gov (United States)

    Tetteh, Hassan A

    2012-01-01

    Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement. PMID:22201574

  1. Kaizen: a process improvement model for the business of health care and perioperative nursing professionals.

    Science.gov (United States)

    Tetteh, Hassan A

    2012-01-01

    Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement.

  2. The perioperative care of the paediatric neurosurgical patient.

    Science.gov (United States)

    Wheatley, R

    1994-07-01

    The Queen's Medical Centre, University of Nottingham, is one of the largest neuro-science centres in Britain and serves a population of five million people. Its catchment area covers the counties of Nottinghamshire, Leicestershire, Derbyshire and Lincolnshire though patients are often referred from other parts of Britain and from abroad. The total number of neuro-paediatric beds is 20 plus access to 12 beds in the paediatric intensive care unit and 18 beds of the neonatal unit. In the year 1992 the total number of operations was 300, a number which increased by 25% the following year and included such operations as craniostenosis, craniotomies, spinal surgery, repair of meningocele, shunts, implanting and endoscopic and stereotactic procedures. PMID:7633065

  3. How Well Is Quality Improvement Described in the Perioperative Care Literature? A Systematic Review

    Science.gov (United States)

    Jones, Emma L.; Lees, Nicholas; Martin, Graham; Dixon-Woods, Mary

    2016-01-01

    Abstract Background Quality improvement (QI) approaches are widely used across health care, but how well they are reported in the academic literature is not clear. A systematic review was conducted to assess the completeness of reporting of QI interventions and techniques in the field of perioperative care. Methods Searches were conducted using Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organization of Care database, and PubMed. Two independent reviewers used the Template for Intervention Description and Replication (TIDieR) checklist, which identifies 12 features of interventions that studies should describe (for example, How: the interventions were delivered [e.g., face to face, internet]), When and how much: duration, dose, intensity), to assign scores for each included article. Articles were also scored against a small number of additional criteria relevant to QI. Results The search identified 16,103 abstracts from databases and 19 from other sources. Following review, full-text was obtained for 223 articles, 100 of which met the criteria for inclusion. Completeness of reporting of QI in the perioperative care literature was variable. Only one article was judged fully complete against the 11 TIDieR items used. The mean TIDieR score across the 100 included articles was 6.31 (of a maximum 11). More than a third (35%) of the articles scored 5 or lower. Particularly problematic was reporting of fidelity (absent in 74% of articles) and whether any modifications were made to the intervention (absent in 73% of articles). Conclusions The standard of reporting of quality interventions and QI techniques in surgery is often suboptimal, making it difficult to determine whether an intervention can be replicated and used to deliver a positive effect in another setting. This suggests a need to explore how reporting practices could be improved. PMID:27066922

  4. European Renal Best Practice Guideline on kidney donor and recipient evaluation and perioperative care.

    Science.gov (United States)

    Abramowicz, Daniel; Cochat, Pierre; Claas, Frans H J; Heemann, Uwe; Pascual, Julio; Dudley, C; Harden, Paul; Hourmant, Marivonne; Maggiore, Umberto; Salvadori, Maurizio; Spasovski, Goce; Squifflet, Jean-Paul; Steiger, Jürg; Torres, Armando; Viklicky, Ondrej; Zeier, Martin; Vanholder, Raymond; Van Biesen, Wim; Nagler, Evi

    2015-11-01

    The European Best Practice Guideline group (EBPG) issued guidelines on the evaluation and selection of kidney donor and kidney transplant candidates, as well as post-transplant recipient care, in the year 2000 and 2002. The new European Renal Best Practice board decided in 2009 that these guidelines needed updating. In order to avoid duplication of efforts with kidney disease improving global outcomes, which published in 2009 clinical practice guidelines on the post-transplant care of kidney transplant recipients, we did not address these issues in the present guidelines.The guideline was developed following a rigorous methodological approach: (i) identification of clinical questions, (ii) prioritization of questions, (iii) systematic literature review and critical appraisal of available evidence and (iv) formulation of recommendations and grading according to Grades of Recommendation Assessment, Development, and Evaluation (GRADE). The strength of each recommendation is rated 1 or 2, with 1 being a 'We recommend' statement, and 2 being a 'We suggest' statement. In addition, each statement is assigned an overall grade for the quality of evidence: A (high), B (moderate), C (low) or D (very low). The guideline makes recommendations for the evaluation of the kidney transplant candidate as well as the potential deceased and living donor, the immunological work-up of kidney donors and recipients and perioperative recipient care.All together, the work group issued 112 statements. There were 51 (45%) recommendations graded '1', 18 (16%) were graded '2' and 43 (38%) statements were not graded. There were 0 (0%) recommendations graded '1A', 15 (13%) were '1B', 19 (17%) '1C' and 17 (15%) '1D'. None (0%) were graded '2A', 1 (0.9%) was '2B', 8 (7%) were '2C' and 9 (8%) '2D'. Limitations of the evidence, especially the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research.We present here the complete recommendations about the

  5. The perioperative dialogue--a model of caring for the patient undergoing a hip or a knee replacement surgery under spinal anaesthesia.

    Science.gov (United States)

    Pulkkinen, Maria; Junttila, Kristiina; Lindwall, Lillemor

    2016-03-01

    The aim of the study was to describe how patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia experienced to be a part of the perioperative dialogue as an ideal model of caring. A qualitative approach was chosen as a method. Nineteen patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia participated. These patients and their nurse anaesthetists had three perioperative dialogues in the pre-, intra- and postoperative phase of care. Data were collected by means of conversational interviews by four voluntary nurse anaesthetists who wrote the dialogues from each perioperative phase. The text from the collected data was analysed by qualitative, latent content analysis. The findings of the analysis show three identified themes: Suffering while waiting for surgery (preoperative dialogue), Continuity creates togetherness (intraoperative dialogue) and Uniqueness - the patient has been seen (postoperative dialogue). The findings show evidence that the perioperative dialogue is an ideal model of caring and serves the patients' desires of individual and dignified care. The patients have a deep appreciation when there is time to develop a caring encounter with his or her own nurse. When a caring encounter has been established, the patient is involved in his or her own care. This model of caring offers the perioperative nurses a new way of caring and arouses reflections about their main task caring for the suffering patient. The continuity created by the perioperative dialogue probably has an influence on both patient satisfaction and patient safety.

  6. The perioperative nursing care of patients with malignant obstructive jaundice treated with interventional therapy: clinical experience in 71 cases

    International Nuclear Information System (INIS)

    Objective: To summarize the clinical experience of perioperative nursing for patients with malignant obstructive jaundice who were treated with percutaneous transhepatic biliary drainage. Methods: Sufficient preoperative preparation,careful psychological nursing, serious postoperative observation of vital signs, enhancement of the nutritional support,care of the puncture site and drainage tube, maintenance of the electrolyte balance, correct evaluation of the jaundice, etc. were strictly carried out in all 71 patients with malignant obstructive jaundice who received percutaneous transhepatic biliary drainage. Results: Because the sufficient preoperative preparation and postoperative nursing work were seriously carried out,the obstructive jaundice was well relieved in all patients, the liver function and the living quality were markedly improved and the survival time was prolonged. Conclusion: It is of great clinical significance to intensify the perioperative nursing care for patients with malignant obstructive jaundice who are receiving interventional therapy. (authors)

  7. Computerized surveillance of opioid-related adverse drug events in perioperative care: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Gattis Katherine G

    2009-08-01

    Full Text Available Abstract Background Given the complexity of surgical care, perioperative patients are at high risk of opioid-related adverse drug events. Existing methods of detection, such as trigger tools and manual chart review, are time-intensive which makes sustainability challenging. Using strategic rule design, computerized surveillance may be an efficient, pharmacist-driven model for event detection that leverages existing staff resources. Methods Computerized adverse drug event surveillance uses a logic-based rules engine to identify potential adverse drug events or evolving unsafe clinical conditions. We extended an inpatient rule (administration of naloxone to detect opioid-related oversedation and respiratory depression to perioperative care at a large academic medical center. Our primary endpoint was the adverse drug event rate. For all patients with a naloxone alert, manual chart review was performed by a perioperative clinical pharmacist to assess patient harm. In patients with confirmed oversedation, other patient safety event databases were queried to determine if they could detect duplicate, prior, or subsequent opioid-related events. Results We identified 419 cases of perioperative naloxone administration. Of these, 101 were given postoperatively and 69 were confirmed as adverse drug events after chart review yielding a rate of 1.89 adverse drug events/1000 surgical encounters across both the inpatient and ambulatory settings. Our ability to detect inpatient opioid adverse drug events increased 22.7% by expanding surveillance into perioperative care. Analysis of historical surveillance data as well as a voluntary reporting database revealed that 11 of our perioperative patients had prior or subsequent harmful oversedation. Nine of these cases received intraoperative naloxone, and 2 had received naloxone in the post-anesthesia care unit. Pharmacist effort was approximately 3 hours per week to evaluate naloxone alerts and confirm adverse drug

  8. Accelerating best care at baylor dallas.

    Science.gov (United States)

    Haydar, Ziad; Cox, Marsha; Stafford, Pam; Rodriguez, Vera; Ballard, David J

    2009-10-01

    A culture of quality improvement (QI) is needed to bridge the gap between possible STEEEP (safe, timely, effective, efficient, equitable, and patient-centered) care and actual usual care. Baylor Health Care System (BHCS) developed Accelerating Best Care at Baylor (ABC Baylor), an innovative educational program that teaches health care leaders the theory and techniques of rapid-cycle QI. Course participants learn general principles of continuous QI, as well as health care-specific QI techniques, and finish the course by designing and implementing their own QI project. ABC Baylor has been employed in a variety of settings and has spread its success to other organizations, especially small and rural hospitals. These hospitals, like BHCS, have demonstrated sustained improvements that are due in part to the use of ABC Baylor and its reliance on specific modules that focus on health care safety, service, equity, and chronic disease management. The role of ABC Baylor training and consulting is part of the overall culture and infrastructure that have allowed BHCS to achieve success in its improvement journey, including the receipt of several national awards and the achievement of high reliability in compliance with Centers for Medicare and Medicaid Services core measures of processes of care related to heart failure, acute myocardial infarction, community-acquired pneumonia, and surgical care. The culture of rapid-cycle QI facilitated by ABC Baylor serves to link BHCS's vision and goals to practical execution. PMID:19865500

  9. Noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine.

    Science.gov (United States)

    Saugel, B; Cecconi, M; Wagner, J Y; Reuter, D A

    2015-04-01

    The determination of blood flow, i.e. cardiac output, is an integral part of haemodynamic monitoring. This is a review on noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine. We present the underlying principles and validation data of the following technologies: thoracic electrical bioimpedance, thoracic bioreactance, vascular unloading technique, pulse wave transit time, and radial artery applanation tonometry. According to clinical studies, these technologies are capable of providing cardiac output readings noninvasively and continuously. They, therefore, might prove to be innovative tools for the assessment of advanced haemodynamic variables at the bedside. However, for most technologies there are conflicting data regarding the measurement performance in comparison with reference methods for cardiac output assessment. In addition, each of the reviewed technology has its own limitations regarding applicability in the clinical setting. In validation studies comparing cardiac output measurements using these noninvasive technologies in comparison with a criterion standard method, it is crucial to correctly apply statistical methods for the assessment of a technology's accuracy, precision, and trending capability. Uniform definitions for 'clinically acceptable agreement' between innovative noninvasive cardiac output monitoring systems and criterion standard methods are currently missing. Further research must aim to further develop the different technologies for noninvasive continuous cardiac output determination with regard to signal recording, signal processing, and clinical applicability. PMID:25596280

  10. Point of Care Perioperative Coagulation Management in Liver Transplantation and Complete Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Cristiano Piangatelli

    2014-01-01

    Full Text Available Liver transplantation (LT is a serious hemostatic challenge in patients with portal vein thrombosis (PVT. Advances in monitoring systems have improved surgery in this setting. We report the successful application of a point-of-care (POC rotational viscoelastic thromboelastometry-guided (TEM testing system (ROTEM which allowed management of coagulation during LT in a 64-year-old cirrhotic patient with a model for end-stage liver disease (MELD score of 16. Perioperatively, the patient showed complete PVT, hepatomegaly, splenomegaly, recanalization of the umbilical vein, and portosystemic shunt. Macroscopic liver and spleen adherences with collateral circulation were evident. Coagulation factors and fibrinolysis were assessed preoperatively and at graft reperfusion to evaluate the need of hemostatic therapy. Based on ROTEM findings, the patient received 16 g of human fibrinogen concentrate, half preoperatively (with prothrombin complex concentrate 2000 IU, tranexamic acid 1 g, and platelets 2 IU, and two doses of 4 g before and after graft reperfusion; we achieved normalization of all monitored parameters. No ischemia-reperfusion syndrome was present. Postoperatively portal vein flux at Color-Doppler ultrasonography was normal. After a 3-day ICU stay, the patient was moved to the Department of Surgery and discharged on day 14. The postoperative course was uneventful and did not require any further haemostatic therapy.

  11. CARE07 Coordinated Accelerator Research in Europe

    CERN Multimedia

    2007-01-01

    Annual Meeting, at CERN, 29-31 October 2007 The CARE project started on 1st January 2004 and will end on 31st December 2008. At the end of each year, the progress and status of its activities are reported in a general meeting. This year, the meeting takes place at CERN. The CARE objective is to generate structured and integrated European cooperation in the field of accelerator research and related R&D. The programme includes the most advanced scientific and technological developments, relevant to accelerator research for particle physics. It is articulated around three Networking Activities and four Joint Activities. The Networking Activities ELAN, BENE and HHH aim to better coordinate R&D efforts at the European level and to strengthen Europe’s ability to produce intense and high-energy particle beams (electrons and positrons, muons and neutrinos, protons and ions, respectively). The Joint Activities, SRF, PHIN, HIPPI and NED, aim at technical developments on s...

  12. CARE07 Coordinated Accelerator Research in Europe

    CERN Multimedia

    2007-01-01

    Annual Meeting, at CERN, 29-31 October 2007 The CARE project started on 1st January 2004 and will end on 31st December 2008. At the end of each year, the progress and status of its activities are reported in a general meeting. This year, the meeting is taking place at CERN. The CARE objective is to generate structured and integrated European cooperation in the field of accelerator research and related R&D. The programme includes the most advanced scientific and technological developments, relevant to accelerator research for particle physics. It is articulated around three Networking Activities and four Joint Activities. The Networking Activities ELAN, BENE and HHH aim to better coordinate R&D efforts at the European level and to strengthen Europe’s ability to produce intense and high-energy particle beams (electrons and positrons, muons and neutrinos, protons and ions, respectively). The Joint Activities, SRF, PHIN, HIPPI and NED, aim at technical developments ...

  13. CARE05 coordinated accelerator research in Europe

    CERN Multimedia

    2005-01-01

    Annual Meeting at CERN, 23-25 November 2005 CARE started on 1st January 2004 and will last for five years. At the end of each year it holds a general meeting to report on the progress and status of its activities. This year, the CARE annual meeting is taking place at CERN The objective of the CARE project is to generate structured and integrated European cooperation in the field of accelerator research and related R&D. The program includes the most advanced scientific and technological developments, relevant to accelerator research for Particle Physics. It is articulated around three Networking Activities and four Joint Activities. The Networking Activities ELAN, BENE and HHH aim to better coordinate R&D efforts at the European level and to strengthen Europe's ability to evaluate and develop methods of producing intense and high energy beams of electrons, protons, muons and neutrinos. These activities are embedded in world-wide efforts towards future e+e- linear colliders, superior neutrino beam fa...

  14. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial

    Directory of Open Access Journals (Sweden)

    Swart Annemiek

    2006-11-01

    Full Text Available Abstract Background Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay. The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst track multimodal management versus standard care was conceived to determine whether laparoscopic surgery, fast track perioperative care or a combination of both is to be preferred over open surgery with standard care in patients having segmental colectomy for malignant disease. Methods/design The LAFA-trial is a double blinded, multicenter trial with a 2 × 2 balanced factorial design. Patients eligible for segmental colectomy for malignant colorectal disease i.e. right and left colectomy and anterior resection will be randomized to either open or laparoscopic colectomy, and to either standard care or the fast track program. This factorial design produces four treatment groups; open colectomy with standard care (a, open colectomy with fast track program (b, laparoscopic colectomy with standard care (c, and laparoscopic surgery with fast track program (d. Primary outcome parameter is postoperative hospital length of stay including readmission within 30 days. Secondary outcome parameters are quality of life two and four weeks after surgery, overall hospital costs, morbidity, patient satisfaction and readmission rate. Based on a mean postoperative hospital stay of 9 +/- 2.5 days a group size of 400 patients (100 each arm can reliably detect a minimum difference of 1 day between the four arms (alfa = 0.95, beta = 0.8. With 100 patients in each arm a difference of 10% in subscales of the Short Form 36 (SF-36 questionnaire and social functioning can be detected. Discussion The LAFA-trial is a randomized controlled multicenter trial that will provide evidence on the merits of fast track perioperative care and laparoscopic colorectal surgery in

  15. Perioperative Care of Bladder Cancer%膀胱肿瘤围术期的护理

    Institute of Scientific and Technical Information of China (English)

    李会平

    2014-01-01

    Objective: To investigate the bladder tumor underwent cystectomy, ileal neobladder nursing measures of abdominal wal fistula perioperative period. Methods:retrospective analysis of our hospital department of Urology nursing data of 6 cases of patients with bladder resection, preoperative psychological nursing, postoperative nursing management system for patients, close observation of vital signs, especial y cardiovascular and important organ observation and nursing, pay at ention to the skin around the stoma and proper care of the drainage tube. Results: 6 patients recovered wel after operation, treated normal urination, cured and discharged, no deaths. Conclusion: the nursing staf in the peri operation period in close coordination with the doctor nursing intervention on the patients recover smoothly has important influence, preoperative preparation, postoperative intervention, is the key to the success of the operation, can reduce the complications, improve the cure rate.%目的:探讨膀胱肿瘤行膀胱全切,回肠代膀胱腹壁造瘘术围术期的护理措施。方法回顾性分析我院泌尿外科6例行膀胱切除术患者的护理资料,术前做好心理护理,术后对患者进行系统的护理管理,严密观察生命体征的变化,特别心脑血管及重要器官观察和护理,注重造瘘口周围皮肤及各引流管的妥善护理。结果6例患者术后恢复良好,经对症处理恢复正常排尿,治愈出院,无死亡病例。结论护理人员在围手术期间与医生密切配合做好护理干预对患者顺利恢复有重要影响,术前准备、术后干预,是手术成功与否的关键,可减少并发症,提高治愈率。

  16. [Anesthesiological care in orthogeriatric co-management. Perioperative treatment of geriatric trauma patients].

    Science.gov (United States)

    Luger, Thomas J; Luger, Markus F

    2016-04-01

    Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification. If necessary additional investigations, such as echocardiography must be carried out, in order to guarantee optimal perioperative anesthesiological management. Certain medical factors can delay the initiation of anesthesia and it is absolutely necessary that these are taken into consideration for surgical management. Not every form of anesthesia is equally suitable for every geriatric patient. PMID:27090913

  17. Perioperative hypertension

    Directory of Open Access Journals (Sweden)

    G. Pinna

    2013-05-01

    Full Text Available BACKGROUND Perioperative hypertension is a situation whose management is suggested by the clinical judgement much more than clinical evidences. JNC 7 guidelines give a classification of blood pressure (BP, without any mention specifically dedicated to patients undergoing surgery. The ACC/AHA guidelines recommend deferring surgery if diastolic BP is above 110 mmHg and systolic BP is above 180 mmHg. AIM OF THE STUDY In this review we considered pathogenetic, clinical and therapeutic factors related to perioperative management of hypertensive patients. DISCUSSION In actual trend of the preoperative evaluation, alone hypertension is considered as a minor risk factor. BP values ≤ 180/110 mmHg do not influence the outcomes in patients who underwent noncardiac surgery. Therefore, in these conditions it’s not necessary to delay surgery. Hypertensive picks are possible during the operation, mostly because of the intubation, but, much more dangerous, falls of pressure are possible. The intraoperative arterial pressure should be maintained within 20% of the best estimated preoperative arterial pressure, especially in patients with markedly elevated preoperative pressures. After surgery the arterial BP can increase for stress factors, pain, hypoxia and hypercapnia, hypothermia and infusional liquids overload. For all these reasons a careful monitoring is mandatory. Anti-hypertensive medication should be continued during the postoperative period in patients with known and treated hypertension, as unplanned withdrawal of treatment can result in rebounded hypertension. The decision to give anti-hypertensive drugs must be made for each patient, taking into account their normal BP and their postoperative BP. With regard to the optimal treatment of the patient with poorly or uncontrolled hypertension in the perioperative evaluation, recent guidelines suggest that the best treatment may consider cardioselective β-blockers therapy, but also clonidin by

  18. Perioperative anaphylaxis

    Directory of Open Access Journals (Sweden)

    Marta Inés Berrío Valencia

    2015-08-01

    Full Text Available BACKGROUND AND OBJECTIVE: Anaphylaxis remains one of the potential causes of perioperative death, being generally unanticipated and quickly progress to a life threatening situation. A narrative review of perioperative anaphylaxis is performed.CONTENT: The diagnostic tests are primarily to avoid further major events. The mainstays of treatment are adrenaline and intravenous fluids.CONCLUSION: The anesthesiologist should be familiar with the proper diagnosis, management and monitoring of perioperative anaphylaxis.

  19. Implementing a regional anesthesia block nurse team in the perianesthesia care unit increases patient safety and perioperative efficiency.

    Science.gov (United States)

    Russell, Rebecca Ann; Burke, Kimberly; Gattis, Katherine

    2013-02-01

    A lack of standardized nursing procedures regarding the management of patients receiving preoperative regional anesthesia in the perianesthesia setting raises a number of issues for perianesthesia nurses. In January 2010, Duke University Hospital's perianesthesia care unit implemented a regional anesthesia "block nurse" team in the preoperative holding area as a patient safety initiative. In January 2011, a retrospective data review was conducted. Results indicated that the implementation of the block nurse team not only increased patient safety but also increased perioperative efficiency and productivity, and decreased delays to operating room start times. This article describes the role of the regional anesthesia block nurse, the development of a block nurse team, and the early benefits of implementing a dedicated regional anesthesia block nurse team in the perianesthesia setting. PMID:23351242

  20. Managing new oral anticoagulants in the perioperative and intensive care unit setting.

    Science.gov (United States)

    Levy, Jerrold H; Faraoni, David; Spring, Jenna L; Douketis, James D; Samama, Charles M

    2013-06-01

    Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with any anticoagulant (including the known principles for warfarin) should be considered. This review summarizes the available data regarding the management of bleeding with novel oral anticoagulation agents. Hemodialysis is a therapeutic option for dabigatran-related bleeding, while in vitro studies showed that prothrombin complex concentrates are reported to be useful for rivaroxaban-related bleeding. Additional clinical studies are needed to determine the best method for reversal of the novel oral anticoagulation agents when bleeding occurs. PMID:23416382

  1. Investigation on the Perioperative Care of Flat Nail Groove Plasty%平坦甲沟成形术的围术期护理研究探讨

    Institute of Scientific and Technical Information of China (English)

    李娟玲

    2014-01-01

    Objective To analyze and investigate the perioperative nursing measures for flat nail groove plasty and the effect. Methods 76 cases of patients with ingrown toenails treated in our hospital from January, 2012 to November, 2013 were randomly divided into the control group and the perioperative group according to the treatment sequence. Control group: 38 patients were treated with routine care. Perioperative group: 38 cases were treated with more targeted perioperative nursing on the basis of rou-tine care. And patient satisfaction of two groups of patients was analyzed. Results No complications occurred in the 38 cases of the perioperative group, the difference was significant compared with the control group (P<0.05); patient satisfaction of perioperative group was significantly higher than that of the control group with statistically significance(P<0.05). Conclusion Targeted periopera-tive care given to the patients underwent flat nail groove plasty clinically can effectively prevent the occurrence of complications, and also greatly enhance patient satisfaction.%目的:对平坦甲沟成形术围术期护理措施及效果进行分析、探讨。方法对该院2012年1月-2013年11月间治疗的76例嵌甲症患者,并按治疗顺序进行随机分组。对照组:38例,予以常规护理;围术期组:38例,常规护理基础之上予以更具针对性的围术期护理。并对两组患者满意度进行对比分析。结果围术期组38例患者术后均未发生任何并发症,与对照组比较差异有统计学意义(P<0.05),围术期组患者满意度明显高于对照组,差异有统计学意义(P<0.05)。结论对临床平坦甲沟形成术患者予以针对性的围术期护理,可以有效避免并发症的发生,同时还可极大地提升患者满意度。

  2. Perioperative nursing care in the treatment of 56 patients with diabetic cataract%糖尿病性白内障56例围术期护理

    Institute of Scientific and Technical Information of China (English)

    卞红梅

    2011-01-01

    Objective: To investigate the perioperative nursing methods in the treatment of patients with diabetic cataract.Methods: The perioperative nursing care was given to 56 patients with diabetic cataract, such as psychological care, blood glucose monitoring and dietary guidance. Results: The postoperative visual acuity of the patients was significantly improved compared with that before surgery after being given careful nursing care and no complications occurred. Conclusion: The adequate preoperative preparation and careful postoperative nursing care is the key to ensuring smooth operation.%目的:探讨糖尿病性白内障围术期的护理方法.方法:对56例糖尿病性白内障患者进行围术期的护理,如心理护理、血糖监测、饮食指导等.结果:本组患者经过精心护理,术后视力均较术前明显提高,且无并发症的发生.结论:充分的术前准备、周密的术后护理是保证手术顺利进行的关键.

  3. Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Objective: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS in patients undergoing laparoscopic assisted total gastrectomy. Materials And Methods: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22 patients received enhanced recovery programme (ERAS management and rest twenty-five (n = 25 conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. Results: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h when compared to conventional group (140 ± 28 h. ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h. There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43 g/L vs. (73.07 ± 19.32 g/L, d3 (126.10 ± 18.62 g/L vs. (160.72 ± 26.18 g/L]. Conclusion: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.

  4. [Recommendations of the German Society of Anaesthesiology and Intensive Care Medicine on structured patient handover in the perioperative phase : SBAR concept].

    Science.gov (United States)

    von Dossow, V; Zwissler, B

    2016-02-01

    Teamwork in the operating room and in the intensive care unit necessitates clear and precise communication; however, interruptions in communication frequently occur, especially in the perioperative phase. Patient are particularly susceptible to deficits in communication due to higher stress peaks, simultaneous admission of several patients and concomitant treatment of emergency cases etc. The German Society of Anaesthesiology and Intensive Care Medicine (DGAI) therefore recommends the implementation of the so-called SBAR concept (S: "situation", B: "background", A: "assessment", R: "recommendation") for standardization of patient handover. This concept was originally developed for high-risk areas and organizations with the aim of guaranteeing a rapid, effective and consistent transfer of information. PMID:26841942

  5. Influence of multi-level anaesthesia care and patient profile on perioperative patient satisfaction in short-stay surgical inpatients: A preliminary study

    Directory of Open Access Journals (Sweden)

    Amarjeet Singh

    2007-01-01

    Full Text Available Background and goals of study: Patient satisfaction in relation to perioperative anesthesia care represents essential aspect of quality health-care management. We analyzed the influence of multi-level anesthesia care exposure and patient profile on perioperative patient satisfaction in short-stay surgical inpatients. Methods : 120 short-stay surgical inpatients who underwent laparoscopic surgery have been included in this prospective study. Pertaining to demographic parameters (age, gender, education, profession, duration of stay (preoperative room, recovery room, various patient problems and patient satisfaction (various levels, overall were recorded by an independent observer and analyzed. Overall, adults, male and uneducated patients experienced more problems. Conversely, elderly, females and educated patients were more dissatisfied. Female patients suffered more during immediate postoperative recovery room stay and were more dissatisfied than their male counterparts (p< 0.05. However, patient′s professional status had no bearing on the problems encountered and dissatisfaction levels. Preoperative and early postoperative period accounted for majority of the problems encountered among the study population. There was a positive correlation between problems faced and dissatisfaction experienced at respective levels of anesthesia care (p< 0.05. Conclusion(s : Patient′s demographic profile and problems faced during respective level of anesthesia care has a correlation with dissatisfaction. Interestingly, none of the above stated factors had any effect on overall satisfaction level.

  6. Accelerating patient-care improvement in the ED.

    Science.gov (United States)

    Forrester, Nancy E

    2003-08-01

    Quality improvement is always in the best interest of healthcare providers. One hospital examined the patient-care delivery process used in its emergency department to determine ways to improve patient satisfaction while increasing the effectiveness and efficiency of healthcare delivery. The hospital used activity-based costing (ABC) plus additional data related to rework, information opportunity costs, and other effectiveness measures to create a process map that helped it accelerate diagnosis and improve redesign of the care process. PMID:12938618

  7. Perioperative supply chain management.

    Science.gov (United States)

    Feistritzer, N R; Keck, B R

    2000-09-01

    Faced with declining revenues and increasing operating expenses, hospitals are evaluating numerous mechanisms designed to reduce costs while simultaneously maintaining quality care. Many facilities have targeted initial cost reduction efforts in the reduction of labor expenses. Once labor expenses have been "right sized," facilities have continued to focus on service delivery improvements by the optimization of the "supply chain" process. This report presents a case study of the efforts of Vanderbilt University Medical Center in the redesign of its supply chain management process in the department of Perioperative Services. Utilizing a multidisciplinary project management structure, 3 work teams were established to complete the redesign process. To date, the project has reduced costs by $2.3 million and enhanced quality patient care by enhancing the delivery of appropriate clinical supplies during the perioperative experience.

  8. Auditing perioperative mortality.

    OpenAIRE

    Deans, G. T.; Odling-Smee, W; McKelvey, S T; Parks, G. T.; Roy, D. A.

    1987-01-01

    An audit of mortality following operation was performed over ten years classifying deaths into those that were 'expected' and 'unexpected'. 'Unexpected' deaths were defined as those in which, after careful consideration of the prevailing clinical circumstances at the time of operation, the probability of death following operation was felt to be low. This definition is a more helpful assessment of surgical performance than overall perioperative mortality as it highlights cases where improvemen...

  9. Perioperative Care of Procedure for Prolapse and Hemorrhoids%吻合器痔上黏膜环切术围手术期的护理

    Institute of Scientific and Technical Information of China (English)

    熊家芬; 李继梅; 戴常青

    2011-01-01

    目的 总结吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)围术期的护理体会.方法 时15例重度痔疮患者行PPH的围术期护理情况进行回顾性分析,护理要点包括:术前进行针对性心理护理、肠道准备;术后做好饮食、排便肛门护理以及术后并发症的护理;认真详细地做好出院指导.结果 15例患者痔块完全回缩,其中有7例注射止痛;1例出现术后轻微便血,1例术后大出血,再次探查缝合止血;有7例回病房即留置导尿,4例5h左右小便未解留置导尿,24 h后拔除尿管均自行排尿.结论 PPH是一种安全、有效、术后疼痛少、住院时间短、恢复快的手术,同时重视围术期的护理对增加患者手术信心、提高患者舒适度、减少并发症的发生有重要作用.%Objective To summarize the perioperative care of the procedure for prolapse and hemorrthois (PPH) wethods The perioperative care of 15 cases with severe hemorrhoids undergoing PPH was analyzed retrospectively. The nursing cares included: preoperative psychological nursing, bowel preparation, postoperative eating guidance, defecation and anus nursing, and nursing care for postoperative complications,careful discharge guidance. Results The prolapsed hemorrhoid of 15 cases recovered completely. There were 7 cases needed analgesia by injection analgesic, 1 case with postoperative mild hematochezia, 1 case postoperative hemorrhea and was cured by the secondary detection and suture. The urethral catheterization was performed in 7 cases at the time back to the wards,and in 4 cases at 5h after the operation. After 24 h,the indwelling catheters were extracted in all cases, and they can all self-maturate. Conclusion PPPH is a safe and effective method with less postoperative pain,short in-hospital time and quick recovery. The perioperative nursing cares can improve the confidence of patients, increase their comfort level and decrease complications.

  10. Perioperative Nursing Care of 19 Patients with Tongue Cancer%舌癌患者19例围手术期的护理

    Institute of Scientific and Technical Information of China (English)

    崔奇玉

    2011-01-01

    Objective:To investigate the nursing method of tongue cancer patients during perioperative period.Methods:19 cases of tongue cancer patients were observed and analysed before and after surgery,making deliberate nursing care plans,effective nurse-patient communication,continuing psychological nursing as well as targeted nursing measures.Results:The therapeutic effects of 19 cases of tongue cancer patients were satisfactory.Conclusion:Actively perioperative care of tongue cancer patients is an important link to ensure the success of operation and the increase of cure rate.%目的:探讨舌癌患者围手术期的护理方法.方法:对19例舌癌患者在手术前、手术后进行观察、分析,制定周密的护理计划、进行有效的护患沟通、持续的心理护理以及针对性的护理措施.结果:本组19例舌癌患者均疗效满意.结论:积极做好舌癌患者围手术期的护理,是确保手术成功、提高治愈率的重要环节.

  11. Pulmonary Carbon Dioxide Elimination for Cardiac Output Monitoring in Peri-operative and Critical Care Patients: History and Current Status

    Directory of Open Access Journals (Sweden)

    Philip J. Peyton

    2013-01-01

    Full Text Available Minimally invasive measurement of cardiac output as a central component of advanced haemodynamic monitoring has been increasingly recognised as a potential means of improving perioperative outcomes in patients undergoing major surgery. Methods based upon pulmonary carbon dioxide elimination are among the oldest techniques in this field, with comparable accuracy and precision to other techniques. Modern adaptations of these techniques suitable for use in the perioperative and critical are environment are based on the differential Fick approach, and include the partial carbon dioxide rebreathing method. The accuracy and precision of this approach to cardiac output measurement has been shown to be similar to other minimally invasive techniques. This paper reviews the underlying principles and evolution of the method, and future directions including recent adaptations designed to deliver continuous breath-by-breath monitoring of cardiac output.

  12. THE CARE PROJECT - Coordinated Accelerator Research in Europe

    CERN Multimedia

    2003-01-01

    A one-day presentation of the project will take place on Monday February 10th in the CERN Council Chamber. The meeting will start a 9am and is expected to end at 4:30pm. The meeting, which is open to the whole community, will present an initiative on accelerator R&D in Europe, supported by ECFA, with the aim to bid for European Union support through the Framework 6 scheme. This initiative is coordinated by a steering group (ESGARD - European Steering Group on Accelerator Research and Development), which has been set up to coordinate European efforts on accelerator R&D and the submission of such bids. The initial bids have to be submitted by April 15th. All those interested in accelerator R&D are welcome to attend. Presentation of the CARE project (Coordinated Accelerator Research in Europe) to be submitted within FP6 February 10th, at CERN in the council room Agenda Chair : C. Wyss 9:00 General presentation of FP6 and introduction of IA proposal (R. Aleksan) 9:45 Networking activities on e ...

  13. Perioperative counseling in children

    Directory of Open Access Journals (Sweden)

    Ioannis Koutelekos

    2012-10-01

    Full Text Available Counseling is a part of professional role of nurses and a prerequisite for holistic care. Aim: The aim of the present study was to review the literature about Counseling of children that undergo surgery. Material and method: The methodology οf this study included bibliography research from both the review and the research literature, between 2005-2009 mainly in the pubmed data base which referred to Counseling of children that undergo surgery, using the key words: Counseling, perioperative treatment, holistic care . Results: In the literature it is cited that counseling is provided by well trained and balanced individuals that have communication skills. Prerequisite of effective counseling is Conversation, where the nurse-consultant after elaborate listening proposes remarks, proposals, in order to enhance self-image, self-knowledge and self-esteem of the child and improve its’ personal emotional state. Perioperative counseling procedure as a part of the holistic care of children should follow and individualized approach either on preoperative and postoperative stage. Conclusion: Ultimate goal of effective counseling to children that undergo surgery is to improve the quality of provided care and increase the degree of satisfaction of hospitalized children and their families.

  14. Gastric Cancer Diabetes Mellitus Perioperative Care%胃癌合并糖尿病围手术期的护理

    Institute of Scientific and Technical Information of China (English)

    康艳

    2016-01-01

    目的:分析探讨胃癌合并糖尿病围手术期的护理方法及效果,为临床提供参考依据。方法选择该院收治的胃癌合并糖尿病患者60例作为此次研究的对象,收治时间在2012年2月7日-2015年2月7日之间,这60例患者均使用数字抽取法进行分组,分成各有30例患者的实验组和对照组,对照组在围手术期给予常规护理,实验组在围手术期给予针对性护理。结果实验组的血糖水平和并发症发生率均低于对照组(P<0.05);实验组的住院时间为(10.93±3.57)d,对照组的住院时间为(17.87±3.27)d(P<0.05)。结论给予胃癌合并糖尿病患者针对性的围手术期护理具有显著的临床应用效果。%Objective Analysis to study the gastric cancer diabetes mellitus perioperative nursing method and effect, provide a reference basis for clinic. Methods Select our hospital of gastric cancer patients with diabetes mellitus 60 cases as the re-search object, and treating time on February 7, 2012, to February 7, 2015, between, the digital sampling method should be used in 60 patients group, 30 patients were divided into each have the experimental group and the control group, control group in perioperative given conventional nursing, the experimental group in perioperative give corresponding nursing. Re-sults The results of the experimental group blood sugar level and complication rates are lower than the control group (P<0.05);Experimental group of hospital stay (10.93±3.57) d, control the length of hospital stay (17.87±3.27) d (P<0.05). Con-clusion For gastric cancer patients with diabetes mellitus perioperative nursing care according to the specific has significant clinical effect.

  15. 急性胆囊炎患者的围手术期护理探析%Study on Perioperative Care of Patients with Acute Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    邓爽

    2015-01-01

    目的:探析急性胆囊炎患者应用围手术期护理的临床价值。方法选取2013年7月~2014年7月间我院收治的急性胆囊炎患者39例,观察组与对照组分别施行围手术期护理和常规护理,对比两组患者护理效果。结果观察组术中出血、术后排气、手术时间、住院时间相对较少,并发症少,两组患者护理效果差异显著,有统计学意义(P<0.05)。结论急性胆囊炎患者应用围手术期护理并发症少、安全性高、效果良好,值得推广。%Objective Clinical value of perioperative care of patients with acute cholecystitis is to be explored. Methods Select 39 patients with acute cholecystitis who are treated in hospital from July 2013 to July 2014; patients in study group and in control group are given perioperative care and conventional treatment respectively and then observe and compare treatment efficacy between two groups. Results Patients’operation bleeding loss,postsurgical exhaust time and surgery time their hospitalization days and even complication incidence in study group are much less than counterparts in control group;there is a treatment efficacy differential between the two groups,and such a differential has statistic value(P<0.05). Conclusion Perioperative care is of efficacy and safety in treatment of patients with acute cholecystitis with less complication incidence;thus,such an effective method is quite worthwhile to be promoted.

  16. 下颈椎骨折伴截瘫患者围手术期护理%Perioperative care for patients with paraplegia and fracture of next cervical spine

    Institute of Scientific and Technical Information of China (English)

    丁传红; 彭瑾; 杨媛

    2011-01-01

    目的 总结下颈椎骨折伴截瘫患者围手术期护理经验.方法 回顾性分析18例围手术期护理下颈椎骨折伴截瘫患者情况.结果 18例患者经围手术期精心护理,减少了术后并发症的发生.结论 围手术期精心护理能使患者主动配合手术并减少术后并发症的发生.%Objective To evaluate and summarize the clinical experience of perioperative care for patients with paraplegia and fracture of next cervical spine. Methods From April 2007 to April 2010, i8 patients with paraplegia and fracture of next cervical spine were cared in perioperative period. Results Postoperation complications of 18 patients were reduced with perioperative care. Conclusion Postoperation complications were reduced with perioperative care which could make patients actively cooperate with surgery.

  17. Study on Perioperative Care of Patients Treated With Circumcision Surgery%包皮手术患者的围手术期护理探析

    Institute of Scientific and Technical Information of China (English)

    马美艳

    2015-01-01

    Objective To explore perioperative care of patients treated with circumcision surgery.MethodsSelected 45 patients treated with circumcision surgery who are received and treated in hospital from November 2013 to December 2014 and divide them into two groups according to hospitalization sequence with 24 patients in study group and 21 patients in control group, patients in study group were given perioperative care, while patients in control group were given conventional care intervention, and then care effects of two groups was compared.ResultsPatients’ satisfaction rate, treatment efficacy and complication incidence in study group were much better than counterparts in control group, there is a differential between these two groups, and such a differential has statistic value (P<0.05). Conclusionperioperative care is of significance for patients treated with circumcision surgery, which is conducive to improving patients’ satisfaction with treatment, to increasing treatment efficacy and to decrease complication incidence.%目的:探讨包皮手术患者的围手术期护理探析。方法选取2013年11月~2014年12月我院接诊的45例包皮手术患者,按照入院的先后顺序分为24例实验组和21例对照组,实验组给予围手术期护理,对照组采用常规护理干预,观察两组患者的护理效果。结果实验组患者的护理满意度、治疗总有效率及并发症的发生率明显优于对照组,P<0.05,差异有统计学意义。结论包皮手术患者采用围手术期护理的效果显著,可以有效提高患者的满意度,提高治疗效果,降低并发症的发生率。

  18. [Patient's Risk Factors for Perioperative Aspiration Pneumonia].

    Science.gov (United States)

    Ishikawa, Teruhiko; Isono, Shiroh

    2016-01-01

    This article reviews patient's own risk factors for perioperative aspiration pneumonia. Maintaining the function of the lower esophageal sphincter (LES), the airway protective reflex, and the oral hygiene are the most important to prevent the pneumonia. The LES is adversely affected by excessive stomach distention, some medication given in perioperative periods, and habitual smoking, as well as pathological status such as esophageal hiatus hernia and achalasia. Postapoplectic patients may have insufficient airway protective reflex including swallowing and laryngeal reflex. It is emphasized that the perioperative oral care is increasing in its importance for the prevention of aspiration pneumonia. PMID:27004381

  19. 乳癌患者围手术期的心理护理%Perioperative psychological care for breast cancer patients

    Institute of Scientific and Technical Information of China (English)

    谢谦; 唐珊珊; 刘彦玲; 周焕玉

    2012-01-01

    目的 探讨整体护理对乳腺癌患者手术身心状态的影响.方法 将101例拟作乳腺癌根治术患者随机分为整体护理组和功能护理组(即对照组).整体护理组将围手术期划分为术前1d、手术过程中、术后3d等3个阶段,对患者给予系统化整体护理;对照组给予传统护理方式;观察记录两组患者的血压、心率、睡眠质量及术后疼痛程度.结果 整体护理组血压、心率、睡眠质量受手术影响较对照组小,术后疼痛程度也较对照组轻.两组间的差异有统计学意义.结论 整体护理对改善乳癌患者心理状态,减轻患者的焦虑情绪和痛感有积极作用,从而有利于患者早日康复.%OBJECTIVE To study the influence of holistic nursing care on mind and body for patients with breast cancer. METHODS 101 breast cancer patients with radical mastectomy were randomly divided into holistic nursing care group and function care group (namely the control group) . Perioperative period was divided into three phases that a day before, in the process of operation, three days after operation in the holistic group, the patients were given systematic holistic nursing; The control group was given traditional care; observed the heart rate, blood pressure, sleep quality and postoperative pain in two groups. RESULTS The influence of operation on the heart rate, blood pressure, sleep quality in the holistic care group was smaller than that in the control group, postoperative pain degree was also lower in the holistic care group than in the control group. There were significant differences between the groups. CONCLUSION The holistic nursing care could improve breast cancer patients' psychological condition, reduce their anxiety and pain, which has a positive effect to make patients recover soon.

  20. Resectable adenocarcinoma of the oesophago-gastric junction care: Which perioperative treatment?; Prise en charge des adenocarcinomes de la jonction oesogastrique resecables: quel traitement perioperatoire?

    Energy Technology Data Exchange (ETDEWEB)

    Crehangea, G.; Maingon, P. [Centre de Lutte Contre le Cancer Georges-Francois-Leclerc, Dept. de Radiotherapie, 21 - Dijon (France); Bonnetain, F. [Centre de Lutte Contre le Cancer Georges-Francois-Leclerc, Dept. de Biostatistiques, 21 - Dijon (France); Chauffert, B. [Centre de Lutte Contre le Cancer Georges-Francois-Leclerc, Dept. d' Oncologie Medicale, 21 - Dijon (France); Rat, P. [Centre Hospitalier Universitaire le Bocage, Service de Chirurgie Digestive, 21 - Dijon (France); Bedenne, L. [Centre Hospitalier Universitaire le Bocage, Service d' Hepatogastroenterologie, 21 - Dijon (France)

    2008-09-15

    Adenocarcinoma of the oesophago-gastric junction has an ominous prognosis. Until now, oesophageal adenocarcinoma care was close to the squamous cell cancer one whereas adenocarcinoma of the cardia was mixed with gastric cancers. Results from randomized studies mixed them without making distinctions. Nevertheless, context, natural history and clinical outcome differ. Five-year survival rate is around 40 %, all stages included. Results from several phase-III studies or meta-analysis allowed to define three therapeutic strategies applicable to adenocarcinoma of the oesophagus and the oesophago-gastric junction. In Europe, in the case of a resectable tumour, preoperative chemotherapy became a standard treatment since results from the Magic trial. In the United States, post-operative radio chemotherapy according to the 'Macdonald' scheme is used in case of a resected tumour with a R0 surgery. Actually, modern techniques of irradiation could reduce the rate of gastro-intestinal toxicities. The survival benefit from preoperative radio chemotherapy is still very controversial with high rates of postoperative morbidity and mortality. We have performed a review of the literature with a methodological analysis of data with a high level of evidence in order to advise perioperative treatment guidelines for patients with a resectable adenocarcinoma of the lower oesophagus or gastro-oesophageal junction. Results from pre- or postoperative strategies and the role of radiotherapy will need to be analysed in the future through a randomized study. (authors)

  1. PPH surgical treatment of annular prolapse sex mixe dhemorrhoid perioperative care%PPH术式治疗环状脱垂性混合痔的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    程绮艳

    2011-01-01

    目的 探讨PPH术式治疗环状脱垂性混合痔的围手术期护理.方法 对本院2006年9月~2010年1月行PPH治疗环状脱垂性混合痔的围手术期护理情况进行回顾分析,主要是术前心理护理,肠道准备,常规准备;术后体位护理,饮食指导,排便护理,并发症观察及护理,功能锻炼,出院指导.结果 156例患者全部平稳度过围手术期.结论 PPH具有创伤小,恢复快,疗效好等优点,加强围手术期护理对增强患者手术信心,缓解疼痛不适减少并发症有重要作用.%Objective To explore surgical treatment cricoid prolapse PPH sexual mixed hemorrhoid perioperative care, Methods A total September 2006~2010 January line PPH treatment cricoid prolapse sex mixed hemorrhoid perioperative care situation was analyzed retrospectively.with afocuson preoperative psychological nursing, bowel preparation, conventional preparation,postoperative nursing posture, guiding of diet nursing, complication observation, bowel function exercise, nursing, and discharge guidance.Results The 156 patients all smoothly went through the perioperative.Conclusions PPH has advantages of small trauma, faster recovery, good curative effect etc, and it can strengthen the perioperative care to patient surgery confidence, relieve pain discomfort and reduce the complications improve.

  2. 长期服用华法林患者围手术期抗凝治疗分析及药学监护%The discussion of pharmaceutical care on perioperative management of patients with long -term warfarin treatment

    Institute of Scientific and Technical Information of China (English)

    吴癑; 徐航; 彭燕; 戎佩佩; 李萌

    2016-01-01

    目的:探讨临床药师在长期服用华法林抗凝患者围手术期的药学服务内容和作用。方法通过对长期服用华法林抗凝患者围手术期出血风险及栓塞风险评估,临床药师帮助临床医师制定规范、合理的个体化抗凝方案,并提出围手术期抗凝治疗的监护重点。结果通过合理、有效的围手术期抗凝治疗,可在不增加栓塞风险的基础上避免围手术期不良出血事件;同时还可通过药物合理选用及剂量调控,积极有效的规避抗凝药物相关的不良反应。结论在长期服用华法林抗凝患者的围手术期治疗中,临床药师应根据患者栓塞及手术风险,从术前评估、是否给予桥接治疗、术后抗凝、抗凝药物选择及剂量等方面,为患者提供个体化的抗凝治疗方面。%Objective To discuss and explore the role of clinic pharmacists in the pharmaceutical care of perioperative management of patients with long -term warfarin treatment.Methods According to the risk assessment of thrombosis and bleeding,the anticoagulant treatment of perioperative care was proposed as well as the key points of pharmaceutical care.Results The efficacy and safety of the patient's perioperative anticoagulation therapy were guaranteed by reasonable choice of drugs,dosage control and timely pharmaceutical care.With the effective management of perioperative anticoagulant treatment,the severe bleeding could be avoided without increasing risks of thrombosis.Conclusions Individual pharmaceutical care should be provided on the basis of the risk assessment of thrombosis and bleeding in addition to the patient's individual characteristic.The interruption of VKAs,the bridging anticoagulationtherapy,dosing regimen optimization and the resumption of VKAs could be considered in the perioperative management of patients with long -term anti-coagulation therapy.

  3. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

    Kozek-Langenecker, Sibylle A; Afshari, Arash; Albaladejo, Pierre;

    2013-01-01

    The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia...... with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific subcommittees......-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official position of the ESA...

  4. Pulmonary aspiration in perioperative medicine.

    Science.gov (United States)

    Abdulla, Susanne

    2013-01-01

    Perioperative aspiration into the lungs is an infrequent but potentially serious cause of anesthesia-related morbidity and mortality. It is still a leading cause of death from pulmonary complications. Aspiration occurs in approximately three per 10.000 anesthetic procedures with higher incidences in special patient populations and emergency situations. Any patient with symptoms following aspiration that last for more than two hours in the recovery room should be admitted to an intensive care unit for further observation and therapy. This article reviews incidence, morbidity and mortality of perioperative aspiration as well as risk factors and preventive measures. Among preventive measures the use of drugs designed to increase gastric pH, recent developments in supraglottic airway devices and application of rapid sequence induction with cricoid pressure are discussed. Also, international fasting guidelines and clinical management following aspiration are provided. PMID:23767172

  5. 乳腺癌患者围手术期的护理措施及效果分析%The Care Measures and Effect Analysis of Breast Cancer Patients in Perioperative

    Institute of Scientific and Technical Information of China (English)

    陈艳

    2014-01-01

    Objective:To investigate the radical mastectomy perioperative nursing interventions for the treatment of breast cancer patients to provide a reference.Method:130 cases of implementation of the radical mastectomy for patients with perioperative nursing,and the clinical effect were observed.Result:130 cases were successful surgery,rehabilitation and discharged.Among them,2 cases of patients were with relatively mild symptoms of depression,the positive psychological symptoms eased;1 case had mild dysfunction of the affected limb,the active function gradually recovered after training.No serious adverse events was found.Conclusion:Radical mastectomy perioperative care is very important,attentive perioperative nursing care can improve patient outcomes.%目的:探讨乳腺癌根治术患者围术期的护理措施,为乳腺癌患者的治疗提供参考。方法:对130例实施乳腺癌根治术的患者进行围术期护理,观察临床治疗效果。结果:130例患者手术均较成功,康复后出院。2例患者出现较为轻度的抑郁症状,经积极的心理疏导后症状有所缓解;1例患者出现轻度患侧肢体功能障碍,经积极功能训练后渐渐恢复;未见其他严重不良反应发生。结论:乳腺癌根治术患者围术期的护理十分重要,细心周到的围术期护理可以改善患者的治疗效果。

  6. Care for the Caregiver: Evaluation of Mind-Body Self-Care for Accelerated Nursing Students.

    Science.gov (United States)

    Drew, Barbara L; Motter, Tracey; Ross, Ratchneewan; Goliat, Laura M; Sharpnack, Patricia A; Govoni, Amy L; Bozeman, Michelle C; Rababah, Jehad

    2016-01-01

    Stress affects the well-being of both nursing students and the individuals with whom they work. With the theory of cognitive appraisal as a framework for this study, it is proposed that mind-body self-care strategies promote stress management by stabilization of emotions. Outcomes will be a perception of less stress and more mindful engagement with the environment. Objective of the study was to describe an evaluation of student perceived stress and mindfulness to 1-hour per week of class time dedicated to mind-body self-care (yoga, mindful breathing, Reiki, and essential oil therapy). It was a quasi-experimental study; data collection took place at 4 time points. Participants were entry-level accelerated nursing students from 3 US universities: 50 in the treatment group, 64 in the comparison group. Data included health-promoting practices using Health-Promoting Promotion Lifestyle Profile II as a control variable, stress and mindfulness (Perceived Stress Scale [PSS] and Mindful Attention Awareness Scale [MAAS]), and demographic information; analysis using mixed-design repeated-measures analysis of variances. There was a statistically significant interaction between intervention and time on PSS scores, F(3, 264) = 3.95, P = .009, partial η(2) = 0.043, with PSS scores of the intervention group decreasing from baseline to T3 when intervention ended whereas PSS scores of the comparison group increased from baseline. The average scores on the MAAS did not differ significantly. Evaluation of an embedded mind-body self-care module in the first nursing course demonstrated promising improvements in stress management. The findings support the appropriateness of integrating mind-body self-care content into nursing curricula to enhance students' ability to regulate stress.

  7. Care for the Caregiver: Evaluation of Mind-Body Self-Care for Accelerated Nursing Students.

    Science.gov (United States)

    Drew, Barbara L; Motter, Tracey; Ross, Ratchneewan; Goliat, Laura M; Sharpnack, Patricia A; Govoni, Amy L; Bozeman, Michelle C; Rababah, Jehad

    2016-01-01

    Stress affects the well-being of both nursing students and the individuals with whom they work. With the theory of cognitive appraisal as a framework for this study, it is proposed that mind-body self-care strategies promote stress management by stabilization of emotions. Outcomes will be a perception of less stress and more mindful engagement with the environment. Objective of the study was to describe an evaluation of student perceived stress and mindfulness to 1-hour per week of class time dedicated to mind-body self-care (yoga, mindful breathing, Reiki, and essential oil therapy). It was a quasi-experimental study; data collection took place at 4 time points. Participants were entry-level accelerated nursing students from 3 US universities: 50 in the treatment group, 64 in the comparison group. Data included health-promoting practices using Health-Promoting Promotion Lifestyle Profile II as a control variable, stress and mindfulness (Perceived Stress Scale [PSS] and Mindful Attention Awareness Scale [MAAS]), and demographic information; analysis using mixed-design repeated-measures analysis of variances. There was a statistically significant interaction between intervention and time on PSS scores, F(3, 264) = 3.95, P = .009, partial η(2) = 0.043, with PSS scores of the intervention group decreasing from baseline to T3 when intervention ended whereas PSS scores of the comparison group increased from baseline. The average scores on the MAAS did not differ significantly. Evaluation of an embedded mind-body self-care module in the first nursing course demonstrated promising improvements in stress management. The findings support the appropriateness of integrating mind-body self-care content into nursing curricula to enhance students' ability to regulate stress. PMID:27078809

  8. Application of polypropylene mesh to pelvic floor reconstruction and perioperative nursing care%聚丙烯网片在盆底重建术中的应用及围术期护理

    Institute of Scientific and Technical Information of China (English)

    董丽; 张娟娟; 周亚梅

    2012-01-01

    To investigate the application of polypropylene mesh to pelvic floor reconstruction and perioperative nursing method. Methods:66 patients with pelvic floor disorders underwent pelvic floor reconstruction by using polypropylene mesh under spinal - epi-dural anesthesia and they were given careful perioperative nursing care. Results:The phenomenon of postoperative pelvic organ prolapse of 66 patients disappeared and pelvic structure returned to normal basically, without local pain and complications; wound healed well and the cure rate was 100%. Conclusion: The application effect of polypropylene mesh is good in pelvic floor reconstruction and careful perioperative nursing care is the key to the success of operation.%目的:探讨聚丙烯网片在盆底重建术中的应用及围术期护理方法.方法:对66例盆底障碍性疾病患者在腰硬联合麻醉下应用聚丙烯网片行盆底重建术,并给予精心围术期护理.结果:本组66例术后盆腔器官脱垂现象消失,盆底结构基本恢复正常,伴随症状明显改善,无一例局部疼痛及并发症发生,切口愈合良好,治愈率100.0%.结论:聚丙烯网片在盆底重建术中的应用效果较好,精心围术期护理是手术成功的重要保证.

  9. The documentation practice of perioperative nurses

    DEFF Research Database (Denmark)

    Søndergaard, Susanne Friis; Lorentzen, Vibeke; Sørensen, Erik Elgaard;

    2016-01-01

    AIMS AND OBJECTIVE: The aim of this review was to explore and present the existing knowledge of the documentation practices of perioperative nurses in the operating room. BACKGROUND: Studies demonstrate that the documentation of nursing care provided is important for the continuity of patient care...... as well as patient safety. Nurses find that documenting their perioperative services is important to the surgical pathway; however, a number of studies indicate that the documentation practices of perioperative nurses are characterised by subjectivity, randomness and poor quality. DESIGN: A...... literature review with a systematic search of scientific material. METHOD: The content of the studies included was analysed using content analysis as suggested by Krippendorff. The materials were acquired by searching electronic databases. The search was performed for the period 1995-2015 and resulted in 12...

  10. The CARE project - Coordinated Accelerator Research in Europe

    CERN Multimedia

    2003-01-01

    A one-day presentation of the project will take place on Monday February 10th in the CERN Council Chamber. The meeting will start a 9am and is expected to end at 4:30pm. The meeting, which is open to the whole community, will present an initiative on accelerator R&D in Europe, supported by ECFA, with the aim to bid for European Union support through the Framework 6 scheme. This initiative is coordinated by a steering group (ESGARD - European Steering Group on Accelerator Research and Development), which has been set up to coordinate European efforts on accelerator R&D and the submission of such bids. The initial bids have to be submitted by April 15th. All those interested in accelerator R&D are welcome to attend.

  11. Patient Empowerment Improved Perioperative Quality of Care in Cancer Patients Aged ≥ 65 Years - A Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Maren Schmidt

    Full Text Available This randomized controlled, clinical prospective interventional trial was aimed at exploring the effect of patient empowerment on short- and long-term outcomes after major oncologic surgery in elderly cancer patients.This trial was performed from February 2011 to January 2014 at two tertiary medical centers in Germany. The study included patients aged 65 years and older undergoing elective surgery for gastro-intestinal, genitourinary, and thoracic cancer. The patients were randomly assigned to the intervention group, i.e. patient empowerment through information booklet and diary keeping, or to the control group, which received standard care. Randomization was done by block randomization in blocks of four in order of enrollment. The primary outcome were 1,postoperative length of hospital stay (LOS and 2. long-term global health-related quality of life (HRQoL one year postoperatively. HRQoL was assessed using the EORTC QLQ C30 questionnaire. Secondary outcomes encompassed postoperative stress and complications. Further objectives were the identification of predictors of LOS, and HRQoL at 12 months.Overall 652 patients were included. The mean age was 72 ± 4.9 years, and the majority of patients were male (68.6%, n = 447. The ^median of postoperative length of stay was 9 days (IQR 7-14 day. There were no significant differences between the intervention and the control groups in postoperative LOS (p = 0.99 or global HRQoL after one year (women: p = 0.54, men: p = 0.94. While overall complications and major complications occurred in 74% and 24% of the cases, respectively, frequency and severity of complications did not differ significantly between the groups. Patients in the intervention group reported significantly less postoperative pain (p = 0.03 than the control group. Independent predictors for LOS were identified as severity of surgery, length of anesthesia, major postoperative complications, nutritional state, and pre-operative physical

  12. CARE Coordinated Accelerator Research in Europe: integrating activity implemented as integrated infrastructure initiative

    CERN Document Server

    Aleksan, R

    2009-01-01

    The main objective of the CARE project was to generate a structured and integrated European area in the field of accelerator research and related R&D. A set of integrating activities involving the largest European infrastructure laboratories and their user communities “active in accelerator R&D”, including industrial partners was established with the following general objectives: 1) To optimise the use of existing infrastructures for improving the European knowledge on accelerator physics  By promoting a coherent and coordinated utilization and development of infrastructures and to facilitate the access to accelerators and test facilities for carrying accelerator studies  By understanding accelerator operation and reliability issues 2) To tackle new or state-of-the-art technologies in a more co-ordinated and collaborative approach  By developing a coherent and coordinated accelerator R&D program in Europe and carrying out joint R&D projects allowing one to enhance the existing (or...

  13. 肥胖患者妇科腹腔镜手术的围术期护理分析%Analysis of obese patients undergoing gynecologic laparoscopic surgery perioperative nursing care

    Institute of Scientific and Technical Information of China (English)

    胡珍

    2016-01-01

    Objective:To analyze the effect of perioperative nursing care of obese patients undergoing gynecological laparoscopic operation.Methods:100 cases of obese patients were treated with gynecological laparoscopic surgery.They were divided in two groups.50 cases in control group were given routine nursing,and 50 cases in the observation group were treated with perioperative nursing care in 50 cases.The blood pressure,heart rate and complications were compared before and after surgery.Results:There were significant differences in heart rate and blood pressure before and after treatment in the control group,complications of the two groups had significant difference(P<0.05).Conclusion:The perioperative nursing care of obese patients undergoing gynecological laparoscopic surgery can improve blood pressure and heart rate and reduce complications.The effect is significant.%目的:分析肥胖患者妇科腹腔镜手术围术期护理效果。方法:收治实施妇科腹腔镜手术治疗的肥胖患者100例,分两组,对照组50例实施常规护理,观察组50例实施围术期护理,对比手术前后血压、心率以及并发症情况。结果:对照组治疗前后心率血压、两组并发症情况差异有统计学意义(P<0.05)。结论:肥胖患者实施妇科腹腔镜手术的围术期护理可改善血压心率,减少并发症,效果显著。

  14. 股腘动脉血管搭桥术的中西医结合围手术期处理%The Perioperative Care of the Femoral Popliteal Artery Vascular Bypass Operation using Combination of Chinese and Western Medicine

    Institute of Scientific and Technical Information of China (English)

    王秋风; 狄长安

    2013-01-01

    目的:总结股腘动脉人工血管搭桥术治疗股浅动脉闭塞症的中西医结合围手术期处理经验.方法:观察62例股浅动脉闭塞症股腘动脉人工血管搭桥术的中西医结合围手术期处理对疗效的影响.结果:足背动脉搏动恢复,症状消失46例,症状明显改善16例,术后足趾溃疡愈合10例,第一、二趾截趾4例.结论:中西医结合围手术期处理是股腘动脉人工血管搭桥术康复过程中不可忽视的重要环节.%Objective:To summarize the perioperative care experience of combination of Chinese and western medicine on the femoral popliteal artery vascular bypass operation in the treatment of strands of shallow atherosclerosis block. Methods: The impact of perioperative care of Chinese and western medicine on femoral popliteal artery vascular bypass operation for 62 patients with strands of shallow arterial occlusive disease was observed. Results: In terms of pulsation of foot dorsal artery, 46 patients had symptoms disappeared, 16 patients significantly improved, 10 patients had toes ulcer healed, 4 patients had cut the first or the second toes. Conclusion:The perioperative care of combination of Chinese and western medicine is an innegligible important link in the rehabilitation process of the femoral popliteal artery vascular bypass operation.

  15. Application of the evidence-based nursing care in the perioperative nursing care of prostate cancer patients%循证护理在前列腺癌患者围术期护理中的应用

    Institute of Scientific and Technical Information of China (English)

    张兰艳

    2012-01-01

    Objective: To evaluate the effectiveness of evidence - based nursing care in the perioperative nursing care of prostate cancer patients. Methods: 70 patients were randomly divided into an observation group and a control group ( 35 cases in each group ). The routine nursing care was taken in the control group, including the aspects of diet, rest, treatment compliance, health education, postoperative nursing care and psychological care; the evidence - based nursing care was applied in the observation group, the comprehensive assessment of patients was initially implemented to understand the patients illnesses and medical conditions, and then the nursing procedures was formulated in detail according to the results of assessment and foresight nursing procedures and preventive measures were also prepared aiming at the problems might occur in the perioperative nursing care. Results: Compared with control group, the length of hospital stay was shorter and treatment compliance and satisfaction of the patients were better and the incidence of complications was lower in the observation group, EORTC QLQ - C30 score was better ( P <0. 05 ). Conclusion: The evidence - based nursing care applied to the patients with prostate cancer surgery is more effective and it can significantly improve the patients quality of life.%目的:探讨循证护理在前列腺癌患者围术期中的实施的效果.方法:将70例患者随机分为观察组与对照组各35例.对照组采用常规护理模式进行护理,包括饮食、休息、治疗配合、健康宣教、术后护理、心理护理等;观察组实施循证护理,先给予患者针对性的综合评估,了解其机体素质、疾病状况等,然后根据评估结果进行护理程序及细节的制订,并对可能发生的问题进行预见性护理程序的制订及预防性措施的实施.结果:与对照组比较,观察组住院时间更短,治疗依从性和护理满意度更高,并发症发生率更低,EORTC QLQ-C30

  16. Clinical Observation of Breast Cancer and Diabetes Perioperative Care Ef-fect%乳腺癌合并糖尿病围术期护理效果的临床探讨

    Institute of Scientific and Technical Information of China (English)

    高丽萍

    2015-01-01

    目的:观察乳腺癌合并糖尿病围术期的治疗护理效果。方法以该院手术治疗的50例乳腺癌合并糖尿病患者为研究对象,合理控制血糖,采用乳腺癌改良根治术进行手术,围术期采用个体化的整体护理方案和措施。结果该组患者经过积极的治疗和护理,均治愈出院。围术期出现低血糖2例,切口感染和皮下积液各1例,未见其他并发症发生。结论给予乳腺癌合并糖尿病患者个体化的整体护理干预,可有效控制感染,减少并发症的发生,促进患者尽早康复。%Objective Observation treatment and care effect of perioperative of breast cancer and diabetes. Methods In 50 cases of breast cancer patients with diabetes mellitus surgery in our hospital for the study, reasonable control of blood sugar, using modified radical mastectomy surgery, perioperative use individualized holistic nursing programs and measures. Results This group of patients after active treatment and care, were cured. Perioperative hypoglycemia 2 cases, wound infection and seroma in 1 case, no other complications. Conclusion Give breast cancer patients with diabetes mellitus individualized holistic nursing intervention can effectively control the infection, reduce the incidence of complications and promote early rehabilitation of patients.

  17. Perioperative nursing in public university hospitals

    DEFF Research Database (Denmark)

    Sørensen, Erik Elgaard; Olsen, Ida Østrup; Tewes, Marianne;

    2014-01-01

    BACKGROUND: In recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light...... of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of perioperative nursing and how do nurses facilitate the interaction between nursing care and technology in highly...... specialized operating rooms in public university hospitals? METHODS: An ethnography involving participant observations and interviews was conducted during a 9-month study period. The participants comprised 24 nurses from 9 different operating wards at 2 university hospitals in different regions of Denmark...

  18. States leverage telepsychiatry solutions to ease ED crowding, accelerate care.

    Science.gov (United States)

    2015-02-01

    Many states are having success turning to telepsychiatry-based solutions to connect mental health patients with needed care while also decompressing crowded EDs. Just one year into a statewide telepsychiatry initiative in North Carolina (NC-STeP), administrators say the approach has saved as much as $7 million, and hospital demand for the service is higher than anticipated. In Texas, mental health emergency centers (MHEC) that use telepsychiatry to connect patients in rural areas with needed psychiatric care are freeing up EDs to focus on medical care. In just 11 months, 91 North Carolina hospitals have at least started the process to engage in NC-STeP. Much of the savings from NC-STeP come from involuntary commitment orders being overturned as a result of the telepsychiatry consults, reducing the need for expensive inpatient care. Implementing NC-STeP has involved multiple hurdles including credentialing difficulties and technical/firewall challenges. The Texas model provides 24/7 availability of psychiatrists via telemedicine through a network of MHECs. In-person staff at the MHECs perform basic screening tests and blood draws so that medical clearance can be achieved without the need for an ED visit in most cases. Funding for the MHECs comes from the state, hospitals in the region, and local governmental authorities that reap savings or benefits from the initiative.

  19. 腹腔镜手术治疗子宫内膜异位症围手术期护理效果%Laparoscopic Surgery for Endometriosis Perioperative Nursing Care

    Institute of Scientific and Technical Information of China (English)

    李守香

    2015-01-01

    目的:探讨腹腔镜手术治疗子宫内膜异位症围手术期的护理效果。方法将74例子宫内膜异位症患者分为两组,对照组采用常规护理模式护理,观察组在对照组基础上采用综合护理模式护理。结果观察组患者的总满意度为97.30%,对照组患者的总满意度为72.97%,对比差异显著(P<0.05)。结论腹腔镜手术治疗子宫内膜异位症患者在围手术期实施综合护理模式,能够明显提高患者对护理工作的满意度,值得在临床上大力推广。%Objective To investigate the laparoscopic surgery for endometriosis perioperative nursing effect.Methods74 cases of uterine endometriosis patients were divided into two groups, the control group received routine nursing care model, the observation group in the control group on the basis of a comprehensive care model of care. ResultsThe overall satisfaction of patients in the observation group was 97.30%, the total satisfaction of the patients in the control group was 72.97%.Conclusion Laparoscopic surgery endometriosis patients in the perioperative period the implementation of integrated care model can signiifcantly improve patient satisfaction with care, and worthy of clinical promoting.

  20. Colonic surgery with accelerated rehabilitation or conventional care

    DEFF Research Database (Denmark)

    Basse, Linda; Thorbøl, Jens Erik; Løssl, Kristine;

    2004-01-01

    BACKGROUND: For patients undergoing colonic surgery, the postoperative hospital stay is usually 6 to 10 days, and the morbidity rate is 15 to 20 percent. Fast-track rehabilitation programs have reduced the hospital stay to 2 to 3 days. The aim of this study was to evaluate the postoperative outcome...... after colonic resection with conventional care compared with fast-track multimodal rehabilitation. METHODS: One hundred thirty consecutive patients receiving conventional care (group 1) in one hospital were compared with 130 consecutive patients receiving multimodal, fast-track rehabilitation (group 2...... ( P day 4.5 in group 1 and day 2 in group 2 ( P hospital stay was 8 days in group 1 and 2 days in group 2 ( P

  1. Perioperative care of patients undergoing holmium laser resection of the prostate (HoLRP) compared with transurethral resection of the prostate (TURP)

    Science.gov (United States)

    Gilling, Peter J.; Mackey, Michael; Cresswell, Michael D.; Kennett, Katie M.; Cass, Carol B.; Fraundorfer, Mark R.; Kabalin, John N.

    1998-07-01

    HoLRP is a technique which produces a defect in the prostatic fossa analogous to TURP but does so with significantly less blood loss. The perioperative outcome was assessed in a randomized clinical trial. The patients in the HoLRP arm (61 patients) had a longer resection time when compared to the TURP group (59 patients) but had less nursing contact time, shorter catheter time and a shorter hospital stay. Four patients in the TURP arm (6.8%) required blood transfusion compared to none in the HoLRP arm. Postoperative dysuria was similar in the two groups. Overall, the perioperative morbidity of HoLRP is less than that of TURP.

  2. Perioperative Education of Patient Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alexandros Zacharis

    2011-04-01

    Full Text Available In recent years, the number of patients undergoing cardiac surgeries is steadily increasing. In Greece, approximately 10,500 patients per year are admitted to some kind of cardiac operation. Constant evolution of heart surgery techniques calls for adaptation of the perioperative nursing care given. Patient education, as an important part of the perioperative care, is directly related to the reduction of postoperative complications and stress management, thus promoting the patient's overall postoperative well-being. Aim: The aim of this review was to present the most important aspects of the patient's perioperative education and the role that the nurse has to play in it. Methods: Data from selected articles were extracted from Pubmed, Chinahl and Cohrane, as well as from non-electronically published scientific studies ranging from 1998-2010 and 2003-2008 respectively. Results: According to the literature, perioperative patient education can be implemented in various ways, such as through verbal updates, the use of audiovisual means and the provision of informative leaflets. The teaching topics can be divided into those of the preoperative and postoperative phase. Stress management prepares the patients psychologically and also enhances the therapeutic nurse-patient relationship. The teaching of breathing techniques and isometric exercises of the lower limbs, the cessation of smoking, the diet to be followed, as well as the management of medication, aim in the patients' physical preparation, in order to optimize their postoperative course. Conclusion: Perioperative patient education, regardless of how it is implemented, constitutes both an integral part of the nursing care and an independent nursing intervention per se, which strengthens the nurses' autonomy and improves the patient's postoperative course.

  3. Job analysis. National Certification Board: Perioperative Nursing, Inc, document.

    Science.gov (United States)

    Fox, V; Blue, M R

    1988-05-01

    The document is the critical element in developing an exam that reflects current perioperative nursing practice. The test specifications ensure that each phase of perioperative nursing practice is adequately measured at a proficient level of care. In addition to developing test specifications, the NCB:PNI has recommended that A Job Analysis could be used in the following situations. 1. Nurse managers could use the document in refining job descriptions, evaluating employee performance, creating clinical ladder criteria, and establishing standards of patient care. 2. Perioperative nurse educators could use it in developing self-directed learning contracts, designing curriculum for students or staff development. 3. Researchers could use the document in justifying the existence of registered nurses in the OR. 4. Perioperative nurses could use it for peer review and self-evaluation.

  4. Accelerating a Network Model of Care: Taking a Social Innovation to Scale

    Directory of Open Access Journals (Sweden)

    Kerry Byrne

    2012-07-01

    Full Text Available Government-funded systems of health and social care are facing enormous fiscal and human-resource challenges. The space for innovation in care is wide open and new disruptive patterns are emerging. These include self-management and personal budgets, participatory and integrated care, supported decision making and a renewed focus on prevention. Taking these disruptive patterns to scale can be accelerated by a technologically enabled shift to a network model of care to co-create the best outcomes for individuals, family caregivers, and health and social care organizations. The connections, relationships, and activities within an individual’s personal network lay the foundation for care that health and social care systems/policy must simultaneously support and draw on for positive outcomes. Practical tools, adequate information, and tangible resources are required to coordinate and sustain care. Tyze Personal Networks is a social venture that uses technology to engage and inform the individual, their personal networks, and their care providers to co-create the best outcomes. In this article, we demonstrate how Tyze contributes to a shift to a network model of care by strengthening our networks and enhancing partnerships between care providers, individuals, and family and friends.

  5. EuCARD and CARE - development of accelerator technology in Poland

    OpenAIRE

    Romaniuk, Ryszard

    2009-01-01

    EuCARD (2009-1013) and CARE (2004-2008) are examples of big European R&D projects for building integrated accelerator infrastructures in Europe. Several research teams from a number of European countries are participating in this consolidated effort. Here we summarize the tasks done by some teams from Poland on a more general background.

  6. 76 FR 66931 - Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center...

    Science.gov (United States)

    2011-10-28

    ... (76 FR 28988). This third and final ADLS will combine the third and fourth sessions called for in the... HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center for Medicare and Medicaid Innovation November 17 and...

  7. 胃肠外科疾病合并糖尿病患者的围手术期护理%Gastrointestinal surgery patients with diabetes, the authors combined perioperative care

    Institute of Scientific and Technical Information of China (English)

    周驰艳

    2012-01-01

    Objective To gastrointestinal surgery with diabetic patients perioperative care, nursing curative effect, improve nursing level. Methods In June 2011 in July 2012 in our hospital,were 60 cases with gastrointestinal surgery combined with diabetes patients.the patients preoperative and intraoperative urgent postoperative nursing, etc are analyzed, in order to improve the patient's quality of life, fast to its body back to health. Results All of the gastrointestinal surgery with diabetes mellitus patients after timely treatment, elaborate care, make a more satisfactory effect, patients are improving hospital discharge, and no complications appeared. Conclusion Gastrointestinal surgery with diabetic patients perioperative care, has the vital significance,and improve the patient's quality of life.%目的:对胃肠外科疾病合并糖尿病患者的围术期护理进行分析,观察护理疗效,提高护理水平及患者的生活质量,促进患者身体快速恢复.方法:将2011年6月~2012年7月在我院收治的60例胃肠外科疾病合并糖尿病患者,对其术前与术中及术后等方面的护理进行分析.结果:所有的胃肠外科合并糖尿患者者经过及时治疗、精心护理,取得较为满意的效果,患者均好转出院,无并发症出现.结论:对胃肠外科伴有糖尿病患者的围术期进行护理,具有重要的意义,提高了患者的生活质量.

  8. 前纵隔肿瘤切除术30例围术期护理%Perioperative nursing care in the treatment of 30 patients with anterior mediastinal tumor by surgical operation

    Institute of Scientific and Technical Information of China (English)

    陈丽

    2011-01-01

    目的:探讨前纵隔肿瘤切除术患者围术期的护理方法.方法:对30例行前纵隔肿瘤切除术患者加强围术期护理,密切观察病情变化,预防术后并发症.结果:本组均痊愈出院,平均住院时间为15.6 d.其中2例行二次手术,1例开胸止血,1例切除肿瘤细胞侵及器官.术后并发心律失常4例,经心内科会诊给予药物后好转;并发肺水肿3例,给予利尿剂和激素治疗后好转.结论:对前纵隔肿瘤切除术患者加强围术期护理,可有效提高手术成功率,促进患者的康复.%Objective: To explore the perioperative nursing methods in the treatment of anterior mediastinal tumor by surgical operation.Methods: 30 patients with anterior mediastinal tumor resection were given careful perioperative nursing care and close observation and the measures to prevent postoperative complications were strengthened.Results: All patients were cured and discharged from hospital.The average length of hospitalization was 15.6 days.Two patients received the second surgical operation,reoperation to stop bleeding in one patient and removal of organs invaded by tumor cell in one patient; arrhythmia occurred in 4 patients after operation and the patients had improvement after drugs therapy; pulmonary edema occurred in 3 patients, who were given diuretics and hormone treatment and got improvement.Conclusion: Strengthening perioperative nursing care can effectively improve the success rate of surgery and promote the rehabilitation of patients in the treatment of anterior mediastinal tumor by surgical operation.

  9. Optimizing Perioperative Decision Making: Improved Information for Clinical Workflow Planning

    OpenAIRE

    Doebbeling, Bradley N.; Burton, Matthew M.; Eric A. Wiebke; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40–70% of hospital revenues and 30–40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasib...

  10. Perioperative nursing for patients with diabetic foot receiving endovascular interventional therapy

    International Nuclear Information System (INIS)

    Objective: To study the effect of perioperative nursing on the living quality of patients with diabetic foot who are treated with endovascular interventional therapy. Methods: Specific perioperative nursing care plan was accordingly designed for 43 patients with diabetic foot. Endovascular balloon angioplasty and stent implantation were formed in these patients to treat their diabetic foot. The clinical results were observed. Results: Perioperative nursing effectively improved patient's limb blood supply, enhanced the healing of diabetic foot ulceration and increased the possibility of limb preservation. Conclusion: Endovascular therapy combined with corresponding perioperative nursing care can benefit more patients with diabetic foot. (authors)

  11. Promoting Patient Safety With Perioperative Hand-off Communication.

    Science.gov (United States)

    Robinson, Nancy Leighton

    2016-06-01

    Effective perioperative hand-off communication is essential for patient safety. The purpose of this quality improvement project was to demonstrate how a structured hand-off tool and standardized process could increase effective perioperative communication of essential elements of care and assist in the timely recognition of patients at risk for clinical deterioration in the initial postoperative period. A team-based pilot project used the Iowa Model of Evidence-Based Practice and the principles of Lean Six Sigma to implement Perioperative PEARLS, a perioperative specific hand-off communication tool and a standardized framework for hand-off communication. The implementation of a structured hand-off tool and standardized process supports compliance with regulatory standards of care and eliminates waste from the hand-off process. A review of pre-implementation and post-implementation data revealed evidence of safer patient care. Evidence-based perioperative hand-off communication facilitates expedited patient evaluation, rapid interventions, reduction in adverse events, and a safer perioperative environment.

  12. Promoting Patient Safety With Perioperative Hand-off Communication.

    Science.gov (United States)

    Robinson, Nancy Leighton

    2016-06-01

    Effective perioperative hand-off communication is essential for patient safety. The purpose of this quality improvement project was to demonstrate how a structured hand-off tool and standardized process could increase effective perioperative communication of essential elements of care and assist in the timely recognition of patients at risk for clinical deterioration in the initial postoperative period. A team-based pilot project used the Iowa Model of Evidence-Based Practice and the principles of Lean Six Sigma to implement Perioperative PEARLS, a perioperative specific hand-off communication tool and a standardized framework for hand-off communication. The implementation of a structured hand-off tool and standardized process supports compliance with regulatory standards of care and eliminates waste from the hand-off process. A review of pre-implementation and post-implementation data revealed evidence of safer patient care. Evidence-based perioperative hand-off communication facilitates expedited patient evaluation, rapid interventions, reduction in adverse events, and a safer perioperative environment. PMID:27235961

  13. Risk reduction: perioperative smoking intervention

    DEFF Research Database (Denmark)

    Møller, Ann; Tønnesen, Hanne

    2006-01-01

    Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk...... of postoperative intensive care admission. Even passive smoking is associated with increased risk at operation. Preoperative smoking intervention 6-8 weeks before surgery can reduce the complications risk significantly. Four weeks of abstinence from smoking seems to improve wound healing. An intensive, individual...... approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation...

  14. Risk reduction: perioperative smoking intervention

    DEFF Research Database (Denmark)

    Møller, Ann; Tønnesen, Hanne

    2006-01-01

    approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation......Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk...... of postoperative intensive care admission. Even passive smoking is associated with increased risk at operation. Preoperative smoking intervention 6-8 weeks before surgery can reduce the complications risk significantly. Four weeks of abstinence from smoking seems to improve wound healing. An intensive, individual...

  15. Perioperative thermoregulation and heat balance.

    Science.gov (United States)

    Sessler, Daniel I

    2016-06-25

    Core body temperature is normally tightly regulated to within a few tenths of a degree. The major thermoregulatory defences in humans are sweating, arteriovenous shunt vasoconstriction, and shivering. The core temperature triggering each response defines its activation threshold. General anaesthetics greatly impair thermoregulation, synchronously reducing the thresholds for vasoconstriction and shivering. Neuraxial anaesthesia also impairs central thermoregulatory control, and prevents vasoconstriction and shivering in blocked areas. Consequently, unwarmed anaesthetised patients become hypothermic, typically by 1-2°C. Hypothermia results initially from an internal redistribution of body heat from the core to the periphery, followed by heat loss exceeding metabolic heat production. Complications of perioperative hypothermia include coagulopathy and increased transfusion requirement, surgical site infection, delayed drug metabolism, prolonged recovery, shivering, and thermal discomfort. Body temperature can be reliably measured in the oesophagus, nasopharynx, mouth, and bladder. The standard-of-care is to monitor core temperature and to maintain normothermia during general and neuraxial anaesthesia. PMID:26775126

  16. Forensic perioperative nursing. Advocates for justice.

    Science.gov (United States)

    Carrigan, M; Collington, P; Tyndall, J

    2000-12-01

    Facts and evidence have been negated or lost by the inexperience of health care professionals who are not cognizant of the legal requirements concerning potential criminal cases. In the perioperative setting, policy and procedure should provide guidelines for potential criminal cases based on the key concepts and principles of forensic science. Potential forensic cases and traumatic injuries are not limited to major health care centres. All hospitals should have policies and procedures which outline: traumatic injuries/death, staff responsibilities, details of collecting evidence, documentation, chain of custody. The procedure should also include care of victims, suspected perpetrators as well as family/persons accompanying patient.

  17. Accelerator

    International Nuclear Information System (INIS)

    The invention claims equipment for stabilizing the position of the front covers of the accelerator chamber in cyclic accelerators which significantly increases accelerator reliability. For stabilizing, it uses hydraulic cushions placed between the electromagnet pole pieces and the front chamber covers. The top and the bottom cushions are hydraulically connected. The cushions are disconnected and removed from the hydraulic line using valves. (J.P.)

  18. Laparoscopic cholecystectomy perioperative management: an update

    OpenAIRE

    Jakobsson, Jan

    2015-01-01

    Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no fir...

  19. Lower fornix combined approach of functional outer canthal plasty orbital fracture Perioperative Care%下穹窿联合外眦入路功能性眼眶骨折整复术的围术期护理

    Institute of Scientific and Technical Information of China (English)

    崔莉萍; 韩丽芬

    2013-01-01

    目的:观察下穹窿联合外眦入路功能性眼眶骨折整复术的围术期护理效果。方法对经下穹窿联合外眦入路功能性眼眶骨折整复术的患者给予心理护理、术前护理、术后护理及眼外肌训练等观察疗效。结果所有患者经综合护理后术后经CT三维成像观察眼眶部骨折复位良好,眼球移位及复视得到良好的纠正。本组病例均以钛板行骨折固定,术后植入物兼容性好,术后恢复好。部分术后仅留术眼外眦部伤痕,不影响美观,有良好的美容效果。结论规范的围术期护理对下穹窿联合外眦入路功能性眼眶骨折整复术的治疗及恢复有重要的作用。%Objective To observe the outer canthus lower fornix combined approach of functional orbital fractures plasty perioperative care effect .Methods for the inferior fornix combined approach of functional outer canthal plasty orbital fractures in patients given psychological care ,preoperative care,postoperative care and extraoc-ular muscle training effects were observed .Results All patients with comprehensive care after the observation of three -dimensional imaging by CT after orbital fractures good eye displacement and diplopia get good correction.The patients are titanium line fracture fixation and implant compatibility ,good postoperative recovery.After leav-ing only part of the lateral canthus of eye surgery scars,do not affect the appearance,good cosmetic results.Conclusion standardized perioperative nursing care under the dome on the outer canthus combined approach of functional plasty orbital fracture treatment and recovery has an important role.

  20. Perioperative thermoregulation and temperature monitoring.

    Science.gov (United States)

    Insler, Steven R; Sessler, Daniel I

    2006-12-01

    patients becoming sufficiently hypothermic. Mild hypothermia in the perioperative period has been associated with adverse outcomes, including impaired drug metabolism, prolonged recovery from anesthesia, cardiac morbidity, coagulopathy, wound infections, and postoperative shivering. Perioperative temperature monitoring devices vary by transducer type and site monitored. More important than the specific device is the site of temperature monitoring. Sites that are accessible during surgery and give an accurate reflection of core temperature include esophageal, nasopharynx, bladder, and rectal sites. Core temperature also may be estimated reasonably using axillary temperature probes except under extreme thermal conditions. Rather than taking a passive approach to thermal management, anesthesiologists need to be proactive in monitoring patients in cold operating rooms and use available technology to prevent gross disturbances in the core temperature. Various methods are available to achieve this. Prewarming patients reduces redistribution hypothermia and is an effective strategy for maintaining intraoperative normothermia. Additionally, forced-air warming and circulating water garments also have been shown to be effective. Heating intravenous fluids does not warm patients, but does prevent fluid-induced hypothermia in patients given large volumes of fluid. This article examined the evolutionary adaptations people possess to combat inadvertent hypothermia and hyperthermia. Because thermal disturbances are associated with severe consequences, the standard of care is to monitor temperature during general anesthesia and to maintain normothermia unless otherwise specifically indicated.

  1. An Agenda for Improving Perioperative Code Status Discussion.

    Science.gov (United States)

    Hickey, Thomas R; Cooper, Zara; Urman, Richard D; Hepner, David L; Bader, Angela M

    2016-06-15

    Code status discussions (CSDs) clarify patient preferences for cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. CSDs are a key component of perioperative care, particularly at the end of life, and must be both patient-centered and shared. Physicians at all levels of training are insufficiently trained in and inappropriately perform CSD; this may be particularly true of perioperative physicians. In this article, we describe the difficulty of achieving a patient-centered, shared perioperative CSD in the case of a medical professional with a do-not-resuscitate order. We provide a brief background in cardiopulmonary resuscitation, do-not-resuscitate, and CSD before proposing an agenda for improving perioperative CSD. PMID:27301059

  2. Perioperative nutritional support.

    Science.gov (United States)

    Morán López, Jesús Manuel; Piedra León, María; García Unzueta, María Teresa; Ortiz Espejo, María; Hernández González, Miriam; Morán López, Ruth; Amado Señaris, José Antonio

    2014-01-01

    The relationship between preoperative malnutrition and morbi-mortality has been documented for years. Despite the existence of tools that allow its detection, and therefore treat this entity, their introduction into clinical practice is not wide-spread. Both perioperative insulin resistance and hyperglycemia are associated with increased perioperative morbidity and length of hospital stay. The intake of carbohydrate-rich drinks 2-4h prior to surgery reduces insulin resistance. In the immediate postoperative period, the enteral route is safe and well tolerated and its early use reduces hospital stay and postoperative complications compared with parenteral nutritional support. Inmunonutrition has been proven effective to decrease postoperative complications and hospital stay. In view of these data we opted for the adoption of these measures replacing bowel rest and the indiscriminate use of postoperative parenteral nutrition.

  3. Perioperative acute kidney injury

    Directory of Open Access Journals (Sweden)

    Calvert Stacey

    2012-07-01

    Full Text Available Abstract Acute kidney injury (AKI is a serious complication in the perioperative period, and is consistently associated with increased rates of mortality and morbidity. Two major consensus definitions have been developed in the last decade that allow for easier comparison of trial evidence. Risk factors have been identified in both cardiac and general surgery and there is an evolving role for novel biomarkers. Despite this, there has been no real change in outcomes and the mainstay of treatment remains preventive with no clear evidence supporting any therapeutic intervention as yet. This review focuses on definition, risk factors, the emerging role of biomarkers and subsequent management of AKI in the perioperative period, taking into account new and emerging strategies.

  4. Burnout in perioperative context

    OpenAIRE

    Galvão, Ana Maria; Gonçalves, Ana Rita Veloso; Certo, Ana

    2014-01-01

    Companies in a global context are going through moments of great development of information and technologies. In these environments Burnout is highly prevalent, this syndrome is considered as one of physical and emotional stress that leads to a lack of motivation to work, leading to a progressive sense of inadequacy and failure. Objectives: What level of stress Perioperative nurses for nurses in the Region of Tras-os-Montes and Alto Douro. Methods: Non-experimental study,...

  5. PERIOPERATIVE MYOCARDIAL INFRACTION

    Directory of Open Access Journals (Sweden)

    Ravindra S

    2015-10-01

    Full Text Available Perioperative myocardial ischaemia and infarction (PMI is a major cause of short and long term morbidity and mortality in the surgical population. It is estimated that more than one half of postoperative deaths are caused by cardiac events, most of which are ischaemic in origin. Over 50,000 patients each year sustain a perioperative MI . Thus prevention of a PMI is important to improve overall postoperative outcome. Myocardial ischaemia is a dual state composed of inadequate myocardial oxygenation and accu mulation of anaerobic metabolites and occurs when myocardial oxygen demand exceeds the supply. Myocardial infarction is defined as the death of myocardial myocytes due to prolonged ischaemia. In patients with, or at risk of coronary artery disease (CAD, t he reported incidence of perioperative myocardial ischaemia is 20 - 63%. Various studies have shown that postoperative myocardial ischaemia was consistently found to occur considerably more often than preoperative and intraoperative ischaemia ( R atio approxim ately 3:1 and 5:1 respectively. As more and more patients coming for non - cardiac surgeries who have already undergone coronary intervention such as balloon angioplasty, stenting or CABG, we as anaesthesiologists should have thorough knowledge of the perio perative implications of the same in a day to day practice. Secondly, as the geriatric population is increasing there are more chances of encountering patients with known or unknown ischaemic heart disease both on an emergency and elective basis.

  6. Perioperative acute kidney injury.

    Science.gov (United States)

    Goren, O; Matot, I

    2015-12-01

    Perioperative acute kidney injury (AKI) is not uncommon and is associated with considerable morbidity and mortality. Recently, several definition systems for AKI were proposed, incorporating both small changes of serum creatinine and urinary output reduction as diagnostic criteria. Novel biomarkers are under investigation as fast and accurate predictors of AKI. Several special considerations regarding the risk of AKI are of note in the surgical patient. Co-morbidities are important risk factors for AKI. The surgery in itself, especially emergency and major surgery in the critically ill, is associated with a high incidence of AKI. Certain types of surgeries, such as cardiac and transplantation surgeries, require special attention because they carry higher risk of AKI. Nephrotoxic drugs, contrast dye, and diuretics are commonly used in the perioperative period and are responsible for a significant amount of in-hospital AKI. Before surgery, the anaesthetist is required to identify patients at risk of AKI, optimize anaemia, and treat hypovolaemia. During surgery, normovolaemia is of utmost importance. Additionally, the surgical and anaesthesia team is advised to use measures to reduce blood loss and avoid unnecessary blood transfusion. Hypotension should be avoided because even short periods of mean arterial pressure patients. Urine output can be reduced significantly during surgery and is unrelated to perioperative renal function. Thus, fluids should not be given in excess for the sole purpose of avoiding or treating oliguria. Use of hydroxyethyl starch needs to be reconsidered. Recent evidence indicates a beneficial effect of administering low-chloride solutions. PMID:26658199

  7. 胫腓骨骨折98例的围术期护理探讨%Perioperative nursing care of 98 patients with fracture of tibia and fibula

    Institute of Scientific and Technical Information of China (English)

    郭海萍

    2016-01-01

    ObjectiveTo summarize the nursing of patients with fracture of tibia and fibula before and after operation,ensure and consolidate the curative effect,avoid wound infection and reduce the occurrence of complications. MethodsSelect from September 2015 to January 2013,98 cases of fracture of the tibia and fibula and patients with surgery,preoperative psychological care,physical care and preoperative preparation of special care;postoperative nursing,daily care and postoperative functional exercise guidance special care.Resultsall the operations were expected to achieve the desired results,lower limb function recovery is good,can be free of activity.ConclusionThe effective nursing care of patients with fracture of the tibia and fibula and the perioperative period can improve the medical quality and achieve the expected results.%目的:探讨胫腓骨骨折患者的围术期护理方法及效果。方法选取2013年1月—2015年9月我院98例胫腓骨骨折手术患者,在术前给予心理护理、生理护理和术前准备专项护理;术后给予饮食护理、日常护理和术后功能性锻炼指导专项护理。结果患者均达到手术预期效果,下肢功能恢复良好,均能自由活动。结论给予胫腓骨骨折手术患者全面的围术期护理,可有效提高医疗质量、达到预期的护理效果。

  8. Application of fast track surgical rehabilitation nursing care to the perioperative period of laparoscopic nephrectomy%快速康复外科护理在腹腔镜肾切除术围术期中的应用

    Institute of Scientific and Technical Information of China (English)

    王伟

    2011-01-01

    Objective: To explore the application effect of fast track surgical rehabilitation nursing care to the perioperative period of laparoscopic nephrectomy. Methods: 162 patients who underwent laparoscopic nephrectomy were randomly divided into observation group ( n = 73 ) and control group ( n = 89 ). The fast track surgical rehabilitation nursing care was applied in the observation group and routine nursing care was taken in the control group. The clinical efficacy and peostoperative recovery of the patients were compared between the two groups. Results: The anal exhausting time, the time of eating for the first time, the time of bowel movement for the first time and postoperative hospitalization days were significantly shorter in the observation group than those in the control group ( P < 0.05 ). Conclusion: Application of fast track surgical rehabilitation nursing care to the perioperative period of laparoscopic nephrectomy can reduce hospitalization days and promote patient's postoperative rehabilitation.%目的:探讨快速康复外科护理在腹腔镜肾切除术围术期中的应用效果.方法:将162例行腹腔镜肾切除术患者随机分为观察组73例和对照组89例.观察组给予快速康复外科护理,对照组给予常规护理.比较两组临床治疗效果及术后恢复情况.结果:观察组患者术后肛门排气时间、首次进食时间、首次排便时间及术后住院时间明显少于对照组(P<0.05).结论:快速康复外科护理应用于腹腔镜肾切除术围术期,可减少患者住院时间,促进患者术后康复.

  9. Perioperative management of severe anorexia nervosa.

    Science.gov (United States)

    Hirose, K; Hirose, M; Tanaka, K; Kawahito, S; Tamaki, T; Oshita, S

    2014-02-01

    As the prevalence of anorexia nervosa (AN) increased, surgery in severe AN patients also increased in the 2000s. We experienced a surgical case of a patient with severe AN, showing an extremely low BMI of 8.6 kg m(-2). We investigated the problems associated with this case and propose criteria to manage severe AN. We endeavour to report on the perioperative management of rare and severe symptoms and surgical indications of severely malnourished patients. All published reports were identified through comprehensive searches using PubMed, BioMedLib, and the Japan Medical Abstracts Society with the following terms and keywords: 'anorexia nervosa', 'eating disorder', 'hypoglycaemia', 'leucocytopaenia', 'gelatinous bone marrow', 'surgery', and 'operation'. In cases of AN with a BMI under 13 kg m(-2), marked hypoglycaemia, leucocytopaenia feeding syndrome until surgery. During the course of anaesthesia, careless loading of glucose or catecholamine may lead to disturbance of electrolytes or fatal arrhythmia. Intensive care and early feeding as soon as possible after surgery are important to prevent surgical site infection. Although not many perioperative cases of AN have been reported, clinicians must be aware of the danger and the causes of mortality in critical cases. Thus, the decision to undertake surgery must be taken carefully and close perioperative coordination among physicians, surgeons, psychiatrists, anaesthesiologists, and intensivists is essential.

  10. Perioperative nursing care of elderly patients with intertrochanteric fracture%高龄股骨粗隆间骨折围手术期护理

    Institute of Scientific and Technical Information of China (English)

    孙琳琳

    2011-01-01

    目的 总结高龄股骨粗隆间骨折围手术期的护理措施,降低围手术期的并发症.方法 本组65例高龄股骨粗隆间骨折患者,均患有不同程度的冠心病、糖尿病、高血压等老年性疾病,待患者能够耐受麻醉及手术时行手术治疗,非手术患者行皮肤牵引.指导患者功能锻炼,预防感染、消肿、营养支持治疗.结果 手术后第10天因多脏器功能衰竭死亡1例,术后第5天并发脑血栓形成1例,围手术期内发生肺栓塞1例,肺部感染1例,压疮1例.结论 高龄股骨粗隆间骨折患者需完善围手术期的护理工作,预防并发症,提高机体的抗手术打击能力,才能减少并发症、后遗症,降低死亡率.%Objective To explore the clinical nursing intervention for the elderly with intertrochanteric fracture and preventive measures for complications during perioperative. Methods Sixty - five patients with intertrochanteric fractures were treated. All the patients suffered from different degree coronary heart disease, diabetes, hypertension geriatric diseases and so on. All the patients endured the anesthesia and operation. Non - operation patients were treated with traditional skin traction. The patients were guided to do the exercise effectively to prevent wound infection, reduce the swelling, and have better nutrition support. Results One case died of MODs 10 days after surgery, brain thrombus occurred in 1 case 5 days after surgery, pulmonary embolism occurred in 1 case during perioperative, pulmonary infection occurred in 1 case, and bedsore occurred in 1 case.Conclusion The elderly patient with intertrochanteric fracture should actively complete nursing intervention to reduce the complications and improve the ability of enduring the anesthesia and operation. It can reduce complications, sequelea, and mortality.

  11. Paradigmas e evidências da nutrição peri-operatória Paradigms and evidence of perioperative nutrition

    Directory of Open Access Journals (Sweden)

    Maria Isabel Toulson Davisson Correia

    2005-12-01

    Full Text Available Understanding perioperative pathophysiology and implementing care regimes, through a multimodal approach, to reduce the organic response to stress after surgery and the related postoperative ileus, are major challenges. Multimodal surgical strategies such as pre-operative intake of a carbohydrate drink, instead of the usually recommended 2- to 6-hour period of nothing-bymouth, together with patient's education of the postoperative care plan, plus efficacious analgesia and early postoperative nutrition, among others, have been described to significantly impact on the previous variables. Therefore, these strategies accelerate rehabilitation and, as a consequence, decrease complications and hospital length of stay and, its related costs.

  12. Priority patient safety issues identified by perioperative nurses.

    Science.gov (United States)

    Steelman, Victoria M; Graling, Paula R; Perkhounkova, Yelena

    2013-04-01

    Much of the work done by perioperative nurses focuses on patient safety. Perioperative nurses are aware that unreported near misses occur every day, and they use that knowledge to prioritize activities to protect the patient. The purpose of this study was to identify the highest priority patient safety issues reported by perioperative RNs. We sent a link to an anonymous electronic survey to all AORN members who had e-mail addresses in AORN's member database. The survey asked respondents to identify top perioperative patient safety issues. We received 3,137 usable responses and identified the 10 highest priority safety issues, including wrong site/procedure/patient surgery, retained surgical items, medication errors, failures in instrument reprocessing, pressure injuries, specimen management errors, surgical fires, perioperative hypothermia, burns from energy devices, and difficult intubation/airway emergencies. Differences were found among practice settings. The information from this study can be used to inform the development of educational programs and the allocation of resources to enhance safe perioperative patient care. PMID:23531307

  13. 宫颈环扎术围手术期的临床观察及护理%Nursing care and clinical observation of the peri-operative period of cervical cerclage

    Institute of Scientific and Technical Information of China (English)

    余凤英; 魏雪群; 吴远萍

    2010-01-01

    目的 探讨宫颈环扎术围手术期的治疗及护理.方法 对30例因宫颈机能不全导致复发性流产而行宫颈环扎术的患者进行回顾性分析.结果 30例宫颈环扎术的病例取得良好的效果,无并发症发生.结论 宫颈环扎术能延长妊娠,加强术后护理,很大程度上改善了妊娠结局.%Objectives To explore the nursing care of the peri-operative period of cervical cerclage. Methods Retrospectively analyze 30 cases of patients with cervical incompetence who needed cervical cercalge. Results 30 cases of patients got good pregnancy outcome, and no complications occurred. Conclusion Cervical cerclage can prolong the pregnancy period. Pregnancy outcome is improved by the better nursing care after the operation.

  14. Student Immersion in Perioperative Nursing.

    Science.gov (United States)

    Penprase, Barbara; Monahan, Janean; Poly-Droulard, Lynda; Prechowski, Stephanie

    2016-02-01

    The aging workforce and the lack of perioperative clinical practice and theoretical content in nursing education programs are factors contributing to the perioperative nursing shortage. This article discusses the implementation of a creatively designed perioperative program, which includes a didactic course and a 210-hour clinical course, developed by the faculty members of a Michigan school of nursing in collaboration with administrators at area hospitals. The didactic content covers materials presented during the first three months of orientation for newly employed perioperative nurses. Interested baccalaureate nursing students in their senior year are selected to participate in the program after being interviewed by hospital personnel and university faculty members. To date, the program has 18 student graduates in two semesters; all have been offered positions in the perioperative setting, and 14 have accepted positions. The active learning strategies used in the course are described with examples. PMID:26849984

  15. Nursing care for hypertension patients in the perioperative period of dental implantation%高血压患者种植手术的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    刘翀; 刘欣

    2016-01-01

    目的:探讨高血压患者种植手术的围手术期护理方法。方法:回顾我院种植中心从2012年12月到2014年12月接受种植手术的高血压患者87例,根据患者的术前血压分级情况给予围手术期护理。同时跟踪调查。结果:在术后12天拆线时,患者伤口均愈合良好,术后3~6个月行二期手术时, X线片显示种植体均形成良好的骨结合。结论:采用术前服用降压药进行控制性降压并给予一定的心理辅导,术中心电监护,术后针对性护理,可提高高血压患者种植手术的安全性。高血压作为种植手术的非适应症,今年来随着种植手术的开展,患者量逐年增多,本文旨在为提高高血压患者的手术安全开展提高参考。%Objective: To explore the targeted nursing for hypertension patients in the perioperative period of dental implantation. Method: To review Implant Center in our hospital since December 2012 from De-cember 2014 to accept the implant surgery in 87 patients with hypertension, according to patients be-fore surgery blood pressure grades circumstances give perioperative care. While tracking survey. Re-sults: When stitches after 12 days, the patients wound healed well, when after 3 to 6 months the line second stage surgery, X-ray films showed good form implants are osseointegration. Conclusion:Using preoperative blood pressure medication were induced hypotension and give some psychological counsel-ing, intraoperative electrocardiographic monitoring, targeted postoperative care, patients with hyperten-sion implant surgery can improve safety. As a non-hypertensive implant surgery indications, this year with implant surgery carried out, the patient volume increased year by year, this paper aims to improve surgical safety in patients with hypertension conduct awareness reference.

  16. Optimizing perioperative decision making: improved information for clinical workflow planning.

    Science.gov (United States)

    Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction. PMID:23304284

  17. Perioperative respiratory care in severe scoliosis patients%重度脊柱侧弯患者围术期呼吸道护理

    Institute of Scientific and Technical Information of China (English)

    黎小霞; 张伟玲; 肖萍; 黄天雯; 杨军林

    2013-01-01

    Objective To investigate perioperative nursing of respiratory system in severe scoliosis patients.Methods 26 severe scoliosis patients with respiratory function training before operation were retrospected.All of them tested pulmonary function before and after training,postoperative respiratory system nursing were also taken to maintain airway unobstructed,including respiratory rate and oxygen saturation monitoring,effective pain management and respiratory complications controlling.Results The average forced vital capacity(FVC)was 45.9%and 52.1%before and after breathing exercises,the mean forced expiratory volume in one second(FEV1)was 43.8%and 48.8%before and after breathing exercises,with lung function improvement in 69.2%patients. There were two hemopneumothorax and three mild or moderate pleural effusion occurred within 10 days after surgery,but all recovered after effective treatment and nursing.Conclusions Perioperative systematic and effective training in respiratory function and airway management can improve lung function and surgical safety,reduce the incidence of postoperative pulmonary complications,and promote early rehabilitation .%目的:探讨重度脊柱侧弯患者围手术期呼吸道护理要点。方法对26例重度脊柱侧弯患者实施矫形手术,术前指导患者进行呼吸功能训练,术后给予呼吸道管理,保持呼吸道通畅,有效疼痛管理及加强呼吸道并发症观察和护理。结果呼吸训练前后患者用力肺活量(forced vital capacity,FVC)平均为45.9%与52.1%,第1 s用力呼气容积(forced expiratory volum in one second,FEV1)平均为43.8%与48.8%;肺功能有改善患者18例,占69.2%;术后10 d内2例患者发生血、气胸,3例患者发生轻、中度胸腔积液,经有效治疗和护理均能安全渡过围手术期。结论围手术期系统、有效的呼吸功能训练以及呼吸道管理能改善患者肺功能,提高手术安全性及减少术后肺部并发

  18. Cardiac perioperative complications in noncardiac surgery

    OpenAIRE

    Radovanović Dragana; Kolak Radmila; Stokić Aleksandar; Radovanović Zoran; Jovanović Gordana

    2008-01-01

    Anesthesiologists are confronted with an increasing population of patients undergoing noncardiac surgery who are at risk for cardiac complications in the perioperative period. Perioperative cardiac complications are responsible for significant mortality and morbidity. The aim of the present study was to determine the incidence of perioperative (operative and postoperative) cardiac complications and correlations between the incidence of perioperative cardiac complications and type of surgical ...

  19. Perioperative nursing care of glottic insufficiency patients treated with autologous fat injection%声带注射自体脂肪治疗声门闭合不全的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    宋彩霞

    2010-01-01

    Objective To explore the nursing intervention on glottic insufficiency patients treated with autologous fat injection.Methods The data from forty-five cases of glottic insufficiency treated with autologous fat injection were reviewed and analyzed.Results The situation of dysphonia were improved among all of the cases.Conclusions Intensive perioperative nursing care can improve the function of glottal vocal for patients with glottic insufficiency.%目的 探讨声带自体脂肪注射治疗卢门闭合不全对护理工作的要求.方法 对我院45例行声带自体脂肪注射治疗声门闭合不全患者的临床资料,并对护理工作重点进行回顾、分析、总结.结果 患者的术后声音障碍得到明显改善.结论 细致周密的围手术期护理能够有效地帮助患者改善发音.

  20. 成人先天性髋关节发育不良的围手术期护理%Nursing Care of Perioperative Period in Adult Congenital Hip Dysplasia

    Institute of Scientific and Technical Information of China (English)

    刘倩; 周莉; 何晓凤

    2011-01-01

    Adult congenital hip dysplasia(ACHD) is a congenital defect of acetabular disease. It may develop subluxation or luxation of hip after a long term, and osteonecrosis of the femeral head may occur at last. Now the patients with ACHD at early stage are treated with the operation of rotational osteotomy of the acetabulum, but in later period it can only be treated with the operation of total hip replacement. No matter which method is selected, nursing care of perioperative period plays a very important role in recoveries of the patients.%成人先天性髋关节发育不良是一种髋臼先天性发育缺陷的疾病,长期发展会形成髋关节半脱位、脱位,最终甚至可能出现股骨头坏死等严重合并症.对于早期患者目前主要采用髋臼旋转截骨手术治疗,而晚期出现股骨头脱位及坏死则只能通过全髋关节置换进行治疗.不论哪种手术方式,围手术期的护理时于患者的健康恢复都有着非常重要的意义.

  1. Melatonin in perioperative medicine: Current perspective

    Directory of Open Access Journals (Sweden)

    Souvik Maitra

    2013-01-01

    Full Text Available Melatonin, a new addition to the armamentarium of anesthesiologist, has some unique properties that are highly desirable in routine peri-operative care. Available clinical data show that preoperative melatonin is as effective as benzodiazepines in reducing preoperative anxiety with minimal action on psychomotor performance and sleep wake cycle. It may be considered as a safe and effective alternative of benzodiazepines as preoperative anxiolytic. It may have opioid sparing effect, may reduce intraocular pressure, and have role in prevention of postoperative delirium. The short-term administration of melatonin is free from significant adverse effects also.

  2. Supply chain optimization for pediatric perioperative departments.

    Science.gov (United States)

    Davis, Janice L; Doyle, Robert

    2011-09-01

    Economic challenges compel pediatric perioperative departments to reduce nonlabor supply costs while maintaining the quality of patient care. Optimization of the supply chain introduces a framework for decision making that drives fiscally responsible decisions. The cost-effective supply chain is driven by implementing a value analysis process for product selection, being mindful of product sourcing decisions to reduce supply expense, creating logistical efficiency that will eliminate redundant processes, and managing inventory to ensure product availability. The value analysis approach is an analytical methodology for product selection that involves product evaluation and recommendation based on consideration of clinical benefit, overall financial impact, and revenue implications. PMID:21884843

  3. Ethics in perioperative practice--values, integrity, and social policy.

    Science.gov (United States)

    King, Cecil A; Broom, Catherine

    2002-12-01

    Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and should be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this final article of a nine-part series that is designed to help perioperative nurses relate the ANA code to their own area of practice, the author looks at the ninth provision, which emphasizes the responsibility of professional nursing associations to maintain the value and integrity of the profession. PMID:12528493

  4. Pierre Robin Sequence: a perioperative review.

    Science.gov (United States)

    Cladis, Franklyn; Kumar, Anand; Grunwaldt, Lorelei; Otteson, Todd; Ford, Matthew; Losee, Joseph E

    2014-08-01

    The clinical triad of micrognathia (small mandible), glossoptosis (backward, downward displacement of the tongue), and airway obstruction defines the Pierre Robin sequence (PRS). Airway obstruction and respiratory distress are clinical hallmarks. Patients may present with stridor, retractions, and cyanosis. Severe obstruction results in feeding difficulty, reflux, and failure to thrive. Treatment options depend on the severity of airway obstruction and include prone positioning, nasopharyngeal airways, tongue lip adhesion, mandibular distraction osteogenesis, and tracheostomy. The neonate and infant with PRS require care from multiple specialists including anesthesiology, plastic surgery, otolaryngology, speech pathology, gastroenterology, radiology, and neonatology. The anesthesiologist involved in the care of patients with PRS will interface with a multidisciplinary team in a variety of clinical settings. This perioperative review is a collaborative effort from multiple specialties including anesthesiology, plastic surgery, otolaryngology, and speech pathology. We will discuss the background and clinical presentation of patients with PRS, as well as some of the controversies regarding their care.

  5. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation

    DEFF Research Database (Denmark)

    Møller, M H; Adamsen, S; Thomsen, R W;

    2011-01-01

    Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU.......Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU....

  6. Perioperative management of cardiac disease.

    Science.gov (United States)

    Aresti, N A; Malik, A A; Ihsan, K M; Aftab, S M E; Khan, W S

    2014-01-01

    Pre-existing cardiac disease contributes significantly to morbidity and mortality amongst patients undergoing non cardiac surgery. Patients with pre-existing cardiac disease or with risk factors for it, have as much as a 3.9% risk of suffering a major perioperative cardiac event (Lee et al 1999, Devereaux 2005). Furthermore, the incidence of perioperative myocardial infarction (MI) is increased 10 to 50 fold in patients with previous coronary events (Jassal 2008).

  7. Perioperative Jehovah's Witnesses: a review.

    Science.gov (United States)

    Lawson, T; Ralph, C

    2015-11-01

    There are many patient groups who may refuse blood products; the most well known amongst them is the Jehovah's Witness faith. Treatment of anaemia and bleeding in such patients presents a challenge to medical, anaesthetic, and surgical teams. This review examines the perioperative issues and management of Jehovah's Witnesses. The history and beliefs of Jehovah's Witnesses are outlined together with their impact on ethics and the law, and different management options throughout the perioperative period are discussed.

  8. SWITCH for safety: Perioperative hand-off tools.

    Science.gov (United States)

    Johnson, Fay; Logsdon, Patty; Fournier, Kim; Fisher, Sandra

    2013-11-01

    Communication breakdown is the leading cause of reported sentinel events in the perioperative setting. Barriers to optimal communication include noise, stress, multitasking, and rapid turnover between procedures. AORN has identified communication during personnel changes (ie, hand offs) as a point of vulnerability for the surgical patient. A standardized hand-off method provides an opportunity for personnel to ask and answer questions and should be available in the perioperative setting. At one facility, the standardization of hand-off reporting resulted in the development of new hand-off tools specific to the perioperative environment. A standardized reporting method enabled health care providers to address communication barriers and to maintain their focus on the patient during critical moments (eg, shift changes), thereby improving patient safety.

  9. Gender-affirming Surgeries in the Era of Insurance Coverage: Developing a Framework for Psychosocial Support and Care Navigation in the Perioperative Period.

    Science.gov (United States)

    Deutsch, Madeline B

    2016-01-01

    Transgender people have a gender identity different from their birth-assigned sex. Transgender people may seek gender-affirming surgeries to align their body with their identified gender. With increasing visibility of transgender identities, and recognition of the importance of gender-affirming care, has come a policy shift toward mandated coverage or provision of blanket exclusions of these procedures by insurance companies and Medicaid. The World Professional Association for Transgender Health provides guidance to mental health professionals evaluating patients for gender-affirming surgeries, including making a diagnosis and assessing for capacity to consent. However the expansion of covered gender-affirming surgeries to safety-net populations has highlighted the need for an expanded presurgical process which includes a psychosocial assessment and care navigation. The proposed framework expands the preoperative assessment to include these components, and can be used to guide both health systems and insurance providers in the development of transgender medicine programs. PMID:27180683

  10. Gender-affirming Surgeries in the Era of Insurance Coverage: Developing a Framework for Psychosocial Support and Care Navigation in the Perioperative Period.

    Science.gov (United States)

    Deutsch, Madeline B

    2016-01-01

    Transgender people have a gender identity different from their birth-assigned sex. Transgender people may seek gender-affirming surgeries to align their body with their identified gender. With increasing visibility of transgender identities, and recognition of the importance of gender-affirming care, has come a policy shift toward mandated coverage or provision of blanket exclusions of these procedures by insurance companies and Medicaid. The World Professional Association for Transgender Health provides guidance to mental health professionals evaluating patients for gender-affirming surgeries, including making a diagnosis and assessing for capacity to consent. However the expansion of covered gender-affirming surgeries to safety-net populations has highlighted the need for an expanded presurgical process which includes a psychosocial assessment and care navigation. The proposed framework expands the preoperative assessment to include these components, and can be used to guide both health systems and insurance providers in the development of transgender medicine programs.

  11. Perioperative nursing care in the treatment of 68 patients with female stress urinary incontinence by using modified TVT-O procedure%改良TVT-O术治疗女性压力性尿失禁68例围术期护理

    Institute of Scientific and Technical Information of China (English)

    李琳; 应梅

    2012-01-01

    Objective: To explore the perioperative nursing methods in the treatment of female stress urinary incontinence by using modified TVT - O procedure. Methods: 68 patients were treated with modified TVT - 0 procedure and given careful perioperative nursing care, including strengthening preoperative pelvic floor muscle and tension training,postoperative nursing care of complications and guidance on bladder function training. Results:The patients were followed up for 6months to one year,urinary incontinence recurred in 4 patients after operation for 6 months and the symptoms disappeared after treatment, without any complication. Conclusion: The modified TVT - 0 procedure has good effect in the treatment of female stress urinary incontinence and careful perioperative nursing care is the key to the success of operation.%目的:探讨改良经闭孔无张力阴道吊带术(TVT-O)治疗女性压力性尿失禁(SUI)患者的围术期护理方法.方法:对68例SUI患者行改良TVT-O术治疗,并给予精心围术期护理,术前加强盆底肌力和紧张性训练,术后做好并发症护理,指导进行膀胱功能训练.结果:本组随访6个月~1年,4例于术后6个月再次出现尿失禁症状,经治疗后好转,其余症状均消失,无并发症发生.结论:改良TVT-O术治疗SUI效果满意,做好围术期护理是手术成功的关键.

  12. Perioperative acute renal failure.

    LENUS (Irish Health Repository)

    Mahon, Padraig

    2012-02-03

    PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.

  13. 舒适护理在子宫肌瘤围手术期的应用效果观察%Observation on Comfort Care Applied to the Patients with Hysteromyoma in Perioperative Period

    Institute of Scientific and Technical Information of China (English)

    王新惠; 黄如兰

    2014-01-01

    目的:探讨舒适护理模式在子宫肌瘤患者围手术期护理中的应用效果。方法:将166例子宫肌瘤患者随机分为观察组和对照组。对照组实施传统的常规护理,观察组在术前术后实施舒适护理,比较2组心理状态、治疗依从性、治疗满意度及疼痛程度等。结果:观察组患者负性情绪改善情况、疼痛程度、治疗满意度和治疗依从性均明显优于对照组(P<0.05)。结论:舒适护理能够有效消除患者的恐惧、焦虑及抑郁等不良心理情绪,减轻病痛,增强信心,提高治疗依从性和护理工作满意度,促进医患和谐。%Objective: To discuss the effects of comfort care applied to the nursing for the patients with hysteromyoma during perioperative period. Methods:All 166 cases were randomized into the observation group and the control group. The control group were administered with traditional routine nursing, the observation group comfort care before and after the operation, psychological state, therapeutic compliance, therapeutic satisfaction degree and the pain degrees of both groups were compared. Results:The observation group was notably better than the control group in the improvement of negative feelings, pain degrees, therapeutic satisfaction degree and therapeutic compliance (P<0.05). Conclusion: Comfort care could effectively eliminate the patients' negative feelings, relieve the pain, increase their confidence, raise therapeutic compliance and satisfaction degree of the nursing to promote the harmony between the doctor and patients.

  14. Perioperative functional residual capacity.

    Science.gov (United States)

    Wahba, R W

    1991-04-01

    The literature dealing with the magnitude, mechanism and effects of reduced FRC in the perioperative period is reviewed. During general anaesthesia FRC is reduced by approximately 20%. The reduction is greater in the obese and in patients with COPD. The most likely mechanism is the loss of inspiratory muscle tone of the muscles acting on the rib cage. Gas trapping is an additional mechanism. Lung compliance decreases and airways resistance increases, in large part, due to decreased FRC. The larynx is displaced anteriorly and elongated, making laryngoscopy and intubation more difficult. The change in FRC creates or increases intrapulmonary shunt and areas of low ventilation to perfusion. This is due to the occurrence of compression atelectasis, and to regional changes in mechanics and airway closure which tend to reduce ventilation to dependent lung zones which are still well perfused. Abdominal and thoracic operations tend to increase shunting further. Large tidal volume but not PEEP will improve oxygenation, although both increase FRC. Both FRC and vital capacity are reduced following abdominal and thoracic surgery in a predictable pattern. The mechanism is the combined effect of incisional pain and reflex dysfunction of the diaphragm. Additional effects of thoracic surgery include pleural effusion, cooling of the phrenic nerve and mediastinal widening. Postoperative hypoxaemia is a function of reduced FRC and airway closure. There is no real difference among the various methods of active lung expansion in terms of the speed of restoration of lung function, or in preventing postoperative atelectasis/pneumonia. Epidural analgesia does not influence the rate of recovery of lung function, nor does it prevent atelectasis/pneumonia. PMID:2036700

  15. 腰椎间盘突出症围手术期功能锻炼的护理%Nursing care of functional exercise during the perioperative period of surgial treatment for lumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    植智云; 叶焕兰; 邓雪娇; 梁前芝

    2013-01-01

    Objective To explore the effect of nursing care of functional exercise during the perioperative period of surgial treatment for lumbar disc herniation.Methods 986 patients with lumbar disc hemiation who had been hospitalized during the period of January 2001 to December 2011 were included in this study.The patients in January 2001 to December 2006 were assigned to a control group and those in January 2007 to December 2011 were assigned to a study group.The study group received prone position training,back muscle exercise,and training for cough,expectoration,and bed excretion to adapt postoperative lying in bed for a long time and avoid the occurrence of complications.After anesthesia,the patients received instruction for straight leg raising and flexion of hip and knee exercises.They performed functional excerise of low back muscle according todifferent surgical procedures.Results During a follow-up of 1 to 10 years,the rate of patients who developed nerve root adhesion,muscle atrophy in the affected lower limbs,or phlebothrombosis in the lower limbs,and who needed repeated surgery due to recurrence were lowered and length of hospital stay was shorter in the study group than in the control group.Conclusions For the patients with lumbar disc herniation,perioperative functional exercise can prevent postoperative adhesion of the nerve root,lower limb muscle disuse atrophy,and deep venous thrombosis of the lower extremities,and shorten length of hospital stay.%目的 探讨腰椎间盘突出症围手术期功能锻炼护理的效果.方法 选取我院2001年1月至2011年12月986例腰椎间盘突出症患者为研究对象,其中2001年1月至2006年12月的493例为对照组,2007年1月至2011年12月的493例为观察组.对照组采用常规护理方法,观察组在手术前进行俯卧位训练、腰背肌训练及咳嗽、咳痰、床上排泄训练,以适应术后长时间卧床,避免发生不良的并发症.手术麻醉过后指导进行直腿抬高和屈髋

  16. Acute Suppurative Cholangitis Patients with Diabetes Mellitus Perioperative Nursing Care%急性化脓性胆管炎合并糖尿病患者的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    尉晓菊

    2014-01-01

    Objective To construct new acute suppurative cholangitis in patients with diabetes mel itus perioperative nursing process,enrich the content of the liver and gal bladder surgery nursing, improve the nursing process. Methods:January 2012-January 2013 in our hospital in liver and gal bladder surgery for acute suppurative cholangitis requires data review procedure of 60 patients with diabetes,patients were randomly divided into group,30 cases in the control group 30 cases,the team with a new mode of nursing process,the control group given surgical routine care,wound healing and hospitalization days were observed. Results:the new nursing process group of patients in the general case, wound healing,are bet er than the routine nursing group, hospitalization days of the new nursing process group is (7.2+1.5)days,routine nursing group was (10.5+2.0)days. Conclusion:the new perioperative nursing process for acute suppurative cholangitis combined with diabetes with stable vital signs, the wound healed wel , the advantages of shorter hospitalization time,can be used in liver and gal bladder surgery to expand.%目的:构造新的急性化脓性胆管炎合并糖尿病患者的围手术期护理程序,充实肝胆外科护理内容,完善护理工作流程。方法选择2012年1月~2013年1月在我院肝胆外科因急性化脓性胆管炎需手术的糖尿病患者60例进行资料回顾,将患者随机分为研究组30例,对照组30例,研究组患者给予新模式的护理流程,对照组给予外科常规护理,观察患者伤口愈合情况以及住院天数。结果新护理流程组患者在一般情况,伤口愈合方面均优于常规护理组,住院天数方面新护理流程组为(7.2±1.5)d,常规护理组为(10.5±2.0)d。结论采用新的围手术期护理程序,对于急性化脓性胆管炎合并糖尿病患者来说,具有生命体征平稳,伤口愈合良好,住院时间短的优点,可以在肝胆外科扩大运用。

  17. Institute of Electronic Systems in CARE and EuCARD Projects Accelerator and FEL Research, Development and Applications in Europe

    CERN Document Server

    Romaniuk, Ryszard

    2009-01-01

    There are described coordinating actions of the accelerator science in Europe in 2003-2009. The actions embrace basic science, as well as development and applications. The accelerator research was not coordinated in Europe at a global scale but was rather concentrated in a few centers owning large infrastructure. These centers include: CERN, DESY, GSI, INFN, LAL, PSI etc. Such coordinating actions enable a lot of positive processes including new possibilities for research centers in this country. It is much easier for them to extend, deepen or even start from the beginning their activities in the field of the accelerator technology. This field includes also free electron lasers. There are described two European framework projects CARE and EuCARD on accelerator technology, their extent and the participation of ISE WUT in them.

  18. 舒适护理在乳腺癌患者围术期护理中的临床应用%Comfort care in breast cancer patients in the perioperative nursing clinical application

    Institute of Scientific and Technical Information of China (English)

    刘朝华; 刘云

    2015-01-01

    目的:探讨舒适护理在乳腺癌患者围术期护理中的临床应用效果。方法收集本院收治的80例乳腺癌患者分为2组,每组40例。对照组患者围术期实施常规护理,实验组患者施加优质护理,比较2组患者的术后生活质量、并发症与护理满意情况。结果实验组患者焦虑、恐惧、抑郁、敌对与躯体化各项评分均显著性低于对照组,差异具有统计学意义(P <0.01);实验组伤口感染与皮瓣坏死发生率明显低于对照组,差异具有统计学意义(P <0.05);皮下积液与上肢水肿发生率显著性低于对照组,差异具有统计学意义(P <0.01);实验组患者护理满意评价显著优于对照组,差异具有统计学意义(P <0.01)。结论舒适护理在乳腺癌患者围术期护理中的临床应用效果显著,可提高满意度。%ABSTRACT:Objective To investigate nursing effect of comfort care in breast cancer patients in the perioperation.Methods A total of 80 breast cancer patients were divided into two groups with 40 people in each group.Control group implemented routine perioperative care and patients in the experimental group applied quality care,quality of life,complications and nursing satisfaction of two groups were compared.Results The anxiety,fear,depression,hostility and somatization scores in the experimental group were significantly lower than that in the control group,there was significant difference (P <0.01);The wound infection and flap necrosis in the experimental group was significantly lower than that in the control group,there was significant difference (P <0.05);Seroma and arm edema was significantly lower than that in the control group,there was significant difference (P <0.01);Patients’care satisfaction in the experimental group was significantly bet-ter than the control group,there was significant difference (P <0.01).Conclusion Nursing ef-fect of comfort care in breast cancer

  19. Accelerated rehabilitation nursing of perioperative surgical treatment of breast cancer%加速康复外科治疗乳腺癌围术期护理配合

    Institute of Scientific and Technical Information of China (English)

    姜金娟

    2014-01-01

    Objective To observe the effect of accelerated rehabilitation surgery idea in the nursing effect of breastcancer during operation period. Methods In our hospital in 91 cases of breast cancer patients with operation in 2012February~2014 year in July admitted to the nursing as the object of study, and randomly divided into experimentalgroup 46 cases and control group 45 cases of patients in the experimental group, using the concept of fast track surgery nursing, the control group of patients with routine nursing, observation and nursing satisfaction and two groups of patients with the occurrence of complications. Results The total satisfaction of patients in the experimental group care rate was 93.4%, control total satisfaction rate of 82.2%groups of patient care, nursing satisfaction of the experimental group were higher than the patients in the control group (P<0.05), and complications from view, the emergence of the patients in the experimental group was less than that in control group of patients with complications.Conclusion The application of fast track surgery concept has a very good application effect in nursing care of patients with breast cancer, nursing satisfaction is high, the emergence of less complications, and can be popularized andapplied in nursing.%目的:观察加速康复外科观念在乳腺癌围手术期的护理效果。方法选取我院在2012年2月~2014年7月收治的乳腺癌手术患者91例作为本次研究的护理对象,并且随意分为实验组46例和对照组患者45例,对实验组采用加速康复外科理念进行护理,对照组患者采用常规护理,观察两组患者的护理满意度和并发症情况。结果实验组患者护理的总满意率为93.4%,对照组患者护理的总满意率为82.2%,实验组患者的护理满意度高于对照组患者(P<0.05),并且从并发症上看,实验组患者出现的并发症也少于对照组患者。结论采用加速康复外科观念应用在乳

  20. 开角型青光眼患者行EX-PRESS青光眼引流钉植入围手术期护理%Perioperative nursing care to patients with open angle glaucoma undergoing EX-PRESS drainage device implantation

    Institute of Scientific and Technical Information of China (English)

    林静仪; 叶荣花; 卢素芬

    2013-01-01

    目的探讨开角型青光眼患者行EX-PRESS青光眼引流钉植入围手术期护理要点。方法给予18例患者行EX-PRESS青光眼引流钉植入术,并做好围手术期护理工作。结果18例患者均成功植入引流钉,手术时间25~45 min,平均(30.0±5.0)min,术后眼内压稳定。结论 EX-PRESS青光眼引流钉植入术是治疗开角型青光眼疾病的一种有效方法,做好围手术期护理工作是确保治疗效果的重要措施。%Objective To investigate the key points in the care of patients with open angle glaucoma undergoing EX-PRESS drainage device implantation during perioperative period.Method Eighteen patients with open angle glaucoma underwent EX-PRESS glaucoma drainage device implantation and received individualized nursing care during perioperative period.Results Drainage device implantation was successfully performed in 18 patients.The mean operation time was(30.0±5.0)mins,ranged 25 to 45 mins.The postoperative intraocular pressure was stable.Conclusions EX-PRESS glaucoma drainage device implantation is an innovative and effective strategy in the treatment of open angle glaucoma.Comprehensive nursing during perioperative period is important to ensure the clinical efficacy.

  1. Perioperative control of blood glucose level in cardiac surgery.

    OpenAIRE

    Minakata, Kenji; Sakata, Ryuzo

    2013-01-01

    It is well recognized that poor perioperative blood glucose (BG) control can increase the risk of infection, cardiovascular accidents, and even death in patients undergoing cardiac surgery. Since it has been reported that tight BG control (80-110 mg/dL) yields better outcomes in critically ill patients, it became a standard of care to control BG using intravenous insulin infusion in ICU. However, it has been debated in terms of the optimal target range whether a strict control with intensive ...

  2. The effects of information technology on perioperative nursing.

    Science.gov (United States)

    Sweeney, Paula

    2010-11-01

    Numerous advances in technology during the past decade require that nurses not only be knowledgeable in nursing science but that they also become educated in information technology (IT). Perioperative IT has the potential to improve the quality of health care, reduce costs, decrease medication administration errors, reduce time spent on paperwork, increase management efficacy, and allow affordable access to health care. Nursing knowledge is needed for designing, implementing, and updating software, including an electronic health record (EHR). With the support of EHR data, nurses will be able to develop best practices for patient care and support research for evidence-based practice. When a standardized terminology, such as the Perioperative Nursing Data Set, is incorporated into an EHR, consistent documentation can be shared among systems. With advances in technology, perioperative nursing roles are expanding in relation to IT requirements and nurses are pursuing additional education. In addition to traditional methods, e-learning is an effective way to provide ongoing technological education. PMID:21040817

  3. Using music interventions in perioperative care.

    Science.gov (United States)

    Gooding, Lori; Swezey, Shane; Zwischenberger, Joseph B

    2012-09-01

    Anxiety and pain are common responses to surgery, and both can negatively affect patient outcomes. Music interventions have been suggested as a nonpharmacological intervention to alleviate pain and anxiety during surgical treatment. Although the data are somewhat mixed, the research suggests that music-based interventions are effective in reducing anxiety, pain perception, and sedative intake. The majority of studies have focused on interventions during the postoperative period and address pain reduction, with preoperative use of music targeting anxiety reduction the second most commonly cited objective. Most of the studies found in the literature involve passive music listening via headphones. The data suggest that researcher-selected music is most effective in reducing anxiety, primarily because it incorporates evidence-based parameters such as consistent tempo and dynamics, stable rhythms, and smooth melodic lines. Finally, the literature suggests that music therapists can serve as experts to help medical personnel identify effective implementation strategies. PMID:22948329

  4. Perioperative care of the visually impaired.

    Science.gov (United States)

    Dobson, F

    1991-07-01

    Eighty-three per cent of sensory input is received optically. Sight impaired patients thus experience substantial sensory deficit, so nursing any visually impaired patient through surgery requires special considerations.

  5. Effects of Perioperative Warm Care on Postoperative Cognitive Function in Elderly Patients%围术期“温暖护理”对老年患者术后认知功能的影响

    Institute of Scientific and Technical Information of China (English)

    马蔚蔚; 李春娥; 汪世高; 杨希英; 张俊秀

    2011-01-01

    目的 探讨围术期“温暖护理”对老年患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)的影响.方法 将40例择期行全身麻醉下腹部外科手术的老年患者[美国卒中学会(Americon Stroke Association,ASA)分级Ⅱ级,>65岁]随机分成两组,对照组仅接受常规护理,观察组在此基础上接受“温暖护理”,即手术当天巡回护士到病房接患者时对患者进行心理辅导,术中控制室温在24~26℃,麻醉开始前30 min患者覆盖保温毯,术中所输液体均加温至39~40℃,冲洗液加温至37~38℃.采用简易智力状态检查表(mini-mental state examination,MMSE)于术前及术后第1、3、7天对两组患者分别进行认知功能评分.结果 术后第1、3天两组患者的MMSE评分都低于术前,差异有统计学意义(P<0.05);术后第1、3天,研究组患者MMSE评分明显高于对照组,发生认知障碍的人数少于对照组,差异均有统计学意义(P<0.05).结论 围术期的心理护理和综合保温措施能改善老年患者术后的认知功能,降低术后认知功能障碍的发生率.%Objective To clarify the effects of perioperative warm care on the postoperative cognitive dys-function (POCD)in elderly patients. Methods Forty elderly patients (ASA Ⅱ , >65 years) undergoing selective abdominal operation were randomly divided into two groups: control group given usual care and experimental group given systematical methods to keep body temperature with mental intervention when circulating nurses received the patients before the operation. For the experimental group,the temperature of operation room was maintained at 24~26 ℃ ; the patients were covered with thermal blanket 30 min be-fore anesthesia;the intraoperative transfusion in the body was heated to 39~40℃ ;the washing fluid was heated to 37 - 38℃. Mini-mental state examination (MMSE) scores were recorded at 1 d, 3 d and 7 d after operation on cognitive function between the

  6. Pulse oximetry for perioperative monitoring

    DEFF Research Database (Denmark)

    Pedersen, Tom; Nicholson, Amanda; Hovhannisyan, Karen;

    2014-01-01

    of perioperative monitoring with pulse oximetry to clearly identify adverse outcomes that might be prevented or improved by its use.The following hypotheses were tested.1. Use of pulse oximetry is associated with improvement in the detection and treatment of hypoxaemia.2. Early detection and treatment...... of perioperative monitoring with pulse oximetry. A single study in general surgery showed that postoperative complications occurred in 10% of participants in the oximetry group and in 9.4% of those in the control group. No statistically significant differences in cardiovascular, respiratory, neurological...... after cardiothoracic surgery; however, routine continuous monitoring did not reduce transfer to an ICU and did not decrease overall mortality. AUTHORS' CONCLUSIONS: These studies confirmed that pulse oximetry can detect hypoxaemia and related events. However, we found no evidence that pulse oximetry...

  7. Strategies for Successful Perioperative Orientation.

    Science.gov (United States)

    Mollohan, Joseph K; Morales, Maria

    2016-08-01

    The successful orientation of new employees facilitates their transition to the complex and demanding world of perioperative nursing. Whether a nurse is a recent graduate or an experienced nurse who has recently joined the facility or department, a new nurse benefits from a transition period during which new skills, processes, and concepts can be learned. Training should offer new employees the opportunity to develop competency, experience, collegial relationships, clinical judgment, and, overall, specialized knowledge for application in the clinical setting. Concerns surrounding orientation and training include the initial costs for training and the possibility of new employees leaving after the completion of training. The associated costs can be staggering, but adopting perioperative nurse residency programs may be a way to provide quality, high-level training and improve retention rates while minimizing long-term costs. PMID:27472970

  8. Prevention of inadvertent perioperative hypothermia.

    Science.gov (United States)

    Burger, Leona; Fitzpatrick, Jane

    All patients undergoing surgery are at risk of developing hypothermia; up to 70% develop hypothermia perioperatively. Inadvertent hypothermia is associated with complications such as impaired wound healing, increased blood loss, cardiac arrest and increased risk of wound infection. Anaesthesia increases the risk as the normal protective shivering reflex is absent. Ambient temperature also has a major effect on the patient's body temperature. Prevention of hypothermia not only reduces the incidence of complications, but patients also experience a greater level of comfort, and avoid postoperative shivering and the unpleasant sensation of feeling cold. Nurses should be aware of the risks of hypothermia so that preventative interventions can be employed to minimize the risk of hypothermia. Preoperative assessment is essential to enable identification of at-risk patients. Simple precautionary measures initiated by nurses can considerably reduce the amount of heat lost, minimize the risk of associated complications and ultimately improve patients' short- and long-term recovery. Minimizing skin exposure, providing adequate bed linen for the transfer to theatre and educating patients about the importance of keeping warm perioperatively are all extremely important. It is also worth considering using forced-air warmers preoperatively as research suggests that initiating active warming preoperatively may be successful in preventing hypothermia during the perioperative period. PMID:19966730

  9. Managing a chronic pain patient in the perioperative period.

    Science.gov (United States)

    Kopf, Andreas

    2013-12-01

    The chronic pain patient with and without chronic opioid medication is at risk for under- and overtreatment perioperatively. Careful planning of the perioperative period by the anesthesiologist, the pain service and the surgeon is crucial. Epidural analgesia requires reduction of preoperative opioid doses to a maximum of 50% to avoid withdrawal as well as continuous postanesthesia care unit-monitoring for the first 24 hours. Brief cognitive behavioral interventions pre- and postoperatively contribute to successful pain management. The perioperative period may be used to re-evaluate the patient's opioid requirements. A follow-up by an experienced pain management service should be available after discharge of the chronic pain patient. Individualized assessment by a pain management team is necessary for this increasing group of patients. This report is adapted from paineurope 2013; Issue 2, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD. and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. PMID:24303836

  10. Innovating in health care management education: development of an accelerated MBA and MPH degree program at Yale.

    Science.gov (United States)

    Pettigrew, Melinda M; Forman, Howard P; Pistell, Anne F; Nembhard, Ingrid M

    2015-03-01

    Increasingly, there is recognition of the need for individuals with expertise in both management and public health to help health care organizations deliver high-quality and cost-effective care. The Yale School of Public Health and Yale School of Management began offering an accelerated Master of Business Administration (MBA) and Master of Public Health (MPH) joint degree program in the summer of 2014. This new program enables students to earn MBA and MPH degrees simultaneously from 2 fully accredited schools in 22 months. Students will graduate with the knowledge and skills needed to become innovative leaders of health care organizations. We discuss the rationale for the program, the developmental process, the curriculum, benefits of the program, and potential challenges.

  11. [Perioperative risk management in anesthesia for thoracic surgery].

    Science.gov (United States)

    Goto, Keiji

    2008-06-01

    Thoracic surgery has become to be performed more safely by recent progress of operative method and anesthetic management. The surgery can be applicable for those patients who were formerly difficult for operation because of preoperative poor respiratory function, however, postoperative mortality and morbidity increase in such patients without appropriate perioperative management. Experienced anesthetic management can contribute to the risk reduction for these conditions. Since respiratory function which is injured by associated diseases is worsen by both thoracic surgery and general anesthesia, patients with coexisting respiratory diseases in particular need to be watched out intensively. Coherent risk management from preoperative to postoperative period becomes important. This is achieved by the comprehensive perioperative patient management which is consisted of the cooperation between the surgeon and the anesthetist, correct preoperartive evaluation, preoperative medical treatment with pulmonary rehabilitation, appropriate anesthetic management, and postoperative intensive care. PMID:18536299

  12. Perioperative aspirin and clonidine and risk of acute kidney injury

    DEFF Research Database (Denmark)

    Garg, Amit X; Kurz, Andrea; Sessler, Daniel I;

    2014-01-01

    IMPORTANCE: Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain...... and each intervention has the potential for harm. OBJECTIVE: To determine whether aspirin compared with placebo, and clonidine compared with placebo, alters the risk of perioperative acute kidney injury. DESIGN, SETTING, AND PARTICIPANTS: A 2 × 2 factorial randomized, blinded, clinical trial of 6905...... patients undergoing noncardiac surgery from 88 centers in 22 countries with consecutive patients enrolled between January 2011 and December 2013. INTERVENTIONS: Patients were assigned to take aspirin (200 mg) or placebo 2 to 4 hours before surgery and then aspirin (100 mg) or placebo daily up to 30 days...

  13. Development of accelerator technology in Poland, Impact of European CARE and EuCARD projects

    OpenAIRE

    Romaniuk, R.

    2008-01-01

    The development of accelerator technology in Poland is strictly combined with the cooperation with specialist accelerator centers of global character, where the relevant knowledge is generated, allowing to build big and modern machines. These are relatively costly undertakings of interdisciplinary character. Most of them are financed from the local resources. Only the biggest machines are financed commonly by many nations like: LHC in CERN, ILC in Fermi Lab, E-XFEL in DESY. A similar financin...

  14. The clinical application of psychological intervention in the total hip replacement of perioperative care%心理干预在人工髋关节置换术围手术期护理中的临床应用

    Institute of Scientific and Technical Information of China (English)

    罗彬

    2012-01-01

    Objective To study the effects when apply the psychological intervention measures on the patients with artificial hip joint replacement who are during the perioperative period. Methods By analyzing the application of psychological intervention measures on the patients who are during the perioperative period, in the preoperative, intraoperative, and postoperative period.To discuss the application of the psychological intervention in clinic. Results Comprehensive psychological nursing intervention is beneficial to the patients' psychologic equilibrium,reduce the feeling of pain.getting through the perioperative period. Conclusions Psychological intervention can improve the cognition level of patients about illness.which is good for postoperative recovery and can reduce complications.%目的:研究实施心理干预对人工髋关节置换术围手术期患者的影响.方法:通过分析对围手术期患者实施术前、术中、术后的心理行为干预,来探讨心理干预在临床中的应用.结果:综合的护理和心理干预对患者的心理平衡有很大帮助,能降低患者对疼痛的耐受,使患者平安渡过围手术期.结论:心理干预能使患者提高对疾病的认知水平,有利于术后康复,减少并发症的发生.

  15. Cardiac perioperative complications in noncardiac surgery

    Directory of Open Access Journals (Sweden)

    Radovanović Dragana

    2008-01-01

    Full Text Available Anesthesiologists are confronted with an increasing population of patients undergoing noncardiac surgery who are at risk for cardiac complications in the perioperative period. Perioperative cardiac complications are responsible for significant mortality and morbidity. The aim of the present study was to determine the incidence of perioperative (operative and postoperative cardiac complications and correlations between the incidence of perioperative cardiac complications and type of surgical procedure, age, presence of concurrent diseases. A total of 100 patients with cardiac diseases undergoing noncardiac surgery were included in the prospective study (Group A 50 patients undergoing intraperitoneal surgery and Group B 50 patients undergoing breast and thyroid surgery. The patients were followed up during the perioperative period and after surgery until leaving hospital to assess the occurrence of cardiac events. Cardiac complications (systemic arterial hypertension, systemic arterial hypotension, abnormalities of cardiac conduction and cardiac rhythm, perioperative myocardial ischemia and acute myocardial infarction occurred in 64% of the patients. One of the 100 patients (1% had postoperative myocardial infarction which was fatal. Systemic arterial hypertension occurred in 57% of patients intraoperatively and 33% postoperatively, abnormalities of cardiac rhythm in 31% of patients intraoperatively and 17% postoperatively, perioperative myocardial ischemia in 23% of patients intraoperatively and 11% of postoperatively. The most often cardiac complications were systemic arterial hypertension, abnormalities of cardiac rhythm and perioperative myocardial ischemia. Factors independently associated with the incidence of cardiac complications included the type of surgical procedure, advanced age, duration of anaesthesia and surgery, abnormal preoperative electrocardiogram, abnormal preoperative chest radiography and diabetes.

  16. Update on perioperative management of the child with asthma

    Directory of Open Access Journals (Sweden)

    Francesco Dones

    2012-04-01

    Full Text Available Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.

  17. Update on perioperative management of the child with asthma.

    Science.gov (United States)

    Dones, Francesco; Foresta, Grazia; Russotto, Vincenzo

    2012-04-01

    Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.

  18. [Croatian guidelines for perioperative enteral nutrition of surgical patients].

    Science.gov (United States)

    Zelić, Marko; Bender, Darija Vranesić; Kelecić, Dina Ljubas; Zupan, Zeljko; Cicvarić, Tedi; Maldini, Branka; Durut, Iva; Rahelić, Velimir; Skegro, Mate; Majerović, Mate; Perko, Zdravko; Sustić, Alan; Madzar, Tomislav; Kovacić, Borna; Kekez, Tihomir; Krznarić, Zeljko

    2014-01-01

    Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals.

  19. Perioperative nursing care and rehabilitation for patients with traumatic elbow joint stiffness%创伤性肘关节僵硬的围手术期护理及康复治疗

    Institute of Scientific and Technical Information of China (English)

    王红莉; 孔祥燕

    2015-01-01

    Background The elbow joint is a composite joint consisted of the humeroulnar joint , humeroradial joint ,and proximal radioulnar joint .The causes for elbow joint stiffness include joint capsule scar contracture ,ectopic ossification around the joint and long‐term immobilization .The conservative treatment can be applied to early elbow joint stiffness .The open elbow release surgery is applicable for patients who do not respond to conservative therapy .Although satisfactory range of motion is obtained after complete release ,the loss of range of motion may occur again if the patients don′t exercise due to pain .The assistance of hinged external fixator helps to prevent joint capsule scar contracture ,promote early function exercise ,and effectively prevent relapse of elbow joint stiffness .In this study ,we reported the perioperative nursing care and rehabilitation in 8 cases who presented good outcomes after open release surgery combined with hinged external fixator for traumatic elbow joint stiffness in the department of traumatic orthopedics in the Peking University‐affiliated People′s Hospital from January 2010 to March 2014 .Methods General data:8 cases including 3 males and 5 females with a mean age of 38 .3 years ranged from 17‐61 years were included in the group .4 cases had primary injury caused by dislocation of elbow joint .1 case had radial head fracture .1 had supracondylar fracture of humerus .2 had intercondylar fracture .The time from the initial injury to the surgery ranged from 10‐36 months ,with a mean of 18 .2 months .According to Morrey classification of elbow joint stiffness ,2 cases had very severe stiffness (range of motion ≤30°);6 cases had severe stiffness (range of motion 30°‐60°) .According to Mayo scale for elbow function ,the score ranged from 45‐75 ,with a mean of 53 .8 .Three cases of them had complicated entrapment of the ulnar nerve .Surgery method:All patients of the group were subject to general anesthesia

  20. Clinical decision support for perioperative information management systems.

    Science.gov (United States)

    Wanderer, Jonathan P; Ehrenfeld, Jesse M

    2013-12-01

    Clinical decision support (CDS) systems are being used to optimize the increasingly complex care that our health care system delivers. These systems have become increasingly important in the delivery of perioperative care for patients undergoing cardiac, thoracic, and vascular procedures. The adoption of perioperative information management systems (PIMS) has allowed these technologies to enter the operating room and support the clinical work flow of anesthesiologists and operational processes. Constructing effective CDS systems necessitates an understanding of operative work flow and technical considerations as well as achieving integration with existing information systems. In this review, we describe published examples of CDS for PIMS, including support for cardiopulmonary bypass separation physiological alarms, β-blocker guideline adherence, enhanced revenue capture for arterial line placement, and detection of hemodynamic monitoring gaps. Although these and other areas are amenable to CDS systems, the challenges of latency and data reliability represent fundamental limitations on the potential application of these tools to specific types of clinical issues. Ultimately, we expect that CDS will remain an important tool in our efforts to optimize the quality of care delivered.

  1. Clinical features of pheochromocytoma and perioperative anesthetic management

    Institute of Scientific and Technical Information of China (English)

    罗爱伦; 郭向阳; 易杰; 任洪智; 黄宇光; 叶铁虎

    2003-01-01

    Objective To investigate clinical features of pheochromocytoma and summarize experiences of anesthetic management during the perioperative period. Methods Two hundred and fifty eight patients who were diagnosed with pheochromocytoma in our hospital were reviewed retrospectively for clinical features. According to different preoperative pharmalogical preparations, perioperative mortalities were analyzed in three periods (Period 1: January 1955-December 1975; Period 2: January 1976-December 1994; Period 3: January 1995-July 2001). In Period 3, hemodynamic changes in the patients undergoing different anesthetic methods were analyzed. Results About 5.8% (15/258) of pheochromocytoma was an integral part of multiple endocrine neoplasia (MEN) type Ⅱ or mixed type. Sixty percent (149/249) of the patients who had undergone surgery possessed evidence of catecholamine cardiac toxicity preoperatively. Impaired glucose tolerance was found in 59% (147/249) of the patients before surgery. Perioperative mortality was significantly decreased from 8% (5/60) in Period 1 to 1.2% (1/75) in Period 2 (P<0.01). No perioperative deaths occurred in Period 3. The volume infused during the operation was significantly higher both in the epidural anesthesia group (3474 ml±624 ml, P<0.01) and in the epidural plus general anesthesia group (3654 ml±475 ml, P<0.01) than in the general anesthesia group (2534 ml±512 ml). There were favorable hemodynamic characteristics in patients before removal of the tumor in the epidural anesthesia group and in the epidural plus general anesthesia group, as compared with the general anesthesia group. Conclusions A positive surgical outcome of the excision of pheochromocytoma depends on multiple factors, including careful assessment of potential vital organ damage before surgery and restoration of blood volume by establishing α-blockade preoperatively, meticulous anesthetic management of patients during surgery, and appropriate circulatory support after

  2. Perioperative Management of Patients with Diabetes and Hyperglycemia Undergoing Elective Surgery.

    Science.gov (United States)

    Thompson, Bithika M; Stearns, Joshua D; Apsey, Heidi A; Schlinkert, Richard T; Cook, Curtiss B

    2016-01-01

    Diabetes mellitus (DM) and hyperglycemia are associated with increased surgical morbidity and mortality. Hyperglycemia is a determinant of risk of surgical complications and should be addressed across the continuum of surgical care. While data support the need to address hyperglycemia in patients with DM in the ambulatory setting prior to surgery and in the inpatient setting, data are less certain about hyperglycemia occurring during the perioperative period-that part of the process occurring on the day of surgery itself. The definition of "perioperative" varies in the literature. This paper proposes a standardized definition for the perioperative period as spanning the time of patient admission to the preoperative area through discharge from the recovery area. Available information about the impact of perioperative hyperglycemia on surgical outcomes within the framework of that definition is summarized, and the authors' approach to standardizing perioperative care for patients with DM is outlined, including the special case of patients receiving insulin pump therapy. The discussion is limited to adult ambulatory non-obstetric patients undergoing elective surgical procedures under general anesthesia.

  3. Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines.

    Science.gov (United States)

    Min, Byung-Woo; Kim, Yeesuk; Cho, Hong-Man; Park, Kyung-Soon; Yoon, Pil Whan; Nho, Jae-Hwi; Kim, Sang-Min; Lee, Kyung-Jae; Moon, Kyong-Ho

    2016-03-01

    Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty. PMID:27536639

  4. Development of accelerator technology in Poland, Impact of European CARE and EuCARD projects

    CERN Document Server

    Romaniuk, R

    2008-01-01

    The development of accelerator technology in Poland is strictly combined with the cooperation with specialist accelerator centers of global character, where the relevant knowledge is generated, allowing to build big and modern machines. These are relatively costly undertakings of interdisciplinary character. Most of them are financed from the local resources. Only the biggest machines are financed commonly by many nations like: LHC in CERN, ILC in Fermi Lab, E-XFEL in DESY. A similar financing solution has to be implemented in Poland, where a scientific and political campaign is underway on behalf of building two big machines, a Polish Synchrotron in Kraków and a Polish FEL in Świerk. Around these two projects, there are realized a dozen or so smaller ones.

  5. Optimal glucose management in the perioperative period.

    Science.gov (United States)

    Evans, Charity H; Lee, Jane; Ruhlman, Melissa K

    2015-04-01

    Hyperglycemia is a common finding in surgical patients during the perioperative period. Factors contributing to poor glycemic control include counterregulatory hormones, hepatic insulin resistance, decreased insulin-stimulated glucose uptake, use of dextrose-containing intravenous fluids, and enteral and parenteral nutrition. Hyperglycemia in the perioperative period is associated with increased morbidity, decreased survival, and increased resource utilization. Optimal glucose management in the perioperative period contributes to reduced morbidity and mortality. To readily identify hyperglycemia, blood glucose monitoring should be instituted for all hospitalized patients. PMID:25814110

  6. Perioperative management of pediatric patients on mechanical cardiac support.

    Science.gov (United States)

    Mossad, Emad B; Motta, Pablo; Rossano, Joseph; Hale, Brittani; Morales, David L

    2011-05-01

    The population of children with end-stage heart failure requiring mechanical circulatory support is growing. These children present for diagnostic imaging studies, various interventions and noncardiac surgical procedures that require anesthetic care. This article is a review of the population demographics of children on mechanical cardiac support, the alternative devices available, and the important concepts for safe perioperative management of these patients. The discussion will be limited to devices for short- and long-term cardiac support, excluding extracorporeal membrane oxygenation (ECMO) for respiratory support. PMID:21332879

  7. [Perioperative Management of PD Patients].

    Science.gov (United States)

    Reichmann, H

    2016-07-01

    Both patients and caregivers but also treating physicians are concerned about complications along with surgical interventions. A major problem is abrupt cessation of anti-Parkinson medication, which leads to manifold disturbances, sometimes even to an akinetic crisis. There are several means to guarantee continuous dopaminergic stimulation even in patients that are not allowed to take medication orally before they undergo surgery. Amongst others rectally applied levodopa, amantadine infusions, and especially the use of a rotigotine patch are good means to overcome oral intake. Perioperative management is important due to the fact that in Germany alone each year more than 10 000 PD patients undergo surgery. Main reasons for this are fractures, but also elective interventions. Further emergency situations that cause treatment as an inpatient are psychosis, motoric disability, but also pneumonia and cardiovascular disturbances. In contrast PD patients suffer less often from cancer. PMID:27276074

  8. Association between Perioperative Parameters and

    Directory of Open Access Journals (Sweden)

    Saba Ghaffary

    2015-10-01

    Full Text Available Background: Postoperative cognitive dysfunction (POCD has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient’s life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery.Methods: One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change.Results: The study population consisted of 101 patients, comprising 14 (13.8% females and 87 (86.2% males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05, whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change.Conclusion: Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients’ basic cognition and POCD. Preoperative nitrate administration led to a significant improvement

  9. A Primer on Population Health Management and Its Perioperative Application.

    Science.gov (United States)

    Boudreaux, Arthur M; Vetter, Thomas R

    2016-07-01

    The movement toward value-based payment models, driven by governmental policies, federal statutes, and market forces, is propelling the importance of effectively managing the health of populations to the forefront in the United States and other developed countries. However, for many anesthesiologists, population health management is a new or even foreign concept. A primer on population health management and its potential perioperative application is thus presented here. Although it certainly continues to evolve, population health management can be broadly defined as the specific policies, programs, and interventions directed at optimizing population health. The Population Health Alliance has created a particularly cogent conceptual framework and interconnected and very useful population health process model, which together identify the key components of population health and its management. Population health management provides a useful rationale for patients, providers, payers, and policymakers to move collectively away from the traditional system of individual, siloed providers to a more integrated, coordinated, team-based approach, thus creating a holistic view of the patient population. The goal of population health management is to keep the targeted patient population as healthy as possible, thus minimizing the need for costly interventions such as emergency department visits, acute hospitalizations, laboratory testing and imaging, and diagnostic and therapeutic procedures. Population health management strategies are increasingly more important to leaders of health care systems as the health of populations for which they care, especially in a strong cost risk-sharing environment, must be optimized. Most population health management efforts rely on a patient-centric team approach, coordination of care, effective communication, robust outcomes data analysis, and continuous quality improvement. Anesthesiologists have an opportunity to help lead these efforts in

  10. Stress Dose Steroids: Myths and Perioperative Medicine.

    Science.gov (United States)

    MacKenzie, C Ronald; Goodman, Susan M

    2016-07-01

    Perioperative medication management for patients with systemic autoimmune inflammatory diseases has focused on strategies to improve outcomes and mitigate risks. The emphasis has been to minimize the risk of infection associated with most antirheumatic medications, while attempting to avoid flares of disease precipitated by medication withdrawal. Management of glucocorticoids in the perioperative period has been based on an assumption that supraphysiologic increases in dose were always necessary to avoid hypotension and shock in glucocorticoid treated patients, and alternative strategies were rarely considered despite the known infectious, metabolic, and wound healing risks associated with glucocorticoid administration. This paper will review current recommendations for perioperative glucocorticoid administration for glucocorticoid treated patients with systemic inflammatory autoimmune diseases and discuss glucocorticoid physiology to analyze the basis for these recommendations and consider alternative perioperative management strategies. PMID:27351679

  11. The Science And Art Of Delivery: Accelerating The Diffusion Of Health Care Innovation.

    Science.gov (United States)

    Parston, Greg; McQueen, Julie; Patel, Hannah; Keown, Oliver P; Fontana, Gianluca; Al Kuwari, Hanan; Al Kuwari, Hannan; Darzi, Ara

    2015-12-01

    There is a widely acknowledged time lag in health care between an invention or innovation and its widespread use across a health system. Much is known about the factors that can aid the uptake of innovations within discrete organizations. Less is known about what needs to be done to enable innovations to transform large systems of health care. This article describes the results of in-depth case studies aimed at assessing the role of key agents and agencies that facilitate the rapid adoption of innovations. The case studies-from Argentina, England, Nepal, Singapore, Sweden, the United States, and Zambia-represent widely varying health systems and economies. The implications of the findings for policy makers are discussed in terms of key factors within a phased approach for creating a climate for change, engaging and enabling the whole organization, and implementing and sustaining change. Purposeful and directed change management is needed to drive system transformation.

  12. Perioperative Glucose Control in Neurosurgical Patients

    OpenAIRE

    Daniel Agustín Godoy; Mario Di Napoli; Alberto Biestro; Rainer Lenhardt

    2012-01-01

    Many neurosurgery patients may have unrecognized diabetes or may develop stress-related hyperglycemia in the perioperative period. Diabetes patients have a higher perioperative risk of complications and have longer hospital stays than individuals without diabetes. Maintenance of euglycemia using intensive insulin therapy (IIT) continues to be investigated as a therapeutic tool to decrease morbidity and mortality associated with derangements in glucose metabolism due to surgery. Suboptimal per...

  13. Update in perioperative medicine: practice-changing evidence published in 2015.

    Science.gov (United States)

    Sundsted, Karna K; Mohabbat, Arya B; Regan, Dennis W; Salonen, Bradley R; Daniels, Paul R; Mauck, Karen F

    2016-08-01

    Evidence in perioperative medicine is published in a wide variety of journals, given the multidisciplinary nature of its practice which spans medicine and its subspecialties, as well as surgery and anesthesiology. It can be difficult to identify new and important evidence, as perioperative practice continues to evolve in multiple areas such as medication management, anticoagulation and cardiac risk stratification, among others. New, high-quality evidence is published each year, and must be placed into the context of not only existing literature, but also practical real-world patient care. We sought to systematically identify, critically evaluate and concisely summarize the practice implications of 10 articles published in 2015 for the practicing perioperative clinician. PMID:27400757

  14. Status of the Next European Dipole (NED) Activity of the Collaborated Accelerator Research in Europe (CARE) Project

    CERN Document Server

    Devred, Arnaud; Baynham, D Elwyn; Boutboul, T; Canfer, S; Chorowski, M; den Ouden, A; Fabbricatore, P; Farinon, S; Fessia, P; Fydrych, J; Félice, H; Greco, Michela; Greenhalgh, J; Leroy, D; Loveridge, P W; Michel, F; Oberli, L R; Pedrini, D; Polinski, J; Previtali, V; Quettier, L; Rifflet, J M; Rochford, J; Rondeaux, F; Sanz, S; Sgobba, Stefano; Sorbi, M; Toral-Fernandez, F; Van Weelderen, R; Vincent-Viry, O; Volpini, G; Védrine, P

    2005-01-01

    Plans for LHC upgrade and for the final focalization of linear colliders call for large aperture and/or high-performance dipole and quadrupole magnets that may be beyond the reach of conventional NbTi magnet technology. The Next European Dipole (NED) activity was launched on January 1st, 2004 to promote the development of high-performance, Nb3Sn wires in collaboration with European industry (aiming at a non-copper critical current density of 1500 A/mm2 at 4.2 K and 15 T) and to assess the suitability of Nb3Sn technology to the next generation of accelerator magnets (aiming at an aperture of 88 mm and a conductor peak field of 15 T). It is integrated within the Collaborated Accelerator Research in Europe (CARE) project, involves seven collaborators, and is partly funded by the European Union. We present here an overview of the NED activity and we report on the status of the various work packages it encompasses.

  15. Perioperative nursing care and rehabilitation for patients with traumatic elbow joint stiffness%创伤性肘关节僵硬的围手术期护理及康复治疗

    Institute of Scientific and Technical Information of China (English)

    王红莉; 孔祥燕

    2015-01-01

    study ,we reported the perioperative nursing care and rehabilitation in 8 cases who presented good outcomes after open release surgery combined with hinged external fixator for traumatic elbow joint stiffness in the department of traumatic orthopedics in the Peking University‐affiliated People′s Hospital from January 2010 to March 2014 .Methods General data:8 cases including 3 males and 5 females with a mean age of 38 .3 years ranged from 17‐61 years were included in the group .4 cases had primary injury caused by dislocation of elbow joint .1 case had radial head fracture .1 had supracondylar fracture of humerus .2 had intercondylar fracture .The time from the initial injury to the surgery ranged from 10‐36 months ,with a mean of 18 .2 months .According to Morrey classification of elbow joint stiffness ,2 cases had very severe stiffness (range of motion ≤30°);6 cases had severe stiffness (range of motion 30°‐60°) .According to Mayo scale for elbow function ,the score ranged from 45‐75 ,with a mean of 53 .8 .Three cases of them had complicated entrapment of the ulnar nerve .Surgery method:All patients of the group were subject to general anesthesia .The surgery with medial and lateral approaches were performed to release the capsular ligament and tendon ,and remove the ectopic ossification .Normal release was performed for the prepositioned ulnar nerve .The center of rotation of the elbow joint was positioned under fluoroscopy .2‐mm Kirschner wire was inserted in the center of rotation .Stryker Dynamic Joint Distractor (DJD II) was used for external fixation .2 screws for external fixation were inserted from the humerus and ulna ,respectively .The screws should be in parallel with the Kirschner wire in the same plane .The screws were connected with the external fixator using clamp .The elbow joint gap was open by rotating the retractor .Key points for nursing :(1) Psychological nursing before surgery :The patients were subject to health education

  16. Less noise, more hacking: how to deploy principles from MIT's hacking medicine to accelerate health care.

    Science.gov (United States)

    DePasse, Jacqueline W; Carroll, Ryan; Ippolito, Andrea; Yost, Allison; Santorino, Data; Chu, Zen; Olson, Kristian R

    2014-07-01

    Medical technology offers enormous potential for scalable medicine--to improve the quality and access in health care while simultaneously reducing cost. However, current medical device innovation within companies often only offers incremental advances on existing products, or originates from engineers with limited knowledge of the clinical complexities. We describe how the Hacking Medicine Initiative, based at Massachusetts Institute of Technology has developed an innovative "healthcare hackathon" approach, bringing diverse teams together to rapidly validate clinical needs and develop solutions. Hackathons are based on three core principles; emphasis on a problem-based approach, cross-pollination of disciplines, and "pivoting" on or rapidly iterating on ideas. Hackathons also offer enormous potential for innovation in global health by focusing on local needs and resources as well as addressing feasibility and cultural contextualization. Although relatively new, the success of this approach is clear, as evidenced by the development of successful startup companies, pioneering product design, and the incorporation of creative people from outside traditional life science backgrounds who are working with clinicians and other scientists to create transformative innovation in health care.

  17. Less noise, more hacking: how to deploy principles from MIT's hacking medicine to accelerate health care.

    Science.gov (United States)

    DePasse, Jacqueline W; Carroll, Ryan; Ippolito, Andrea; Yost, Allison; Santorino, Data; Chu, Zen; Olson, Kristian R

    2014-07-01

    Medical technology offers enormous potential for scalable medicine--to improve the quality and access in health care while simultaneously reducing cost. However, current medical device innovation within companies often only offers incremental advances on existing products, or originates from engineers with limited knowledge of the clinical complexities. We describe how the Hacking Medicine Initiative, based at Massachusetts Institute of Technology has developed an innovative "healthcare hackathon" approach, bringing diverse teams together to rapidly validate clinical needs and develop solutions. Hackathons are based on three core principles; emphasis on a problem-based approach, cross-pollination of disciplines, and "pivoting" on or rapidly iterating on ideas. Hackathons also offer enormous potential for innovation in global health by focusing on local needs and resources as well as addressing feasibility and cultural contextualization. Although relatively new, the success of this approach is clear, as evidenced by the development of successful startup companies, pioneering product design, and the incorporation of creative people from outside traditional life science backgrounds who are working with clinicians and other scientists to create transformative innovation in health care. PMID:25096225

  18. A 2-year audit of perioperative mortality in Malaysian hospitals.

    Science.gov (United States)

    Inbasegaran, K; Kandasami, P; Sivalingam, N

    1998-12-01

    An audit of all perioperative deaths within seven days of surgery in 14 major public hospitals is presented. This study is part of a quality assurance programme examining the surgical and anaesthetic practices in these hospitals. During the study period from July 1992 till June 1994, 211,354 surgeries were performed and 715 deaths were reported out of which 699 were available for analysis. The data was obtained by confidential enquiry using predetermined questionnaires filled by participating surgeons and anaesthetists and analysed by a group of peers. The overall crude mortality rate was 0.34% and the majority of the deaths occurred in severely ill patients in whom the clinical management was satisfactory. Polytrauma including head, intra-abdominal and skeletal trauma accounted for 253 of the deaths (36.19%). The other causes were bowel obstruction with sepsis, burns, ischaemic limbs, congenital malformations in neonates and pregnancy-related hemorrhage. 62.52% of the deaths occurred within two days of surgery and 85.87% were related to emergency procedures. The review identified some shortfalls in perioperative care and these were lack of adequate critical care facilities, lack of supervision, unnecessary surgery in the moribund and inadequate preoperative optimisation. The results of the study have been forwarded to all participating hospitals for implementation of remedial measures.

  19. Perbandingan Persepsi Perawat dengan Pasien tentang Perilaku Caring Perawat Perioperatif di Ruang Rawat Bedah Rumah Sakit Umum Binjai

    OpenAIRE

    Nindya, Dessy

    2014-01-01

    Perioperative nurse of caring behavior is a surgical nurse and intervention stance in providing nursing care for patients at the surgical pre and post operation phase operation. This research aims to identify the perceptions of nurse caring about the behavior of perioperative nursing care in surgery, a patient's perception about the behaviors identified the caring nurse perioperative in the outpatient surgery. The research design used in this research is descriptive design comparative. This r...

  20. Laparoscopic cholecystectomy perioperative management: an update

    Directory of Open Access Journals (Sweden)

    Sellbrant I

    2015-07-01

    Full Text Available Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no firm evidence for best anesthetic technique, further high quality studies assessing short as well as more protracted outcomes are needed. Preventive multi-modal analgesia, combining non-opioid analgesics, paracetamol, nonsteroidal anti-inflammatory drugs or coxib, and local anesthesia, has a long history. Local anesthesia improves postoperative pain and facilitates discharge on the day of surgery. Whether transversus abdominis plane-block has clinically important advantages compared to local infiltration analgesia needs further studies. Single intravenous dose steroid, dexamethasone, reduces postoperative nausea and vomiting, pain, and enhances the recovery process. Multi-modal analgesia is reassuringly safe thus having a positive benefit versus risk profile. Adherence to modern guidelines avoiding prolonged fasting and liberal intravenous fluid regime supports rapid recovery. The effects of CO2 insufflation must be acknowledged and low intra-abdominal pressure should be sought in order to reduce negative cardiovascular/respiratory effects. There is no firm evidence supporting heating and humidification of the insufflated gas. The potential risk for CO2/gas entrainment into vasaculture, gas emboli, or subcutaneous/intra-thoracic into the pleural space must be kept in mind. Laparoscopic cholecystectomy in ASA 1-2 patients following a multi-modal enhanced recovery protocol promotes high success rate for discharge on the day of surgery. Keywords: laparoscopic

  1. Prothrombin Complex Concentrates for Bleeding in the Perioperative Setting.

    Science.gov (United States)

    Ghadimi, Kamrouz; Levy, Jerrold H; Welsby, Ian J

    2016-05-01

    Prothrombin complex concentrates (PCCs) contain vitamin K-dependent clotting factors (II, VII, IX, and X) and are marketed as 3 or 4 factor-PCC formulations depending on the concentrations of factor VII. PCCs rapidly restore deficient coagulation factor concentrations to achieve hemostasis, but like with all procoagulants, the effect is balanced against thromboembolic risk. The latter is dependent on both the dose of PCCs and the individual patient prothrombotic predisposition. PCCs are approved by the US Food and Drug Administration for the reversal of vitamin K antagonists in the setting of coagulopathy or bleeding and, therefore, can be administered when urgent surgery is required in patients taking warfarin. However, there is growing experience with the off-label use of PCCs to treat patients with surgical coagulopathic bleeding. Despite their increasing use, there are limited prospective data related to the safety, efficacy, and dosing of PCCs for this indication. PCC administration in the perioperative setting may be tailored to the individual patient based on the laboratory and clinical variables, including point-of-care coagulation testing, to balance hemostatic benefits while minimizing the prothrombotic risk. Importantly, in patients with perioperative bleeding, other considerations should include treating additional sources of coagulopathy such as hypofibrinogenemia, thrombocytopenia, and platelet disorders or surgical sources of bleeding. Thromboembolic risk from excessive PCC dosing may be present well into the postoperative period after hemostasis is achieved owing to the relatively long half-life of prothrombin (factor II, 60-72 hours). The integration of PCCs into comprehensive perioperative coagulation treatment algorithms for refractory bleeding is increasingly reported, but further studies are needed to better evaluate the safe and effective administration of these factor concentrates. PMID:26983050

  2. 外阴肿瘤扩大切除与皮瓣修复术治疗乳房外Paget病患者围手术期的护理%Perioperative care to patients with extramammary Paget’s disease treated with resection of tumor of vulva expansion and flap repair

    Institute of Scientific and Technical Information of China (English)

    陈少红; 陈海燕

    2013-01-01

    Objective To summarize perioperative points for nursing patients with extramammary Paget’s disease undergoing resection of tumor of vulva expansion and flap repair.Method Eleven patients with extramammary Paget’s disease were managed with resection of tumor of vulva expansion and flap repair,and with perioperative care as well.Results The tumors in all of the patients were removed completely and the flaps survived.All patients were discharged for hospitalization of(4.5±0.7)days.No flap infection or necrosis occurred.Conclusion The measures for nursing the patients with extramammary Paget’s disease undergoing resection of tumor of vulva expansion and flap repair may include preoperative preparation,mental care,postoperative observation of flaps, prevention of complications,health education,instruction on nutrition and formation of proper life style,which may be beneficial for the smooth manipulation of resection as well as for the postoperative rehabilitation.%  目的总结外阴肿瘤扩大切除与皮瓣修复术治疗乳房外Paget病患者围手术期的护理要点。方法给予11例乳房外Paget病患者实施外阴肿瘤扩大切除与皮瓣修复术,同时配合做好围手术期护理工作。结果11例患者手术顺利,术后恢复良好,皮瓣全部成活,平均(4.5±0.7)d后I期愈合出院。术后未出现皮瓣感染、坏死等并发症。结论外阴肿瘤扩大切除与皮瓣修复术应做好患者术前准备、心理护理,术后做好皮瓣的观察,预防并发症,并加强健康宣教,指导患者加强营养及建立良好生活方式,其有利于患者手术顺利进行及促进患者术后恢复。

  3. Perioperative care to patients with extramammary Paget’s disease treated with resection of tumor of vulva expansion and flap repair%外阴肿瘤扩大切除与皮瓣修复术治疗乳房外Paget病患者围手术期的护理

    Institute of Scientific and Technical Information of China (English)

    陈少红; 陈海燕

    2013-01-01

    Objective To summarize perioperative points for nursing patients with extramammary Paget’s disease undergoing resection of tumor of vulva expansion and flap repair.Method Eleven patients with extramammary Paget’s disease were managed with resection of tumor of vulva expansion and flap repair,and with perioperative care as well.Results The tumors in all of the patients were removed completely and the flaps survived.All patients were discharged for hospitalization of(4.5±0.7)days.No flap infection or necrosis occurred.Conclusion The measures for nursing the patients with extramammary Paget’s disease undergoing resection of tumor of vulva expansion and flap repair may include preoperative preparation,mental care,postoperative observation of flaps, prevention of complications,health education,instruction on nutrition and formation of proper life style,which may be beneficial for the smooth manipulation of resection as well as for the postoperative rehabilitation.%  目的总结外阴肿瘤扩大切除与皮瓣修复术治疗乳房外Paget病患者围手术期的护理要点。方法给予11例乳房外Paget病患者实施外阴肿瘤扩大切除与皮瓣修复术,同时配合做好围手术期护理工作。结果11例患者手术顺利,术后恢复良好,皮瓣全部成活,平均(4.5±0.7)d后I期愈合出院。术后未出现皮瓣感染、坏死等并发症。结论外阴肿瘤扩大切除与皮瓣修复术应做好患者术前准备、心理护理,术后做好皮瓣的观察,预防并发症,并加强健康宣教,指导患者加强营养及建立良好生活方式,其有利于患者手术顺利进行及促进患者术后恢复。

  4. Anaesthetic Considerations in the Perioperative Management of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

    Science.gov (United States)

    Sheshadri, Deepak B; Chakravarthy, Murali R

    2016-06-01

    Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has emerged as one of the primary modalities of treatment of diffuse peritoneal malignancies. It is a complex surgical procedure with the patients facing major and potentially life threatening alterations of haemodynamic, respiratory, metabolic and thermal balance with significant fluid losses and the perioperative management is challenging for anaesthesiologists and intensive care physicians. Though the alterations are short lived, these patients require advanced organ function monitoring and support perioperatively. The anaesthesiologist is involved in the management of haemodynamics, respiratory function, coagulation, haematologic parameters, fluid balance, thermal variations, and metabolic and nutritional support perioperatively. The chemotherapy instillate used are known to cause nephrotoxicity, cardiotoxicity, dyselectrolytemia and lactic acidosis. The preoperative polypharmacy for pain control, previous surgery and/or chemotherapy, malnourished status secondary to feeding problems and tumour wasting syndrome make the task all the more challenging. The anaesthesiologist also needs to consider the perioperative care from a quality of life perspective and proper preoperative counselling is important. The present overview summarizes the challenges faced by the anaesthesiologist regarding the pathophysiological alterations during the Cytoreductive surgery and Hyperthermic intraperitoneal chemotherapy in the preoperative, intraoperative and postoperative periods. PMID:27065715

  5. Detrimental effects of perioperative blood transfusion

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen

    1995-01-01

    Evidence suggests that perioperative allogeneic blood transfusion increases the risk of infectious complications after major surgery and of cancer recurrence after curative operation. This has been attributed to immunosuppression. Several authors have suggested that filtered whole blood and/or red...... cell concentrate, or leucocyte- and buffy coat-reduced red cells in artificial medium or their own plasma, may reduce postoperative immunosuppression. It was also anticipated that the use of autologous blood might minimize the risk of perioperative transfusion, but studies have unexpectedly shown...

  6. The role of prophylactic antibiotics in preventing perioperative infection.

    Science.gov (United States)

    Setiawan, Budi

    2011-10-01

    With the increasing number of surgery or operation, perioperative infection has become one of problems that have been found more often. Surgical site infection is the most common perioperative infection causing increased hospitalization stay, high cost, morbidity and mortality rate. Infection occurs within 30 days after the operation on surgical site or within one year if implant is in place. Such infection may be prevented through several ways including some aspects of health-care provider, operating-room environment, and adequate preoperative preparation of the patients. Antibiotic prophylaxis is one of important modalities in preventing surgical site infection. Antibiotic prophylaxis administration significantly reduces the incidence of surgical site infection up to four-fold of decrease. Short-term antibiotic is given prior to incision in order to reduce the contamination of bacterial inoculums during surgery. The decision to administer antibiotic prophylaxis should be made by considering their risk and benefits. One of them includes utilization of the NNIS (National Nosocomial Infections Surveillance) score system, which considers three factors, such as wound class, ASA physical status scale, and duration of operation according to the NNIS Survey. The selection on timing and appropriately administered antibiotic prophylaxis is critical to maximize the benefits. PMID:22156360

  7. Perioperative pain management in hip arthroscopy; what options are there?

    Science.gov (United States)

    Bech, N H; Hulst, A H; Spuijbroek, J A; van Leuken, L L A; Haverkamp, D

    2016-08-01

    Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given. PMID:27583156

  8. Angioedema: Classification, management and emerging therapies for the perioperative physician

    Directory of Open Access Journals (Sweden)

    Lopa Misra

    2016-01-01

    Full Text Available Angioedema is a rare condition which manifests as sudden localised, non-pitting swelling of certain body parts including skin and mucous membranes. It is vital that anaesthesiologists understand this condition, as it may present suddenly in the perioperative period with airway compromise. To identify literature for this review, the authors searched the PubMed, Medline, Embase, Scopus and Web of Science databases for English language articles covering a 10-year period, 2006 through 2016. Angioedema can be either mast-cell mediated or bradykinin-induced. Older therapies for histaminergic symptoms are well known to anaesthesiologists (e.g., adrenaline, anti-histamines and steroids, whereas older therapies for bradykinin-induced symptoms include plasma and attenuated androgens. New classes of drugs for bradykinin-induced symptoms are now available, including anti-bradykinin, plasma kallikrein inhibitor and C1 esterase inhibitors. These can be used prophylactically or as rescue medications. Anaesthesiologists are in a unique position to coordinate perioperative care for this complex group of patients.

  9. Angioedema: Classification, management and emerging therapies for the perioperative physician.

    Science.gov (United States)

    Misra, Lopa; Khurmi, Narjeet; Trentman, Terrence L

    2016-08-01

    Angioedema is a rare condition which manifests as sudden localised, non-pitting swelling of certain body parts including skin and mucous membranes. It is vital that anaesthesiologists understand this condition, as it may present suddenly in the perioperative period with airway compromise. To identify literature for this review, the authors searched the PubMed, Medline, Embase, Scopus and Web of Science databases for English language articles covering a 10-year period, 2006 through 2016. Angioedema can be either mast-cell mediated or bradykinin-induced. Older therapies for histaminergic symptoms are well known to anaesthesiologists (e.g., adrenaline, anti-histamines and steroids), whereas older therapies for bradykinin-induced symptoms include plasma and attenuated androgens. New classes of drugs for bradykinin-induced symptoms are now available, including anti-bradykinin, plasma kallikrein inhibitor and C1 esterase inhibitors. These can be used prophylactically or as rescue medications. Anaesthesiologists are in a unique position to coordinate perioperative care for this complex group of patients. PMID:27601734

  10. CARE-HHH-APD Workshop on Finalizing the Roadmap for the Upgrade of the CERN and GSI Accelerator Complex

    CERN Document Server

    Zimmermann, Frank; BEAM'07; BEAM 2007; Finalizing the Roadmap for the Upgrade of the LHC and GSI Accelerator Complex

    2008-01-01

    This report contains the Proceedings of the CARE-HHH-APD Event BEAM’07, “Finalizing the Roadmap for the Upgrade of the CERN & GSI Accelerator Complex,” which was held at CERN in Geneva, Switzerland, from 1 to 5 October 2007. BEAM’07 was primarily devoted to beam dynamics limitations for the two, or three, alternative baseline scenarios of the LHC luminosity upgrade and to critical design choices for the upgrade of the LHC injector complex at CERN and for the FAIR complex at GSI. It comprised five parts: (1) a Mini-Workshop on LHC+ Beam Performance, (2) a CERN-GSI Meeting on Collective Effects, (3) the Francesco Ruggiero Memorial Symposium, (4) a Mini-Workshop on the LHC Injectors Upgrade, and (5) the BEAM’07 Summaries. Topics addressed in the first mini-workshop of BEAM’07 ranged from the luminosity performance reach of the upgraded LHC in different scenarios, over the generation and stability of the future LHC beams, the turnaround time, beam–beam effects, luminosity levelling methods, and ...

  11. Assistência ao paciente obeso mórbido submetido à cirurgia bariátrica: dificuldades do enfermeiro Asistencia al paciente obeso mórbido sometido a la cirugía bariátrica: dificultades del enfermero Perioperative care for morbid obese patient undergoing bariatric surgery: challenges for nurses

    Directory of Open Access Journals (Sweden)

    Denise Spósito Tanaka

    2009-10-01

    Full Text Available OBJETIVO: Identificar as dificuldades de enfermeiros de centro cirúrgico ao assistir pacientes obesos mórbidos submetidos à cirurgia bariátrica no período transoperatório. MÉTODOS: A amostra constou de 70 enfermeiros com experiência em assistência ao paciente obeso mórbido. Os dados foram coletados durante o 7º Congresso Brasileiro de Enfermeiros de Centro Cirúrgico, Recuperação Anestésica e Centro de Material e Esterilização por meio de um questionário. RESULTADOS: A análise dos resultados apontou como dificuldades aquelas relacionadas ao espaço físico, materiais e equipamentos e à assistência de enfermagem específica ao paciente obeso mórbido. CONCLUSÃO: O conhecimento específico, a especialização e a experiência em Centro Cirúrgico darão o conforto, a segurança física e emocional necessárias a estes pacientes.OBJETIVO: Identificar las dificultades de enfermeros de centro quirúrgico en el cuidado a pacientes obesos mórbidos sometidos a cirugía bariátrica en el período transoperatorio. MÉTODOS: La muestra constó de 70 enfermeros con experiencia en asistencia al paciente obeso mórbido. Los datos fueron recolectados por medio de un cuestionario durante el 7º Congreso Brasileño de Enfermeros de Centro Quirúrgico, Recuperación Anestésica y Centro de Material y Esterilización. RESULTADOS: El análisis de los resultados identificó como dificultades aquellas relacionadas al espacio físico, materiales y equipos y a la asistencia de enfermería específica al paciente obeso mórbido. CONCLUSIÓN: El conocimiento específico, la especialización y la experiencia en Centro Quirúrgico darán el confort, la seguridad física y emocional que necesitan estos pacientes.OBJECTIVE: To identify the challenges for nurses during the perioperative for patients undergoing bariatric surgery. METHODS: The sample consisted of 70 nurses who had experience in providing care for morbid obese patients. Data were collected

  12. Application Research of Peer-led Education on Psychological Care of Patients with Colostomy in Perioperative%同伴教育在围手术期结肠造口患者心理护理中的应用研究

    Institute of Scientific and Technical Information of China (English)

    金莉

    2014-01-01

    To evaluate the effect of perioperative patients with colostomy psychological impact by peer-led education. Firstly, eight postoperative patients with colostomy for many years and have rich experience were trained to become peer-led educators. A total of 40 cases of patients with colostomy were extracted which were assigned into a control group and an experimental group respectively. The control group was given psychological care and health guidance by the ward nurses. The experimental groups were given peer-led education on the basis of conventional nursing. The patients' psychosocial adaptation level before discharge was compared between the two groups. The patients' psychosocial adaptation level of experimental group is higher than the control group (P < 0.01), significant difference was statistically significant. The implementation of peer-led education can provide psychological support for the perioperative patients with colostomy and improve the level of its social psychological adaptation.%探讨同伴教育对围手术期结肠造口患者心理的影响。首先选取8例行造口术后多年并有丰富经验的患者,经培训合格后成为同伴教育者。抽取行结肠造口术的患者共40例分别放在对照组和试验组。对照组由病区护理人员给予心理护理及健康指导。试验组在常规护理基础上再选择同伴教育。出院前,评估两组患者的社会心理适应水平。试验组社会心理适应水平高于对照组(P<0.01),差异显著,有统计学意义。实施同伴教育可为围手术期结肠造口患者提供心理支持,提高其社会心理适应水平。

  13. Relacionamento terapêutico com criança no período perioperatório: utilização do brinquedo e da dramatização Relación terapéutica com el nino en el período perioperatorio Therapeutic relationship with child in perioperative nursing care

    Directory of Open Access Journals (Sweden)

    Fabiana Faleiros

    2002-03-01

    Full Text Available Este estudo de caso tem o objetivo de analisar o relacionamento terapêutico desenvolvido entre aluna de enfermagem e uma criança de 3 anos , durante o período perioperatório, utilizando o brinquedo e a dramatização para facilitar a explicação dos procedimentos e dos objetos do hospital para a criança.Ouso do brinquedo mostrou-se uma forma adequada para comunicar-se efetivamente com a criança, e para prepará-la para a intervenção cirúrgica, pois, através da dramatização, ela participou ativamente dos procedimentos, mostrando que compreendia e aceitava o que estava acontecendo,nãoapresentando em nenhum momento medo ou ansiedade diante do ambiente do hospital e dos procedimentos cirúrgicos. Ao final do relacionamento, a mãe e a equipe cirúrgica avaliaram positivamente o preparo da criança para a cirurgia.El presente estudio tiene como finalidad analizar el proceso de relación terapéutica entre alumna de enfermería y una niña de 3 años de edad durante el período perioperatorio. Utilizando técnicas de comunicación terapéutica y medidas terapéuticas de enfermería, la alumna desarrolló empatía con la niña y su madre, proponiendo ayudarlas a superar sus dificultades frente sus miedos y ansiedad debida ala hospitalización y cirugia. La madre y equipo cirúgica han evaluado la preparación para la cirugia positivamente.The purpose of this study was to analyse the therapeutic relationship between a nursing student and a 3 years old child during perioperative period . Through the use of careful development assessments, preoperative tours, and therapeutic play techniques her fears and anxiety because of hospitalization and surgery were reduced and the surgical experience was lived by the child in a constructive manner. Parents and peri-operative team have evaluated positively the preparation and assessment of the child for surgery.

  14. Periop erative treatment of liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Shengbin Zhang ∗; Rui Liu; Shipeng Song; Weiqing Wang; Jin Zhao; Xiaoshi Dong

    2014-01-01

    A case of liver transplantation in the department of general surgery of the third affiliated hospital of Inner Mongolia medical school was collected and analyzed on the basis of diagnosis, physical examination and treatment. Liver transplantation was very complicated, accompanied by various postoperative complications. So this paper aims to share experience of perioperative management of liver transplantation among physicians.

  15. Perioperative contamination in primary total hip arthroplasty

    NARCIS (Netherlands)

    Maathuis, PGM; Neut, D; Busscher, HJ; van der Mei, HC; van Horn, [No Value

    2005-01-01

    All surgical procedures have the risk of microbial contamination. However, procedures in which prosthetic materials are involved have a high risk for future infectious problems because of the protection offered by the biofilm mode of growth. Studies of perioperative contamination have been done on i

  16. Perioperative nursing for laparoscopic liver resection

    Institute of Scientific and Technical Information of China (English)

    CHEN Li-jia; WEN Guo-fen

    2005-01-01

    Sir Run Run Shaw Hospital (SRRSH) has developed a form of laparoscopic hepatectomy, resecting by curettage and suction. Such resection has been carried out successfully in 6 patients who had liver tumors. The results are satisfactory. And after the operation, there is a very effective perioperative nursing ensuring the patient's recovery.

  17. Perioperative Glucose Control in Neurosurgical Patients

    Directory of Open Access Journals (Sweden)

    Daniel Agustín Godoy

    2012-01-01

    Full Text Available Many neurosurgery patients may have unrecognized diabetes or may develop stress-related hyperglycemia in the perioperative period. Diabetes patients have a higher perioperative risk of complications and have longer hospital stays than individuals without diabetes. Maintenance of euglycemia using intensive insulin therapy (IIT continues to be investigated as a therapeutic tool to decrease morbidity and mortality associated with derangements in glucose metabolism due to surgery. Suboptimal perioperative glucose control may contribute to increased morbidity, mortality, and aggravate concomitant illnesses. The challenge is to minimize the effects of metabolic derangements on surgical outcomes, reduce blood glucose excursions, and prevent hypoglycemia. Differences in cerebral versus systemic glucose metabolism, time course of cerebral response to injury, and heterogeneity of pathophysiology in the neurosurgical patient populations are important to consider in evaluating the risks and benefits of IIT. While extremes of glucose levels are to be avoided, there are little data to support an optimal blood glucose level or recommend a specific use of IIT for euglycemia maintenance in the perioperative management of neurosurgical patients. Individualized treatment should be based on the local level of blood glucose control, outpatient treatment regimen, presence of complications, nature of the surgical procedure, and type of anesthesia administered.

  18. 临床路径结合中医理念在腰椎间盘突出症患者围术期护理中的应用%Application of clinical pathway combined with tradional Chinese Medicine on perioperative nursing care forpatients with lumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    崔爱评; 贺建华; 李雪梅; 巩向丽

    2014-01-01

    Object To explore the influence of clinical pathway combined with tradional Chinese Medicine on perioperative nursing care for patients with lumbar disc herniation in order to improve the quality of postoperative recovery. Methods 120 cases of patients with lumbar disc herniation surgery were randomly divided into experimental group and control group, each group of 60 patients. the patients in control group were given conventional treatment with the perioperative nurising care, while patients in the experimental group were given care with model of clinical pathway combined with traditional chinese medicine. the lumbar disc herniation clinical symptom scores were observed and recorded including Joa scale score, average hospitalization days, the satisfaction of nursing care, nursing complaint rate, the condition of complications and the acquisition of health knowledge. Results the Joa scores of the experimental group was higher than that of the control group (P<0.05), and the difference was statistically significant. The satisfaction of nursing staff and the acquisition of health knowledge in the experimental group were both higher than that in the control group (P<0.05). the average hospitalization days in the experimental group were lower than that in the control group (P<0.05), and the difference was statistically significant. The nursing complaints rate of experimental group was significantly lower than that of the control group. Conclusion the implementation of clinical pathway combined with tradional chinese Medicine in patients with lumbar disc herniation, can shorten the hospitalization days, and improve the nursing quality and efficiency. it has important implications for clinical practice.%目的:探讨临床路径结合中医理念对腰椎间盘突出症患者围术期护理的影响,以期提高患者术后恢复质量。方法将120例腰椎间盘突出症手术患者随机分为试验组和对照组,每组60例,对照组给予围手术期院

  19. [Disease-related malnutrition and its influence on perioperative outcome].

    Science.gov (United States)

    Grecu, Irina; Grinţescu, Ioana; Tulbure, D

    2007-01-01

    Disease-related malnutrition is highly prevalent among surgical patients and has important deleterious effects on postoperative outcome: increased complications rate, length of hospital stay, mortality and costs. Malnutrition (equivalent with undernutrition in the surgical patients) can be present already on admission, could rapidly develop or aggravate during hospital stay. The determination of malnutrition in this high-risk group of patients in multifactorial: decreased intake (anorexia, gastrointestinal symptoms, prolonged perioperative fasting) and increased demands (hyper-catabolism due to underlying disease, surgical stress, eventual postoperative complications). The identification of patients at nutritional risk by screening on admission and whenever the patient situation changes throughout hospitalization is the first, mandatory step for developing an accurate nutritional care plan in these patients, in order to positively influence postoperative outcome.

  20. Similar clinical outcome after unicompartmental knee arthroplasty using a conventional or accelerated care program: a randomized, controlled study of 40 patients

    DEFF Research Database (Denmark)

    Borgwardt, Lotte; Zerahn, Bo; Bliddal, Henning;

    2009-01-01

    BACKGROUND AND PURPOSE Over the last 5 years, there has been increasing interest in reducing length of hospitalization (LOS) through accelerated programs. We examined the clinical outcome of patients undergoing a unicompartmental knee replacement (UKR) in an accelerated care program (A group......) compared to a conventional care program (C group). METHODS: 40 patients randomized into 2 groups were included (A group: 17 patients; C group: 23 patients). Nausea, micturition problems, lower limb dysfunction, pain (VAS), opiate consumption, Knee Society score (KSS), day of discharge, rehospitalization....... Patients in the A program were treated with NSAID and paracetamol postoperatively. Opiates were used in both groups in the case of breakthrough pain. The patients were considered ready for discharge when they were able to climb stairs to the second floor within 5 min. RESULTS: The median length of stay...

  1. Perioperative intensive insulin therapy using artificial endocrine pancreas in patients undergoing pancreatectomy

    OpenAIRE

    Maeda, Hiromichi; Okabayashi, Takehiro; Yatabe, Tomoaki; Yamashita, Koichi; Hanazaki, Kazuhiro

    2009-01-01

    Perioperative glycemic control is important for reducing postoperative infectious complications. However, clinical trials have shown that efforts to maintain normoglycemia in intensive care unit patients result in deviation of glucose levels from the optimal range, and frequent attacks of hypoglycemia. Tight glycemic control is even more challenging in those undergoing pancreatic resection. Removal of lesions and surrounding normal pancreatic tissue often cause hormone deficiencies that lead ...

  2. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    Directory of Open Access Journals (Sweden)

    Kaye AD

    2014-05-01

    Full Text Available Alan David Kaye,1 Olutoyin J Okanlawon,2 Richard D Urman21Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston MA, USAAbstract: Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care.Keywords: physician education, outcomes measurement, performance improvement, anesthesiology

  3. Accelerated baccalaureate nursing students use of emotional intelligence in nursing as "caring for a human being": a mixed methods grounded theory study.

    Science.gov (United States)

    Ball, Lisa Sherry

    2013-11-30

    Accelerated nursing students are ideal informants regarding abstract nursing concepts. How emotional intelligence (EI) is used in nursing remains a relatively elusive process that has yet to be empirically modeled. The purpose of this study was to generate a theoretical model that explains how EI is used in nursing by accelerated baccalaureate nursing students. Using a mixed methods grounded theory study design, theoretical sampling of EI scores directed sampling for individual interviews and focus groups. Caring for a human being emerged as the basic social process at the heart of which all other processes--Getting it; Being caring; The essence of professional nurse caring; Doing something to make someone feel better; and Dealing with difficulty--are interconnected. In addition to a theoretical explanation of the use of EI in nursing, this study corroborates findings from other qualitative studies in nursing and contributes a rich description of accelerated baccalaureate nursing students and an example of a mixed methods study design to the small but growing literature in these areas.

  4. Perioperative modifications of respiratory function.

    LENUS (Irish Health Repository)

    Duggan, Michelle

    2012-01-31

    Postoperative pulmonary complications contribute considerably to morbidity and mortality, especially after major thoracic or abdominal surgery. Clinically relevant pulmonary complications include the exacerbation of underlying chronic lung disease, bronchospasm, atelectasis, pneumonia and respiratory failure with prolonged mechanical ventilation. Risk factors for postoperative pulmonary complications include patient-related risk factors (e.g., chronic obstructive pulmonary disease (COPD), tobacco smoking and increasing age) as well as procedure-related risk factors (e.g., site of surgery, duration of surgery and general vs. regional anaesthesia). Careful history taking and a thorough physical examination may be the most sensitive ways to identify at-risk patients. Pulmonary function tests are not suitable as a general screen to assess risk of postoperative pulmonary complications. Strategies to reduce the risk of postoperative pulmonary complications include smoking cessation, inspiratory muscle training, optimising nutritional status and intra-operative strategies. Postoperative care should include lung expansion manoeuvres and adequate pain control.

  5. Perioperative Variables Contributing to the Rupture of Intracranial Aneurysm: An Update

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2013-01-01

    Full Text Available Background. Perioperative aneurysm rupture (PAR is one of the most dreaded complications of intracranial aneurysms, and approximately 80% of nontraumatic SAHs are related to such PAR aneurysms. The literature is currently scant and even controversial regarding the issues of various contributory factors on different phases of perioperative period. Thus this paper highlights the current understanding of various risk factors, variables, and outcomes in relation to PAR and try to summarize the current knowledge. Method. We have performed a PubMed search (1 January 1991–31 December 2012 using search terms including “cerebral aneurysm,” “intracranial aneurysm,” and “intraoperative/perioperative rupture.” Results. Various risk factors are summarized in relation to different phases of perioperative period and their relationship with outcome is also highlighted. There exist many well-known preoperative variables which are responsible for the highest percentage of PAR. The role of other variables in the intraoperative/postoperative period is not well known; however, these factors may have important contributory roles in aneurysm rupture. Preoperative variables mainly include natural course (age, gender, and familial history as well as the pathophysiological factors (size, type, location, comorbidities, and procedure. Previously ruptured aneurysm is associated with rupture in all the phases of perioperative period. On the other hand intraoperative/postoperative variables usually depend upon anesthesia and surgery related factors. Intraoperative rupture during predissection phase is associated with poor outcome while intraoperative rupture at any step during embolization procedure imposes poor outcome. Conclusion. We have tried to create such an initial categorization but know that we cannot scale according to its clinical importance. Thorough understanding of various risk factors and other variables associated with PAR will assist in better

  6. Detrimental effects of perioperative blood transfusion

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen

    1995-01-01

    Evidence suggests that perioperative allogeneic blood transfusion increases the risk of infectious complications after major surgery and of cancer recurrence after curative operation. This has been attributed to immunosuppression. Several authors have suggested that filtered whole blood and/or red...... cell concentrate, or leucocyte- and buffy coat-reduced red cells in artificial medium or their own plasma, may reduce postoperative immunosuppression. It was also anticipated that the use of autologous blood might minimize the risk of perioperative transfusion, but studies have unexpectedly shown...... similar postoperative infectious complications and cancer recurrence and/or survival rates in patients receiving autologous blood donated before operation and those receiving allogeneic blood. Future studies should identify common risk factors associated with blood storage....

  7. Perioperative Nerve Blockade: Clues from the Bench

    Directory of Open Access Journals (Sweden)

    M. R. Suter

    2011-01-01

    Full Text Available Peripheral and neuraxial nerve blockades are widely used in the perioperative period. Their values to diminish acute postoperative pain are established but other important outcomes such as chronic postoperative pain, or newly, cancer recurrence, or infections could also be influenced. The long-term effects of perioperative nerve blockade are still controversial. We will review current knowledge of the effects of blocking peripheral electrical activity in different animal models of pain. We will first go over the mechanisms of pain development and evaluate which types of fibers are activated after an injury. In the light of experimental results, we will propose some hypotheses explaining the mitigated results obtained in clinical studies on chronic postoperative pain. Finally, we will discuss three major disadvantages of the current blockade: the absence of blockade of myelinated fibers, the inappropriate duration of blockade, and the existence of activity-independent mechanisms.

  8. Perioperative lung protective ventilation in obese patients

    OpenAIRE

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F.; Repine, John E.

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increa...

  9. Contribution of perioperative imaging to radioguided surgery

    International Nuclear Information System (INIS)

    Radioguided surgery has been investigated and applied to almost any neoplastic disease that is surgically treated. The impact of radioguided surgery on the surgical management of cancer patients includes relevant and real-time information to the surgeon regarding the location and extent of the disease, as well as regarding the assessment of surgical resection margins. Despite the fact that sentinel lymph node biopsy has been worldwide accepted as a highly accurate staging method for various solid cancers (among which breast cancer and cutaneous melanoma), some potential intraoperative drawbacks still remain. This article provides an update on currently available perioperative techniques regarding the use of radiotracers for radioguided surgery and sentinel lymph node mapping and biopsy, in particular in combination with vital dyes or other agents. The integration of computer technology and data processing makes it possible to integrate anatomic and functional images together with 3D rendering systems. This facilitates the targeted-tissue perioperative localization, especially in anatomically complex areas. Furthermore, we provide an update on advances in the integration of intraoperative imaging devices as well as optical tracers for the surgical management of patients. Evidence is emerging that these devices, together with new potential tracers, may improve intraoperative identification of sentinel nodes and/or tumors. A detailed presentation on a portable gamma camera in breast cancer patients, and the application of perioperative imaging devices in gynaecological cancers are included. Other important procedures, such as ROLL and RSL for occult lesion excision in the breast and other organs, are extensively discussed

  10. Making a difference: using the safe surgery checklist to initiate continuing education for perioperative nurses in low-income settings.

    Science.gov (United States)

    Leifso, Genelle

    2014-03-01

    The WHO Safe Surgery Checklist (2008) patient safety focus and communication prompts are widely accepted. In many low-income regions (as defined by the World Bank and accepted by the World Health Organization) perioperative nurses have little or no formal training; continuing and in-service education are virtually unknown; nor does an articulated "culture of safety" exist. In 2009 the Canadian Network for International Surgery (CNIS) piloted a two-day perioperative nursing course, in Addis Ababa, Ethiopia, using lectures, case studies, skills sessions, and role-play exercises based on the SSSL Checklist outline and protocols. Canadian instructors (who are certified after taking the Canadian Network for International Surgery-sponsored Instructor's Course) have since returned and taught at additional sites in Ethiopia and Uganda. Course participants now include perioperative nurses, anaesthetists, and junior surgical residents--mirroring the interdisciplinary teamwork that is crucial to safe perioperative patient care. The course's facilitated discussions focus on workplace and practice issues in order to allow for appropriate evaluation and planning of future educational initiatives. Participants complete pre- and post-course questionnaires, which evaluate baseline and post-course knowledge, and further follow-up is completed four months after course completion. This article explains the need for aiding in the expansion of perioperative nursing knowledge and skill in low-income settings and provides the author's personal perspective and experience in responding to this need. Her experience as facilitator in a pilot project and subsequent course development described. The objective is to discuss ways that other perioperative nurses can work to make a positive difference on professional practice and patient care in low-income regions. PMID:24791444

  11. Strategies for decreasing patient anxiety in the perioperative setting.

    Science.gov (United States)

    Bailey, Laila

    2010-10-01

    Perioperative patient anxiety is a pervasive problem that can have far-reaching effects. Among these effects are increased postoperative pain, increased risk for infection, and longer healing times. Many factors affect perioperative patient anxiety, including the need for surgery, perceived loss of control, fear of postoperative pain, and alteration of body image. This systematic review of current literature was undertaken to identify evidence-based interventions for decreasing patient anxiety in perioperative practice. According to the current research literature, perioperative education and music therapy can be used to successfully reduce surgical patients' anxiety. PMID:20888947

  12. Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review

    Science.gov (United States)

    Opperer, Mathias; Danninger, Thomas; Stundner, Ottokar; Memtsoudis, Stavros G

    2014-01-01

    Over the last decades the demand for hip surgery, be it elective or in a traumatic setting, has greatly increased and is projected to expand even further. Concurrent with demographic changes the affected population is burdened by an increase in average comorbidity and serious complications. It has been suggested that the choice of anesthesia not only affects the surgery setting but also the perioperative outcome as a whole. Therefore different approaches and anesthetic techniques have been developed to offer individual anesthetic and analgesic care to hip surgery patients. Recent studies on comparative effectiveness utilizing population based data have given us a novel insight on anesthetic practice and outcome, showing favorable results in the usage of regional vs general anesthesia. In this review we aim to give an overview of anesthetic techniques in use for hip surgery and their impact on perioperative outcome. While there still remains a scarcity of data investigating perioperative outcomes and anesthesia, most studies concur on a positive outcome in overall mortality, thromboembolic events, blood loss and transfusion requirements when comparing regional to general anesthesia. Much of the currently available evidence suggests that a comprehensive medical approach with emphasis on regional anesthesia can prove beneficial to patients and the health care system. PMID:25035837

  13. Peri-operative treatment of most severely head-injured patients

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To summarize the peri-operative experience from 53patients with traumatic head injuries with GCS score 3-5.Methods: Fifty-three most severely head-injured patients with GCS score 3-5 were admitted to our department and treated operatively from Oct. 1994 to Jun. 1998 and the data were analyzed retrospectively. Results: Thirty-seven cases (69.8%) survived, among them 28 (52.8%) had a good recovery or moderate disability, and 9 (17%) had severe deficits. The other 16 (30.2%) died after therapy.Conclusions: The prognosis of most severely head-injured patients could be improved by peri-operative treatment including premedical care, early evacuation of intracranial hematoma with large decompressive craniectomies, intracranial hypertension monitoring, moderate hypothermia therapy, effective prevention and treatment of cerebral vasospasm and complications.

  14. Maintaining Perioperative Normothermia: Sustaining an Evidence-Based Practice Improvement Project.

    Science.gov (United States)

    Levin, Rona F; Wright, Fay; Pecoraro, Kathleen; Kopec, Wendy

    2016-02-01

    Unintentional perioperative hypothermia has been shown to cause serious patient complications and, thus, to increase health care costs. In 2009, an evidence-based practice improvement project produced a significant decrease in unintentional perioperative hypothermia in colorectal surgical patients through monitoring of OR ambient room temperature. Project leaders engaged all interdisciplinary stakeholders in the original project, which facilitated the sustainability of the intervention method. An important aspect of sustainability is ongoing monitoring and evaluation of a new intervention method. Therefore, continued evaluation of outcomes of the protocol developed in 2009 was scheduled at specific time points after the initial small test of change with colorectal patients. This article focuses on how attention to sustainability factors during implementation of an improvement project led to the sustainability of a protocol for monitoring OR ambient room temperature with all types of surgical patients five years after the initial project.

  15. Liver Transplant From Unexpected Donation After Circulatory Determination of Death Donors: A Challenge in Perioperative Management.

    Science.gov (United States)

    Blasi, A; Hessheimer, A J; Beltrán, J; Pereira, A; Fernández, J; Balust, J; Martínez-Palli, G; Fuster, J; Navasa, M; García-Valdecasas, J C; Taurá, P; Fondevila, C

    2016-06-01

    Unexpected donation after circulatory determination of death (uDCD) liver transplantation is a complex procedure, in particular when it comes to perioperative recipient management. However, very little has been published to date regarding intraoperative and immediate postoperative care in this setting. Herein, we compare perioperative events in uDCD liver recipients with those of a matched group of donation after brain death liver recipients. We demonstrate that the former group of recipients suffers significantly greater hemodynamic instability and derangements in coagulation following graft reperfusion. Based on our experience, we recommend a proactive recipient management strategy in uDCD liver transplantation that involves early use of vasopressor support; maintaining adequate intraoperative levels of red cells, platelets, and fibrinogen; and routinely administering tranexamic acid before graft reperfusion. PMID:26601629

  16. Acerto pós-operatório: avaliação dos resultados da implantação de um protocolo multidisciplinar de cuidados peri-operatórios em cirurgia geral Acerto project: outcome evaluation after the implementation of a multidisciplinary protocol of peri-operative care in general surgery

    Directory of Open Access Journals (Sweden)

    José Eduardo de Aguilar-Nascimento

    2006-06-01

    Full Text Available OBJETIVO: O objetivo do presente estudo foi avaliar os resultados clínicos iniciais após a implementação do projeto Acerto Pós-operatório (ACERTO em pacientes operados num serviço universitário de cirurgia geral. MÉTODO: 161 pacientes foram prospectivamente observados durante dois períodos: o primeiro, entre janeiro a junho de 2005 (n=77 formado por pacientes submetidos a condutas convencionais (período PRÉ-ACERTO e o segundo, entre agosto a dezembro de 2005 (n=84, formado por pacientes submetidos a um novo protocolo de condutas peri-operatório estabelecidas pelo projeto ACERTO (período PÓS-ACERTO. A coleta de dados nos dois períodos ocorreu sem o conhecimento dos profissionais do serviço. As variáveis observadas foram: indicação de suporte nutricional pré-operatório, tempo de jejum pré e pós operatório, volume de hidratação, uso de sondas e drenos, tempo de internação e morbidade pós-operatória. RESULTADOS: Na fase pós-ACERTO, o percentual de pacientes desnutridos que receberam suporte nutricional foi trêsês vezes maior (78,6%; 11/14 vs. 23,5%; 4/17; p BACKGROUND: The aim of this study was to evaluate the initial results after the implementation of the ACERTO project in patients submitted to abdominal operations at the Julio Muller Universitary Hospital. METHODS: 161 consecutive patients were studied in two different periods: from January to July 2005 and from August to December 2005 (n=84; POST-ACERTO phase. The patients received either traditional peri-operative management (n=77; PRE-ACERTO phase or a multidisciplinary protocol of peri-operative care (n=84; POST-ACERTO phase established by the ACERTO project. During both periods, the surgical staff was unaware of the prospective data collection. RESULTS: The number of malnourished patients receiving pre-operative nutritional support was higher after the implementation of the project (78.6%; 11/14 vs. 23.5%; 4/17; p <0.01.This second phase was associated with

  17. TRALI in the perioperative period

    Directory of Open Access Journals (Sweden)

    Berdai MA

    2014-07-01

    Full Text Available Mohamed Adnane Berdai, Smael Labib, Mustapha HarandouChild and Mother Intensive Care Unit, University Hospital Hassan II, Fes, MoroccoBackground: Transfusion-related acute lung injury (TRALI is one of the leading causes of transfusion-related morbidity and mortality. Although it is a serious complication of blood transfusion, it is still underestimated because of underrecognition and misdiagnosis, which can lead to inappropriate management.Case report: We report the case of a 34-year-old female, who presented with hemorrhagic shock during cesarean section and was transfused with packed red blood cells and fresh frozen plasma. Three hours after the end of transfusion, while still intubated, the patient developed acute respiratory failure, with diffuse crackles at auscultation and bilateral lung infiltrations on chest radiography. The ratio of the arterial partial pressure of O2 and the fraction of inspired O2 (PaO2/FiO2 was 51. The diagnosis of TRALI was made after excluding other possible causes of acute lung injury. She was managed symptomatically with ventilatory support and vasopressors. The patient later died secondary to multiple organ failure.Conclusion: The diagnosis of TRALI relies on the exclusion of other causes of acute pulmonary edema following transfusion. All plasma-containing blood products have been involved in the genesis of this syndrome. This is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management. Challenges are ahead as preventive strategies have reduced but not eliminated the onset of TRALI.Keywords: acute lung injury, transfusion related acute lung injury, anti-human leukocyte antigen antibody, pulmonary edema, transfusion accident

  18. Perioperative interstitial brachytherapy for recurrent keloid scars

    International Nuclear Information System (INIS)

    Purpose: Evaluation of the results of perioperative interstitial brachytherapy with low dose-rate (L.D.R.) Ir-192 in the treatment of keloid scars. Patients and methods: We performed a retrospective analysis of 73 histologically confirmed keloids (from 58 patients) resistant to medico surgical treated by surgical excision plus early perioperative brachytherapy. All lesions were initially symptomatic. Local control was evaluated by clinical evaluation. Functional and cosmetic results were assessed in terms of patient responses to a self-administered questionnaire. Results: Median age was 28 years (range 13-71 years). Scars were located as follows: 37% on the face, 32% on the trunk or abdomen, 16% on the neck, and 15% on the arms or legs. The mean delay before loading was four hours (range, 1-6 h). The median dose was 20 Gy (range, 15-40 Gy). Sixty-four scars (from 53 patients) were evaluated. Local control was 86% (follow-up, 44.5 months; range, 14-150 months). All relapses occurred early within 2 years posttreatment. At 20 months, survival without recurrence was significantly lower when treated lengths were more than 6 cm long. The rate was 100% for treated scars below 4.5 cm in length, 95% (95% CI: 55-96) for those 4.5-6 cm long, and 75% (95% CI: 56-88) beyond 6 cm (p = 0.038). Of the 35 scars (28 patients) whose results were reassessed, six remained symptomatic and the esthetic results were considered to be good in 51% (18/35) and average in 37% (13/35) (median follow-up, 70 months; range, 16-181 months). Conclusion: Early perioperative L.D.R. brachytherapy delivering 20 Gy at 5 mm reduced the rate of recurrent keloids resistant to other treatments and gave good functional results. (authors)

  19. Effect of perioperative insulin infusion on surgical morbidity and mortality

    DEFF Research Database (Denmark)

    Gandhi, Gunjan Y; Murad, M Hassan; Flynn, Errol David;

    2008-01-01

    To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients.......To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients....

  20. Perioperative beta blockers in patients having non-cardiac surgery

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi;

    2008-01-01

    American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidenc...

  1. [Perioperative disorders of mental functions].

    Science.gov (United States)

    Tonković, Dinko; Adam, Visnja Nesek; Kovacević, Marko; Bogović, Tajana Zah; Drvar, Zeljko; Baronica, Robert

    2012-03-01

    Mental disorders are characterized by disturbances of thought, perception, affect and behavior, which occur as a result of brain damage. Recognizing and treating these conditions is necessary not only for psychiatrists but for all physicians. Disorder of mental function is one of the most common associated conditions in intensive care unit (ICU) patients. However, disturbances of mental function often remain unrecognized. In ICU patients, different types of mental function disorders may develop. They range from sleep disorders, severe depression, anxiety, posttraumatic stress disorder (PTSD) to cognitive disorders including delirium. The causes of mental dysfunction in ICU patients can be divided into environmental and medical. Cognitive disorders are related to mental processes such as learning ability, memory, perception and problem solving. Cognitive disorders are usually not prominent in the early postoperative period and in many cases are discovered after hospital discharge because of difficulties in performing everyday activities at home or at work. The etiology of postoperative cognitive impairment is unclear. Older age, previous presence of cognitive dysfunction, severity of disease, and polypharmacy with more than four drugs are some of the risk factors identified. Delirium is a multifactorial disorder. It is an acute confusional state characterized by alteration of consciousness with reduced ability to focus, sustain, or shift attention. It is considered as the most common form of mental distress in ICU patients. Nearly 30% of all hospitalized patients pass through deliriant phase during their hospital stay. Delirium can last for several days to several weeks. Almost always it ends with complete withdrawal of psychopathological symptoms. Sometimes it can evolve into a chronic brain syndrome (dementia). The causes are often multifactorial and require a number of measures to ease the symptoms. Delirious patient is at risk of complications of immobility and

  2. Performance improvement in the perioperative system.

    Science.gov (United States)

    Brooks, Kathleen V; Krupka, Dan C

    2012-12-01

    Hospital finance leaders should work with their organizations' perioperative leaders to implement a three-step process for identifying projects with the greatest potential for improving quality while reducing costs and increasing revenue. In essence, this process involves mapping the strategy, developing a list of potential projects, and culling projects that cannot reasonably be accomplished with available resources. The extent to which staff resources are available for such projects can best be measured using a simple spreadsheet designed for tracking special assignments of each staff member.

  3. [Use of clonidine for perioperative therapy].

    Science.gov (United States)

    Fidziańska-Długosz, E

    1998-01-01

    Clonidine is a selective alpha 2 adrenergic receptors agonist with a wide spectrum of activity. Except well known hypotensive effect, clonidine stabilizes circulatory system and has sedative, anxiolytic, analgesic, diuretic etc. activities. Clonidine has some appliance during perioperative period. When used in premedication it has a lot of advantages: causes sedation, has anxiolytic properties, reduces secretion of saliva, stabilizes circulatory system, diminishes stress reaction, augments action of anaesthetic and analgesic drugs. When used during the operation, regulates circulatory system, prolongs and amplifies central and peripheral blocks. Clonidine diminishes patients requirement for opioids and local anaesthetics during postoperative and long-term pain therapy.

  4. [Perioperative conflicts between anaesthesiologists and surgeons: ethics and professionalism].

    Science.gov (United States)

    Bazin, J-E; Attias, A; Baghdadi, H; Baumann, A; Bizouarn, P; Claudot, F; Eon, B; Fieux, F; Frot, C; Guibet Lafaye, C; Muzard, O; Nicolas-Robin, A; Orjubin, V; Otero-Lopez, M; Pelluchon, C; Pereira, J; Roussin, F; Vigué, B; Beydon, L

    2014-05-01

    In the perioperative period, several potential conflicts between anaesthetists/intensive care specialists and surgeons may exist. They are detrimental to the quality of patient care and to the well-being of the teams. They are a source of medical errors and contribute to burn-out. Patients can become the victims of such conflicts, which deserve ethical reflection. Their resolution through analysis and shared solutions is necessary. This article seeks to analyse these conflicts, taking into account their specificities and constraints. In order to understand this context, it is important to consider the specificities of each group involved and the records of such situations. Several factors can prevent these conflicts, first and foremost the patients themselves and the quality of the care that is provided. Medical deontology aims mainly at preventing and resolving these conflicts. Generally speaking, the quality approach which is increasingly applied in health care institutions (involving declarations of adverse events, morbidity/mortality reviews, benchmarking, analysis and improvement of practices, etc.) also contributes to the prevention and resolution of disagreements. The teaching of communication techniques that begins with the initial training, the evaluation of team behaviours (through simulation training for example), the respect of others' constraints, particularly when it comes to learning, as well as transparency regarding conflicts of interests, are all additional elements of conflict prevention. Lastly, conflicts may at times be caused by deviant behaviours, which must be met with a clear and uncompromising collective and institutional approach. This article concludes by offering a standardised approach for conflict resolution. PMID:24821342

  5. Perioperative Vision Loss in Spine Surgery and Other Orthopaedic Procedures.

    Science.gov (United States)

    Su, Alvin W; Lin, Shuai-Chun; Larson, A Noelle

    2016-10-01

    Perioperative vision loss is a rare complication of orthopaedic surgery and has been documented after spine, knee, hip, and shoulder procedures. It is associated with several ophthalmologic diagnoses, most commonly ischemic optic neuropathy. Although the pathophysiology remains unclear, current evidence suggests that systemic hemodynamic compromise and altered balance of intraocular perfusion contribute to the development of ischemic optic neuropathy. Although vision recovery has been reported, the prognosis of perioperative vision loss is poor, and no proven effective treatment is available. Perioperative vision loss is unpredictable and can occur in healthy patients. Associated risk factors include pediatric or elderly age, male sex, obesity, anemia, hypotension or hypertension, perioperative blood loss, prolonged surgical time, and prone positioning. Preventive strategies include avoiding direct pressure to the eye, elevating the head, optimizing perioperative hemodynamic status, and minimizing surgical time with staged surgical procedures as appropriate.

  6. Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

    Directory of Open Access Journals (Sweden)

    Miguel L. Tedde

    2012-11-01

    Full Text Available OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.

  7. 16 Cases of Depression in Patients with Free Tissue Flap to Repair Facial Defects Perioperative Care%16例抑郁患者行游离组织瓣移植修复颌面部缺损的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    任凌; 易力; 陶秀健

    2015-01-01

    Objective To investigate 16 cases underwent preoperative assessment of depression free tissue flap to repair facial defects perioperative care. Methods Zung's Self-Rating Depression Scale (SDS), on the admission of patients to do screening for depressive symptoms in caregivers of patients given nursing intervention. Results In 16 cases,Preoperative evaluation of patients with severe depression score of 51,Assessment score the remaining 15 patients were lower than 50 ,Free flap transplantation in 16 patients were successful,The average hospitalization time 16.7 days and discharged the functions of the patients were able to meet the basic needs of life. Conclusion Think before surgery, timely and effective psychological interventions, wel prepared, after close observation, rational functional training is the key to successful operation.%目的:探讨16例术前评估抑郁患者行游离组织瓣移植修复颌面部缺损的围手术期护理。方法应用 Zung 氏抑郁自评量表(SDS),对入院患者做筛查,护理人员针对有抑郁症状的患者给予护理干预。结果16例患者除术前评估为重度抑郁的患者得分为51分外,其余15例患者的评估得分均低于50分。16例患者游离移植皮瓣均成活,平均住院天数为16.7天,出院时各项功能均能满足基本生活需要。结论认为术前、术后及时有效的心理干预、充分的准备,术后密切的观察,合理的功能训练是手术成功的关键。

  8. Clinical implication of perioperative inflammatory cytokine alteration.

    Science.gov (United States)

    Hsing, Chung-Hsi; Wang, Jhi-Joung

    2015-03-01

    Cytokines are key modulators of inflammatory responses, and play an important role in the defense and repair mechanisms following trauma. After traumatic injury, an immuno-inflammatory response is initiated immediately, and cytokines rapidly appear and function as a regulator of immunity. In pathologic conditions, imbalanced cytokines may provide systemic inflammatory responses or immunosuppression. Expression of perioperative cytokines vary by different intensities of surgical trauma and types of anesthesia and anesthetic agents. Inflammatory cytokines play important roles in postoperative organ dysfunction including central nervous system, cardiovascular, lung, liver, and kidney injury. Inhibition of cytokines could protect against traumatic injury in some circumstances, therefore cytokine inhibitors or antagonists might have the potential for reducing postoperative tissue/organ dysfunction. Cytokines are also involved in wound healing and post-traumatic pain. Application of cytokines for the improvement of surgical wound healing has been reported. Anesthesia-related immune response adjustment might reduce perioperative morbidity because it reduces proinflammatory cytokine expression; however, the overall effects of anesthetics on postoperative immune-inflammatory responses needs to be further investigated. PMID:25837846

  9. Developing a perioperative educational video web site.

    Science.gov (United States)

    O'Dowd Bell, Lynn

    2012-04-01

    Nurses frequently have to adjust to changes in technology, particularly in the OR, but cataloging the wealth of resources commonly used in the OR (eg, equipment, supplies, how to use them) has not kept pace. To address this, I worked with the information systems administrative coordinator at the University of Texas Medical Branch, Galveston, to design and implement a perioperative intranet site that includes videos and fact sheets about equipment and supplies and that can be accessed by all perioperative staff members. This required promoting the idea and getting stakeholder sign-on, soliciting videotapes and DVDs and screening all submissions for appropriateness, choosing and formatting applicable resources for use on the site, working with members of the information systems department to create a web site after the video library was assembled, and helping staff members use and accept the site as a valuable educational resource. This intranet web site has been available to staff members for two years, and data from a recent survey of staff members and from mandatory intranet inservice compliance programs show evidence of its effectiveness. PMID:22464619

  10. Fast track surgery accelerates the recovery of postoperative insulin sensitivity

    Institute of Scientific and Technical Information of China (English)

    YANG Dong-jie; ZHANG Chang-hua; HE Yu-long; ZHANG Sheng; HE Wei-ling; CHEN Hua-yun; CAI Shi-rong; CHEN Chuang-qi; SONG Xin-ming; CUI Ji; MA Jin-ping

    2012-01-01

    Background Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity.This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection.Methods Controlled,randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up.Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups:a fast track group (35 cases) and a conventional care group (35 cases).All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia.Clinical parameters (complication rates,return of gastrointestinal function and postoperative length of stay),stress index and insulin sensitivity were evaluated in both groups perioperatively.Reaults Sixty-two patients finally completed the study,32 cases in the fast-track group and 30 cases in the conventional care group.Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group.We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation.Conclusion Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

  11. Perioperative intensive care in patients with brain tumours

    Directory of Open Access Journals (Sweden)

    Mariana A. Aquafredda

    2011-04-01

    Full Text Available The surgery of brain tumours is not free from complications, above all taking into account that today the patients operated are even older and with multiple comorbidities associated. The multidisciplinary preoperative evaluation aims at minimising the risks; nevertheless this evaluation has not yet been defined and is not based on a strong evidence. The detailed clinical history, the physical examination including functional status and the neuroimaging are the fundamental pillars.The more critical complications occur in the immediate postoperative period: cerebral oedema, postoperative haemorrhage, intracranial hypertension and convulsions; other complications, such as pulmonary thromboembolism or infections, develop lately but are not less severe. Every surgical approach has its own complications in addition to the ones common to the whole neurosurgery.

  12. Anaesthesia and peri-operative care for laparoscopic donor nephrectomy

    NARCIS (Netherlands)

    I.R.A.M. Mertens Zur Borg (Ingrid)

    2008-01-01

    textabstractA successful renal transplant for patients with kidney failure reduces mortality rate when compared to patients who continue dialysis. Organ donation from living donors has significant better results over organ donation from deceased donors. Traditionally the surgical approach fo

  13. Perioperative communication practices of anesthesiologists: A need to introspect and change

    Science.gov (United States)

    Hemanth Kumar, V. R.; Jahagirdar, Sameer Mahamud; Ravishankar, M.; Athiraman, Umesh Kumar; Maclean, Jennyl; Parthasarathy, S.

    2016-01-01

    Background: We conducted an audit of various communication practices during perioperative care among anesthesiology resident (R), faculties (F), and private practitioners (PP) in South India. We also documented the level of psycho-social support given to the patient and patient relatives and communication with the surgical colleagues during perioperative care. Methodology: A 15-point questionnaire based on communication practices was distributed in three major anesthesiology conferences requesting anesthesiologists to answer and drop the forms in the drop box provided. Resident and consultant level anesthesiologists of various Medical Schools in South India and private practitioners were involved in the study. The answers were analyzed to find out the various communication practices in perioperative care. Results: The freelancing private practitioners (PP) were more communicative to patient and relatives especially in complicated cases (Q1 - 45.6%, Q2 - 97.8%, Q4 - 94.4%, Q8 - 98.9%, respectively) in comparison with institutionalized practitioners. The choice of anesthesia and discussion related to the advantages of one mode of anesthesia over other was the most neglected part of communication (R - 14.2%, F - 17.6%, and PP - 5.6%). The PP's (95.6%) are more concerned about intraoperative communication (R - 27.6%, F - 39.2%). The discussion of postoperative pain management plan with the surgeon is not given priority in the communication by postgraduates (7.9%) and teaching faculties (8.8%). Conclusion: There is an urgent need to introspect and change the communication practices. We strongly recommend that communications skills should be introduced in anesthesiology resident curriculum. PMID:27212751

  14. Critical care issues in cervical cancer management.

    Science.gov (United States)

    Mirhashemi, R; Janicek, M F; Schoell, W M

    1999-01-01

    Radical pelvic surgery in gynecologic oncology patients poses a challenge to the surgeon and the ancillary team in charge of the peri-operative care. The high frequency of medical problems observed in this patient population, in conjunction with the stresses of radical surgery, necessitates careful monitoring of patients' medical status. A comprehensive team approach in the perioperative period is critical to patient care. Early intervention and anticipation of potential problems for the patient at risk in the postoperative period minimizes morbidity and mortality. This article will review the essentials of critical care as it relates to patients undergoing radical pelvic operations. PMID:10225307

  15. The preoperative interview. Its effect on perioperative nurses' empathy.

    Science.gov (United States)

    Alverson, E

    1987-05-01

    Further studies need to be done to determine the impact preoperative visits have on the perioperative nurse's empathy level. The results of this study could be confirmed, or refuted, if a study with more subjects was conducted over a longer period of time. Also, subjects in both the control and experimental groups should be chosen randomly and should be from the same institution. To measure the long-term effect of preoperative visits on empathy levels, a study could be conducted that measures the levels at various times (eg, six months to a year following the first study). Other evaluations of empathy levels, such as observer rating and patient rating, could be used to supplement nurses self-rating scores to avoid using one standard instrument and rating scale. Few conclusions can be drawn from this limited study, but it does help nurses realize that preoperative interviews can help the nurse become more aware of the surgical patient as a human being. This increased awareness may help the nurse function more effectively and efficiently in helping the patient during intraoperative care.

  16. Depth of Anesthesia as a Risk Factor for Perioperative Morbidity

    Directory of Open Access Journals (Sweden)

    Argyro Petsiti

    2015-01-01

    Full Text Available Introduction. The prognostic value of age, physical status, and duration of surgery on perioperative course has been extensively studied. However, the impact of deep hypnotic time (time when Bispectral Index values are less than 40 has not been well evaluated. Methods. We designed an observational study to clarify the relative influence of deep hypnotic time (DHT on outcome. Eligible participants were mentally stable patients over 18 years old scheduled for elective major abdominal surgery. In total, 248 patients enrolled. Data were analyzed using Fisher’s exact test and multiple logistic regression. Results. Five variables (DHT, hypotension, age, comorbidity, and duration of surgery showed statistically significant association with complications, when examined independently. However, when all variables were examined together in a multiple logistic regression model, age and comorbidity were no longer associated with outcome. DHT, hypotension, and duration of surgery were significant predictors of “complications,” and “hypotension” was a significant predictor of prolonged hospital stay (P<0.001.  Conclusion. Deep hypnotic time emerged as a new factor associated with outcome, and its impact compared to other factors such as age, surgery duration, hypotension, and comorbidity is redefined. Monitoring and managing depth of anesthesia during surgery are important and should be part of careful operation planning.

  17. [Current Status of Perioperative Rehabilitation in Patients who Undergo Esophagectomy for Cancer].

    Science.gov (United States)

    Oikawa, Masato; Hanada, Masatoshi; Hidaka, Shigekazu; Nagayasu, Takeshi; Kozu, Ryo

    2016-01-01

    The esophagectomy for esophageal cancer is major surgery and has the highest rate of postoperative pulmonary complications. Respiratory physiotherapy in patients undergoing esophagectomy has been applied to improve oxygenation and airway secretion clearance. Recently, the utility and effectiveness of enhanced recovery after surgery for gastroenterological surgery have been reported in Japan, and patients should be encouraged to participate in early mobilization. Perioperative rehabilitation which includes early mobilization reduces postoperative complications and improves fast-track recovery after esophagectomy. These interventions play important role in postoperative care. PMID:26975645

  18. European Society of Cardiology 2009 guidelines for preoperative cardiac risk assessment and perioperative cardiac management in noncardiac surgery. Key messages for clinical practice

    Directory of Open Access Journals (Sweden)

    Sanne E. Hoeks

    2010-07-01

    Full Text Available Patients undergoing noncardiac surgery are at risk of adverse perioperative and long-term outcome. When considering a patient for noncardiac surgery, a careful preoperative clinical risk evaluation and subsequent risk-reduction strategies are essential to reduce postoperative complications. To assist physicians with decision making, clinical guidelines are developed. The aim of clinical guidelines is to improve patient care by providing recommendations about appropriate healthcare in specific circumstances. Development of clinical guidelines is an important component in improving the quality of care. By translating the best available scientific evidence into specific recommendations, guidelines can serve as a useful tool to achieve effective and efficient patient care. In 2009, the first European Society of Cardiology guidelines on perioperative care were developed. This decisionmaking process integrates clinical markers, early coronary evaluation, functional capacity, and the type of surgery involved.

  19. [Correlation between pholcodine and perioperative anaphylaxis].

    Science.gov (United States)

    Dumancić, Jelena; Marković, Asja Stipić

    2012-05-01

    A large number of individuals experiencing anaphylactic reaction to neuromuscular blocking agents have not previously been in contact with them. The search for a substance inducing sensitization to muscle relaxants has led Norwegian and Swedish scientists to pholcodine, a cough suppressant, which is widely used in Europe and worldwide. Ammonium ion is an epitope common to pholcodine and neuromuscular blocking agents and it is the basis of their cross-reactivity. Based on the results of published studies that pointed to a connection of the use of pholcodine and perioperative anaphylactic reaction, pholcodine was withdrawn from the Norwegian market and subsequent research revealed a reduction of anaphylactic reactions in that country. In its latest report, the European Medicines Agency made a decision not to withdraw pholcodine mixtures from the market but it urged further research with the aim to clarify the cross-reactivity between pholcodine and neuromuscular blocking agents. PMID:23437637

  20. [Correlation between pholcodine and perioperative anaphylaxis].

    Science.gov (United States)

    Dumancić, Jelena; Marković, Asja Stipić

    2012-05-01

    A large number of individuals experiencing anaphylactic reaction to neuromuscular blocking agents have not previously been in contact with them. The search for a substance inducing sensitization to muscle relaxants has led Norwegian and Swedish scientists to pholcodine, a cough suppressant, which is widely used in Europe and worldwide. Ammonium ion is an epitope common to pholcodine and neuromuscular blocking agents and it is the basis of their cross-reactivity. Based on the results of published studies that pointed to a connection of the use of pholcodine and perioperative anaphylactic reaction, pholcodine was withdrawn from the Norwegian market and subsequent research revealed a reduction of anaphylactic reactions in that country. In its latest report, the European Medicines Agency made a decision not to withdraw pholcodine mixtures from the market but it urged further research with the aim to clarify the cross-reactivity between pholcodine and neuromuscular blocking agents.

  1. Implementing AORN recommended practices for a safe environment of care.

    Science.gov (United States)

    Hughes, Antonia B

    2013-08-01

    Providing a safe environment for every patient undergoing a surgical or other invasive procedure is imperative. AORN's "Recommended practices for a safe environment of care" provides guidance on a wide range of topics related to the safety of perioperative patients and health care personnel. The recommendations are intended to provide guidance for establishing best practices and implementing safety measures in all perioperative practice settings. Perioperative nurses should be aware of risks related to musculoskeletal injuries, fire, equipment, latex, and chemicals, among others, and understand strategies for reducing the risks. Evidence-based recommendations can give practitioners the tools to guide safe practice.

  2. Nursing Care of the Laryngeal Mask Airway in Pediatric Cataract Surgery

    Institute of Scientific and Technical Information of China (English)

    Aihuan Chen; Ronghua Ye; Yanchan Liu; Weici Liu; Jingyi Lin

    2014-01-01

    Purpose:To investigate the important experience of nursing care of the laryngeal mask airway (LMA) in children under-going cataract surgery. Methods: Fifty-five children undergoing cataract surgery were anesthetized by inhaling sevoflurane through a LMA and re-ceived perioperative nursing care. The safety of perioperative nursing for these children was also evaluated. Results:Through perioperative nursing care and psychological counseling for children with LMA,.all patients were anes-thetized without complications and underwent successful surgeries..No severe postoperative complications were ob-served. Conclusion: Nursing care specific for LMA is a vital part of the success of anesthesia and pediatric cataract surgery.

  3. Colour coding scrubs as a means of improving perioperative communication.

    Science.gov (United States)

    Litak, Dominika

    2011-05-01

    Effective communication within the operating department is essential for achieving patient safety. A large part of the perioperative communication is non-verbal. One type of non-verbal communication is 'object communication', the most common form of which is clothing. The colour coding of clothing such as scrubs has the potential to optimise perioperative communication with the patients and between the staff. A colour contains a coded message, and is a visual cue for an immediate identification of personnel. This is of key importance in the perioperative environment. The idea of colour coded scrubs in the perioperative setting has not been much explored to date and, given the potential contributiontowards improvement of patient outcomes, deserves consideration. PMID:21834289

  4. Pharmacological modification of the perioperative stress response in noncardiac surgery.

    Science.gov (United States)

    Priebe, Hans-Joachim

    2016-06-01

    The perioperative period is associated with alterations in the neuroendocrine, metabolic, and immune systems, referred to as "stress response." The resultant increased sympathetic activity and elevated serum concentrations of catecholamines may adversely affect the cardiovascular system, resulting in cardiovascular instability (hypertension, tachycardia, and arrhythmia), morbidity (myocardial ischemia, myocardial infarction, and stroke), and mortality (cardiac death and fatal stroke), particularly in patients at an elevated cardiovascular risk and with reduced cardiovascular reserve. Various strategies have been used to ameliorate the adverse perioperative cardiovascular sequelae of the perioperative stress response. Effective pharmacologic blunting of the stress response plays a crucial role in perioperative cardiac risk reduction strategies. In this context, the role of beta-adrenoceptor blockers, alpha2-adrenoceptor agonists, and statins has been extensively examined. This chapter evaluates the available evidence with respect to treatment efficacy of these commonly prescribed drugs in patients undergoing noncardiac surgery. PMID:27396805

  5. Chasing myocardial outcomes: perioperative myocardial infarction and cardiac troponin.

    Science.gov (United States)

    Royo, Marc B; Fleisher, Lee A

    2016-02-01

    Perioperative myocardial infarction represents the most common cardiovascular complication following non-cardiac surgery, but frequently presents without the usual clinical signs and symptoms consistent with acute coronary syndrome. Given the silent nature of this event, a clinician's reliance on risk stratification tools and cardiac specific biomarkers to assist in the identification of at-risk individuals is heightened in the perioperative setting. Although cardiac troponin elevations following non-cardiac surgery have been consistently linked to increased mortality, uncertainty remains over how to clinically intervene to prevent harm. This decision is further complicated by the increasing sensitivity of the newest generation of cardiac biomarker immunoassays. In this narrative review, the growing body of evidence surrounding cardiac troponin elevations in the perioperative setting, how the evidence has been integrated into recent clinical practice guidelines, and its implications for the detection of perioperative myocardial infarction are discussed. PMID:26634279

  6. Perioperative leadership: managing change with insights, priorities, and tools.

    Science.gov (United States)

    Taylor, David L

    2014-07-01

    The personal leadership of the perioperative director is a critical factor in the success of any change management initiative. This article presents an approach to perioperative nursing leadership that addresses obstacles that prevent surgical departments from achieving high performance in clinical and financial outcomes. This leadership approach consists of specific insights, priorities, and tools: key insights include self-understanding of personal barriers to leadership and accuracy at understanding economic and strategic considerations related to the OR environment; key priorities include creating a customer-centered organization, focusing on process improvement, and concentrating on culture change; and key tools include using techniques (e.g., direct engagement, collaborative leadership) to align surgical organizations with leadership priorities and mitigate specific perioperative management risks. Included in this article is a leadership development plan for perioperative directors.

  7. A Nationwide Retrospective Study of Perioperative Chemotherapy for Gastroesophageal Adenocarcinoma

    DEFF Research Database (Denmark)

    Larsen, Anders Christian; Holländer, Cecilie; Duval, Lone;

    2015-01-01

    BACKGROUND: Recent clinical trials have demonstrated the benefit and feasibility of perioperative chemotherapy for treatment of gastroesophageal adenocarcinoma (GEA). Despite convincing results, patients entering such trials usually represent only a fraction of those who are candidates for treatm......BACKGROUND: Recent clinical trials have demonstrated the benefit and feasibility of perioperative chemotherapy for treatment of gastroesophageal adenocarcinoma (GEA). Despite convincing results, patients entering such trials usually represent only a fraction of those who are candidates...... for treatment. Confirmation of trial-reported effects and tolerability in unselected cohorts is therefore required. The aims of this study were to confirm the safety and efficacy of perioperative chemotherapy for resectable GEA and to delineate risks of treatment failure. METHODS: We conducted a national...... retrospective cohort analysis of patients admitted for perioperative chemotherapy for resectable GEA. Regimens were epirubicin and capecitabine combined with oxaliplatin or cisplatin. RESULTS: The intention-to-treat analysis included 271 patients. Eighty-seven percent of patients completed preoperative...

  8. Anxiety and Depression among maxillofacial cancer patients during perioperative period

    OpenAIRE

    Miloseva, Lence; Vukosavljevic-Gvozden, Tanja; Milosev, Vladimir

    2014-01-01

    Aim of the study: The aim of this study was to examine changes in psychological distress, such as depression and anxiety, and quality of life (QOL) during the perioperative period in maxillofacial cancer patients undergoing surgery. We also investigated the relationship between patient’s psychological distress and QOL. We hypothesized that perioperative psychological distress would affect QOL.Thus, maxillofacial cancer patients with lower psychological distress would experience better QOL ...

  9. Quantifizierung des perioperativen Risikos [Quantifications of perioperative risk

    OpenAIRE

    Ohmann, C; Lorenz, Wilfried

    1987-01-01

    In this paper standardized and quantitative definitions of perioperative risk and risk factor using probabilities are given. A calculation of risk and risk factors is performed using data from a study on perioperative risk in colon resection and a study on a preoperative risk check in general surgery. The problem of one risk factor, a combination of two risk factors and the use of many risk factors to quantify preoperative risk is discussed. Confidence intervals are recommended as a standard ...

  10. Perioperative nursing in public university hospitals: an ethnography

    OpenAIRE

    Sørensen, Erik Elgaard; Olsen, Ida Østrup; Tewes, Marianne; Uhrenfeldt, Lisbeth

    2014-01-01

    Background In recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of peri...

  11. [Team Approaches for and Future Challenges to Promoting Perioperative Oral Management].

    Science.gov (United States)

    Aimono, Yuka; Kamoshida, Toshiro; Nakashima, Takafumi; Sato, Wataru; Sakamoto, Risa; Saito, Yoshiko; Kikuchi, Sakiko; Ishii, Hideyuki; Maruyama, Tsunehiko; Aoyama, Yoshifumi

    2016-02-01

    When the medical fee system was revised in 2012, the category of perioperative oral management was newly organized. However, the calculation of additional fees for such management required referral from medical to dental departments. In addition, requests for such management were limited, possibly owing to an increased burden on doctors engaged in outpatient services. This study examined the usefulness of an approach to promote patients' use of dental services by increasing their awareness of the importance of oral management. In this approach, pharmacists explained doctors' instructions to patients at a chemotherapy center within the study facility. Explanations were provided to 114 patients, 75 (65.8%) of whom subsequently used dental services in the facility. For patients using dental services, oral care was performed most frequently (40; 53.3%), followed by invasive procedures (23; 30.7%). Furthermore, the facility's ethics committee approved a survey to measure the satisfaction of patients undergoing chemotherapy at the center. Of the 110 patients invited to participate in the survey, 77(70.0%) did not respond. Researchers concluded the low response rate was associated with patients' belief that dental services were intended primarily for treating oral cavities and their lack of awareness of the importance of preventive dental care. However, in 2014, the number of calculations of additional fees for perioperative oral management markedly increased each month after the above-mentioned approach, from 62 (January) to 162 (December). Both the hospital-to family and family-to-hospital dentist referral rates significantly increased, from 11.2% and 10.7%, respectively (June 2013), to 21.0% and 41.9%, respectively(June 2014). Future evaluations of the outcomes of perioperative oral management and promoting cooperation between medical and dental communities may be necessary. PMID:27067687

  12. 腋窝皱襞小切口大汗腺剪除术根治腋臭334例疗效观察及围手术期护理%The Clinical Effect Observation and Perioperative Care of A Treatment Method, Cutting off Apocrine Sweat Gland Precisely with Minimally Invasive in Axillary Folds, for Bromhidrosis

    Institute of Scientific and Technical Information of China (English)

    张璃; 林孝华; 宣喧; 李智铭

    2011-01-01

    目的 观察腋窝皱襞小切口大汗腺剪除术根治腋臭的疗效,探讨其围手术期预防并发症的措施.方法 入选患者均沿腋毛区外1.0cm处标记手术区域,在腋窝中央皮肤皱褶处切口,长约1.5 ~2.0cm,沿皮下组织浅层分离术区皮肤组织,翻转皮瓣,剪除皮肤上脂肪组织、大汗腺及毛囊,修剪成仅含皮肤全层和真皮下血管网的超薄皮瓣,再缝合切口.结果 334例患者,共治疗668侧,均有效,痊愈412侧,显效256侧,无效0侧.围手术期出现皮下血肿21侧、局部皮肤坏死6侧、切口延迟愈合11侧、局部湿疹样皮炎12侧、水疱和血疱56侧,积极对症处理后,预后良好.结论 腋窝皱襞小切口大汗腺剪除术根治腋臭,疗效肯定,手术切口瘢痕不明显.围手术期应积极预防和处理各种并发症的发生.%Objective To discuss the clinical effect and perioperative care of a treatment method to cure the bromhidro-sis completely. Methods Mark the surgical area 1cm away around the armpit hair, draw the operative incision along the center of the area, which is around 1.5 ~2.0cm; Peel and turn off the skin, directly cut off the fat, apocrine sweat gland and hair follicle attached to the skin, and left full-thickness skin and subcutaneous vascular net only, then sew up the incision. Results Total 334 suffers, 668 sides were all cured properly. Of which 412 sides were healed completely. 256 sides gained remarkable curative effect. There were some complications incurred,such as subcutaneous hematoma(21 sides) ,local skin necrosis(6 sides) , delayed wound healing (11 sides ), local eczematous dermatitis ( 12 sides ), blister and blood blister ( 56 sides). In the end, they had also been appropriately cured. Conclusion This surgery is a useful treatment method for bromhidrosis, and the Scar is not obvious. However, it is also necessary to prevent and appropriately cure in case of any complications.

  13. Prevention of the renarrowing of coronary arteries using drug-eluting stents in the perioperative period: an update

    Directory of Open Access Journals (Sweden)

    Juan V Llau

    2010-09-01

    Full Text Available Juan V Llau1, Raquel Ferrandis1, Pilar Sierra2, Aurelio Gómez-Luque31Department of Anaesthesiology and Critical Care Medicine, Hospital Clínic Universitari, València, Spain; 2Department of Anaesthesiology, Fundació Puigvert, Barcelona, Spain; 3Department of Anaesthesiology and Critical Care Medicine, Hospital Clínico Universitario, Málaga, SpainAbstract: The management of patients scheduled for surgery with a coronary stent, and receiving 1 or more antiplatelet drugs, has many controversies. The premature discontinuation of antiplatelet drugs substantially increases the risk of stent thrombosis (ST, myocardial infarction, and cardiac death, and surgery under an altered platelet function could also lead to an increased risk of bleeding in the perioperative period. Because of the conflict in the recommendations, this article reviews the current antiplatelet protocols after positioning a coronary stent, the evidence of increased risk of ST associated with the withdrawal of antiplatelet drugs and increased bleeding risk associated with its maintenance, the different perioperative antiplatelet protocols when patients are scheduled for surgery or need an urgent operation, and the therapeutic options if excessive bleeding occurs.Keywords: stent thrombosis, antiplatelet agents, aspirin, clopidogrel, surgical bleeding, perioperative management

  14. Algorithmic Summaries of Perioperative Blood Pressure Fluctuations.

    Science.gov (United States)

    Toddenroth, Dennis; Ganslandt, Thomas; Drescher, Caroline; Weith, Thomas; Prokosch, Hans-Ulrich; Schuettler, Juergen; Muenster, Tino

    2016-01-01

    Automated perioperative measurements such as cardiovascular monitoring data are commonly compared to established upper and lower thresholds, but could also allow for more complex interpretations. Analyzing such time series in extensive electronic medical records for research purposes may itself require customized automation, so we developed a set of algorithms for quantifying different aspects of temporal fluctuations. We implemented conventional measures of dispersion, summaries of absolute gradients between successive values, and Poincaré plots. We aggregated the severity and duration of hypotensive episodes by calculating the average area under different mean arterial pressure (MAP) thresholds. We applied these methods to 30,452 de-identified MAP series, and analyzed the similarity between alternative indices via hierarchical clustering. To explore the potential utility of these propositional metrics, we computed their statistical association with presumed complications due to cardiovascular instability. We observed that hierarchical clustering reliably segregated features that had been designed to quantify dissimilar aspects. Summaries of temporary hypotension turned out to be significantly increased among patient subgroups with subsequent signs of a complicated recovery. These associations were even stronger for measures that were specifically geared to capturing short-term MAP variability. These observations suggest the potential capability of our proposed algorithms for quantifying heterogeneous aspects of short-term MAP fluctuations. Future research might also target a wider selection of outcomes and other attributes that may be subject to intraoperative variability. PMID:27577440

  15. Oxygraphy: an unexplored perioperative monitoring modality.

    Science.gov (United States)

    Gadhinglajkar, Shrinivas Vitthal; Sreedhar, Rupa; Unnikrishnan, K P

    2009-06-01

    Capnography waveforms and capnometry are useful perioperative monitoring tools. The paramagnetic oxygen analyzers incorporated in many clinical monitoring systems estimate oxygen concentration in the breathing circuit during various phases of ventilation. The oxygen concentration is plotted as a real-time waveform and displayed as an oxygraph. However, the clinical utility of oxygraphy is under evaluated. We are reporting four different clinical scenarios in neurosurgical patients, wherein the information yielded by oxygraphy were either not available on the capnograph or were revealed in a more promising way on the oxygraph than on the capnograph. A real-time oxygraphy waveform has four phases similar to a capnograph, although displayed in a reverse manner. Oxygraphy was useful in our patient to determine the adequacy of preoxygenation. Airway complications and unwanted neuromuscular recovery can be detected earlier by oxygraphy compared to capnography. The oxygraphy peak-to-baseline scale difference can be compressed to as low as to 6% of oxygen concentration. When the peak-to-baseline scale difference is 6 mmHg, the oxygraph becomes sensitive to even minute changes in respiratory flow characteristics. Oxygraphy may have a potential role in clinical monitoring. PMID:19353279

  16. Perioperative implications and management of dextrocardia.

    Science.gov (United States)

    Rapoport, Yury; Fox, Charles J; Khade, Parth; Fox, Mary E; Urman, Richard D; Kaye, Alan David

    2015-10-01

    Dextrocardia, a term used to describe all varieties of developmental malformations resulting in the positioning of the heart in the right hemithorax, is linked to a number of highly significant cardiac disorders. Current estimates vary tremendously in the literature. Only about 10 % of patients with diagnosed dextroversion show no substantial cardiac pathology; however, the incidence of congenital heart defects associated with dextrocardia is close to 100 %. The majority of studies previously reported include dextrocardia associated with situs inversus and cases of Kartagener syndrome. There is complex embryology and pathogenesis that results in dextrocardia. Physical examinations of the heart, such as percussion and palpation during routine exams, are vitally important initial diagnostic instruments. X-ray, CT scan, echocardiography (ECHO), and MRI are all invaluable imaging modalities to confirm and classify the diagnosis of dextrocardia. In summary, heart malposition is a group of complex pathologic associations within the human body, rather than just a single congenital defect. Clinicians such as anesthesiologists have unique challenges managing patients with dextrocardia. An appreciation of associated pathogenesis, appropriate diagnosis, and management is paramount in ensuring the best outcome for these patients perioperatively.

  17. PERIOPERATIVE MANAGEMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    V. N. Amirdzhanova

    2014-01-01

    Full Text Available The paper considers the joint management of rheumatoid arthritis patients needing endoprosthetic replacement of the large joints of the lower extremities by rheumatologists and orthopedic traumatologists.Due to the fact that there are no conventional standards or guidelines for the perioperative management of patients with rheumatic diseases, adopted by international rheumatology associations, the authors generalize their experience in managing the patients in terms of international approaches and guidelines from different countries. The medical assessment and reduction of cardiovascular risks, the prevention of infectious complications, hemorrhages, and lower extremity deep vein thrombosis, and the specific features of management of patients with osteoporosis are under consideration. The authors' experience in managing the patients receiving antirheumatic therapy with nonsteroidal antiinflammatory and disease-modifying antirheumatic drugs, such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine, is detailed. Recommendations for managing patients taking glucocorticoids and biologic agents (tumor necrosis factor-α inhibitors, anti-B-cell therapy, and interleukin-6 receptor inhibitors in the preoperative andpostoperative periods are given.

  18. Perioperative coagulation management--fresh frozen plasma.

    Science.gov (United States)

    Kor, Daryl J; Stubbs, James R; Gajic, Ognjen

    2010-03-01

    Clinical studies support the use of perioperative fresh frozen plasma (FFP) in patients who are actively bleeding with multiple coagulation factor deficiencies and for the prevention of dilutional coagulopathy in patients with major trauma and/or massive haemorrhage. In these settings, current FFP dosing recommendations may be inadequate. However, a substantial proportion of FFP is transfused in non-bleeding patients with mild elevations in coagulation screening tests. This practice is not supported by the literature, is unlikely to be of benefit and unnecessarily exposes patients to the risks of FFP. The role of FFP in reversing the effects of warfarin anticoagulation is dependent on the clinical context and availability of alternative agents. Although FFP is commonly transfused in patients with liver disease, this practice needs broad reconsideration. Adverse effects of FFP include febrile and allergic reactions, transfusion-associated circulatory overload and transfusion-related acute lung injury. The latter is the most serious complication, being less common with the preferential use of non-alloimmunised, male-donor predominant plasma. FP24 and thawed plasma are alternatives to FFP with similar indications for administration. Both provide an opportunity for increasing the safe plasma donor pool. Although prothrombin complex concentrates and factor VIIa may be used as alternatives to FFP in a variety of specific clinical contexts, additional study is needed.

  19. Re: Perioperative Complications after Living Kidney Donation: A National Study

    Directory of Open Access Journals (Sweden)

    Serkan Akıncı

    2016-09-01

    Full Text Available The authors have investigated the perioperative complications after donor nephrectomy integrating the US transplant registry with administrative records from an academic hospital consortium (97 centers, 2008-2012. 14.964 patients were verified as live donors through linkage with the Organ Procurement and Transplantation Network registry. Overall, 16.8% of donors experienced a perioperative complication, including Clavien grade 2 or higher events in 8.8%, Clavien grade 3 or higher in 7.3%, and Clavien grade 4 or higher events in 2.5%. The most common complications were gastrointestinal (4.4%, bleeding (3.0%, respiratory (2.5%, and surgical/anesthesia-related injuries (2.4%. After adjustment for demographic and clinical factors, African American donors were 26% more likely to experience any perioperative complication and 56% more likely to experience the most severe complications. Other factors associated with increased risk of any perioperative complication, and with the most severe complications included predonation hematologic and psychiatric conditions and more recent years of donation. Donation at centers with the highest annual volume of living donor nephrectomies (>50 cases/year was associated with approximately 45% lower risk of any perioperative complication and of the most severe complications. Donors who underwent robotic nephrectomy were twice as likely to experience severe perioperative complications (adjusted odds ratio 2.07 for Clavien grade 4 or higher events. To conclude, the authors found that while one in six US living kidney donors experienced a perioperative complication, the most severe complications were infrequent, affecting only 2.5% of donors.

  20. Successful implementation of a perioperative glycemic control protocol in cardiac surgery: barrier analysis and intervention using lean six sigma.

    Science.gov (United States)

    Martinez, Elizabeth A; Chavez-Valdez, Raul; Holt, Natalie F; Grogan, Kelly L; Khalifeh, Katherine W; Slater, Tammy; Winner, Laura E; Moyer, Jennifer; Lehmann, Christoph U

    2011-01-01

    Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.

  1. Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

    Directory of Open Access Journals (Sweden)

    Elizabeth A. Martinez

    2011-01-01

    Full Text Available Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.

  2. Perioperative challenges in management of a deaf and dumb patient posted for high-risk cardiac surgery.

    Science.gov (United States)

    Chowdhry, Vivek; Padhi, Manoranjan; Mohanty, B B; Biswal, Suvakanta

    2016-01-01

    Perioperative management of deaf and dumb patients can be a challenging task. For smooth postoperative recovery, proper care should begin in the preoperative period. Understanding the patients' needs and training him to follow the instructions requires to involve a communication specialist. Judicious use of sedatives and analgesics is essential to keep the patient pain-free and comfortable. Postoperatively, the patient should be kept awake, enough to understand the internal need of the body and to make a meaningful response to external stimuli. Adequate preoperative planning and coordinated team efforts with involvement of specialists can help in delivering better postoperative care. PMID:27397473

  3. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    Science.gov (United States)

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  4. Surgical technology and pharmacology of hyperthermic perioperative chemotherapy

    Science.gov (United States)

    Van der Speeten, Kurt

    2016-01-01

    Although cytoreductive surgery (CRS) and hyperthermic perioperative chemotherapy (HIPEC) have not been shown to be effective by themselves, as a combined treatment they are now standard of care for peritoneal metastases from appendiceal cancer and from colorectal cancer as well as peritoneal mesothelioma. The timing of the HIPEC in relation to the CRS is crucial in that the HIPEC is to destroy minimal residual disease that remains following the CRS and prevent microscopic tumor emboli within the abdomen and pelvis from implanting within the resection site, within fibrinous clot, or within blood clot. Proper selection of chemotherapy agents is crucial to the long-term benefit of CRS and HIPEC. One must consider the response expected with the cancer chemotherapy agent, its area under the curve (AUC) ratio indicating the amount of dose intensity within the peritoneal space, and the drug retention within the peritoneal space for a prolonged exposure. Hyperthermia will augment the cytotoxicity of the cancer chemotherapy agents and improve drug penetration. Irrigation techniques should not be overlooked as an important means of reducing the cancer cell burden within the abdomen and pelvis. Multiple technologies for HIPEC exist and these have advantages and disadvantages. The techniques vary from a totally open technique with a vapor barrier over the open abdominal space to a totally closed technique whereby the HIPEC is administered at the completion of the surgical procedure. The open techniques depend on a table-mounted retractor for suspension of the skin edges allowing a reservoir to occur within the abdomen and pelvis. There are nearly a dozen commercially available hyperthermia pumps, all of which seem to perform adequately for HIPEC although there is a variable degree of convenience and documentation of the HIPEC procedure. As the management of peritoneal metastases has progressed over three decades, early cases are now seen in which a laparoscopic CRS and HIPEC

  5. Perioperative nursing for patients receiving endovascular therapy for ruptured abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To discuss the nursing strategy and practical measures for patients with ruptured abdominal aortic aneurysm during the perioperative period of endovascular intervention. Methods: Endovascular therapy was carried out in 34 patients with ruptured abdominal aortic aneurysm,who were encountered in our department during the period of July 1997 to September 2008. The clinical data were retrospectively analyzed and the nursing points were summarized. Results: The average hospitalization days of the 34 patients were (14 ± 5) days, the mortality rate within 30 days was 23.5% (8/34). No nursing-related complications occurred. Conclusion: A comprehensive understanding of the mechanism, development and clinical evolution of ruptured abdominal aortic aneurysm is very important for nursing care. For nursing staff, well mastering the relevant nursing technique, carefully guarding against any nursing errors and lessening patient's suffering as far as possible, all these are the task of primary importance. (authors)

  6. Hydroxyethyl starches in the perioperative period. A review on the efficacy and safety of starch solutions.

    Science.gov (United States)

    Ghijselings, I; Rex, S

    2014-01-01

    Several randomized controlled trials have raised alarming concerns about the safety of hydroxyethyl starches (HES) for the hemodynamic stabilization of critically ill patients. It has been repeatedly demonstrated that the use of HES in patients treated in an intensive care unit was associated with an increased occurrence of serious adverse events, including a higher incidence of renal injury or failure, a higher need for renal replacement therapy (RRT), and (in one study) increased mortality. HES solutions are also widely used in the perioperative period, although high-level evidence on both the efficacy and safety of HES in patients undergoing surgery is sparse. It is unknown to which extent the concerning findings in critically ill patients can be extrapolated to the perioperative setting, where a variety of distinct patient populations is encountered. However, caution and an increased awareness for possible adverse effects of HES solutions in the perioperative setting are warranted. In 2013, the European Medicines Agency (EMA) concluded that the benefits of HES solutions no longer outweigh their risks, and therefore recommended that the marketing authorizations for these medicines be suspended (1). Upon request of some of the marketing-authorization holders (MAH), the EMA re-analyzed its recommendation. After a thorough review of the available data, the Pharmacovigilance Risk Assessment Committee (PRAC) concluded, on November 11th, that the increased risk of mortality and RRT or renal failure associated with the use of hydroxyethyl starch containing medicinal products outweighs their limited clinical benefits in the approved indications, and in any patient population. In June 2013, the U.S. Food and Drug Administration also communicated a serious warning with respect to the use of HES (2). The present (non-systematic) review summarizes the evidence upon which these remarkable recommendations are based. Moreover, current guidelines on the use of HES are quoted

  7. Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery

    NARCIS (Netherlands)

    A. Mebazaa; A.A. Pitsis; A. Rudiger; W. Toller; D. Longrois; S.E. Ricksten; I. Bobek; S. de Hert; G. Wieselthaler; U. Schirmer; L.K. von Segesser; M. Sander; D. Poldermans; M. Ranucci; P.C. Karpati; P. Wouters; M. Seeberger; E.R. Schmid; W. Weder; F. Follath

    2010-01-01

    Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, signifi cant arrhyt

  8. Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery

    NARCIS (Netherlands)

    A. Mebazaa (Alexandre); A.A. Pitsis (Antonis); A. Rudiger (Alain); W. Toller (Wolfgang); D. Longrois (Dan); S.E. Ricksten; I. Bobek (Ilona); S. de Hert (Stefan); G. Wieselthaler (Georg); U. Schirmer (Uwe); L.K. von Segesser (Ludwig); M. Sander (Michael); D. Poldermans (Don); M. Ranucci (Marco); P.C.J. Karpati (Peter); P.J. Wouters (Pieter); M. Seeberger (Manfred); E.R. Schmid (Edith); W. Weder (Walter); F. Follath

    2010-01-01

    textabstractAcute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, signifi

  9. Relationship between perioperative glycemic control and postoperative infections

    Institute of Scientific and Technical Information of China (English)

    Kazuhiro Hanazaki; Hiromichi Maeda; Takehiro Okabayashi

    2009-01-01

    Perioperative hyperglycemia in critically ill surgery patients increases the risk of postoperative infection (POI), which is a common, and often costly, surgical complication. Hyperglycemia is associated with abnormalities in leukocyte function, including granulocyte adherence, impaired phagocytosis, delayed chemotaxis,and depressed bactericidal capacity. These leukocyte deficiencies are the cause of infection and improve with tight glycemic control, which leads to fewer POIs in critically ill surgical patients. Tight glycemic control, such as intensive insulin therapy, has a risk of hypoglycemia.In addition, the optimal targeted blood glucose range to reduce POI remains unknown. Since 2006, we have investigated tight perioperative blood glucose control using a closed-loop artificial endocrine pancreas system,to reduce POI and to avoid hypoglycemia. In this Topic Highlight, we review the relationship between perioperative glycemic control and POI, including the use of the artificial pancreas.

  10. Linear Accelerators

    CERN Document Server

    Vretenar, M

    2014-01-01

    The main features of radio-frequency linear accelerators are introduced, reviewing the different types of accelerating structures and presenting the main characteristics aspects of linac beam dynamics.

  11. An interprofessional training course in crises and human factors for perioperative teams.

    Science.gov (United States)

    Stephens, Tim; Hunningher, Annie; Mills, Helen; Freeth, Della

    2016-09-01

    Improving patient safety and the culture of care are health service priorities that coexist with financial pressures on organisations. Research suggests team training and better team processes can improve team culture, safety, performance, and clinical outcomes, yet opportunities for interprofessional learning remain scarce. Perioperative practitioners work in a high pressure, high-risk environment without the benefits of stable team membership: this limits opportunities and momentum for team-initiated collaborative improvements. This article describes an interprofessional course focused on crises and human factors which comprised a 1-day event and a multifaceted sustainment programme for perioperative practitioners, grouped by surgical specialty. Participants reported increased understanding and confidence to enact processes and behaviours that support patient safety, including: team behaviours (communication, coordination, cooperation and back-up, leadership, situational awareness); recognising different perspectives and expectations within the team; briefing and debriefing; after action review; and using specialty-specific incident reports to generate specialty-specific interprofessional improvement plans. Participants valued working with specialty colleagues away from normal work pressures. In the high-pressure arena of front-line healthcare delivery, improving patient safety and theatre efficiency can often be erroneously considered conflicting agendas. Interprofessional collaboration amongst staff participating in this initiative enabled general and specialty-specific interprofessional learning that transcended this conflict. PMID:27314407

  12. Perioperative clinical variables and long-term survival following vascular surgery

    Institute of Scientific and Technical Information of China (English)

    Santiago; Garcia; Edward; O; McFalls

    2014-01-01

    Cardiovascular disease is the leading cause of death in patients with peripheral arterial disease(PAD). Coro-nary artery disease(CAD) is highly prevalent, and often times coexist, in patients with PAD. The management of patients with PAD that requires a high-risk vascular surgical procedure for intermittent claudication, critical limb ischemia or expanding abdominal aortic aneurysm requires risk stratification with the revised cardiac risk index, optimization of medical therapies, and limited use of cardiac imaging prior to surgery. Preventive re-vascularization in patients with stable CAD, with the sole intention to mitigate the risk of cardiac complica-tions in the peri-operative period, is not effective and may be associated with significant bleeding and throm-botic risks, in particular if stents are used. A strategy of universal use of cardiac troponins in the perioperative period for active surveillance of myocardial ischemia may be more reasonable and cost-effective than the current standard of care of widespread use of cardiac imaging prior to high-risk surgery. An elevated cardiactroponin after vascular surgery is predictive of long-term mortality risk. Medical therapies such as aspirin and statins are recommended for patients with post-operative myocardial ischemia. Ongoing trials are as-sessing the role of novel anticoagulants. Additional research is needed to define the role of cardiac imaging and invasive angiography in this population.

  13. 宫颈癌围术期的护理%Perioperative nursing in cervical cancer

    Institute of Scientific and Technical Information of China (English)

    张利琳

    2012-01-01

    目的 探讨宫颈癌围术期的护理方法,以提高手术成功率.方法 观察并总结92例宫颈癌患者手术治疗围术期的护理.结果 通过心理护理,饮食护理,对症护理等提高手术成功率,患者均治愈出院.结论 规范而正确的护理是保证宫颈癌手术成功的关键之一.%Objective To investigate the methods of perioperative nursing in cervical cancer and improve the rate of surgical success. Methods The perioperative nursing in cervical cancer on ninety - two patients was observed and summed up. Results The rate of surgical success has improved by psychological caring, dieting nursing and correct nursing methods. All patients have been cured. Conclusion The key to ensure the success of surgical in cervical cancer is normative and correct nursing.

  14. Perioperative intensive insulin therapy using artificial endocrine pancreas in patients undergoing pancreatectomy

    Institute of Scientific and Technical Information of China (English)

    Hiromichi Maeda; Takehiro Okabayashi; Tomoaki Yatabe; Koichi Yamashita; Kazuhiro Hanazaki

    2009-01-01

    Perioperative glycemic control is important for reducing postoperative infectious complications. However,clinical trials have shown that efforts to maintain normoglycemia in intensive care unit patients result in deviation of glucose levels from the optimal range, and frequent attacks of hypoglycemia. Tight glycemic control is even more challenging in those undergoing pancreatic resection. Removal of lesions and surrounding normal pancreatic tissue often cause hormone deficiencies that lead to the destruction of glucose homeostasis, which is termed pancreatogenic diabetes. Pancreatogenic diabetes is characterized by the occurrence of hyperglycemia and iatrogenic severe hypoglycemia, which adversely effects patient recovery.Postoperatively, a variety of factors including surgical stress, inflammatory cytokines, sympathomimetic drug therapy, and aggressive nutritional support can also affect glycemic control. This review discusses the endocrine aspects of pancreatic resection and highlights postoperative glycemic control using a closed-loop system or artificial pancreas. In previous experiments,we have demonstrated the reliability of the artificial pancreas in dogs with total pancreatectomy, and its postoperative clinical use has been shown to be effective and safe, without the occurrence of hypoglycemic episodes, even in patients after total pancreatectomy.Considering the increasing requirement for tight perioperative glycemic control and the recognized risk of hypoglycemia, we propose the use of an artificial endocrine pancreas that is able to monitor continuously blood glucose concentrations with proven accuracy, and administer automatically substances to return blood glucose concentration to the optimal narrow range.

  15. Preventing "a bridge too far": promoting earlier identification of dislodged dental appliances during the perioperative period.

    Science.gov (United States)

    Denny, John T; Yeh, Sloane; Mohiuddin, Adil; Denny, Julia E; Fratzola, Christine H

    2015-02-01

    The presence of fixed partial dentures presents a unique threat to the perioperative safety of patients that require orotracheal intubation or placement of instruments into the gastrointestinal (GI) tract. There are many chances for the displacement of a fixed partial denture: instrumentation of the airway for intubation, or introduction of temporary devices, such as gastroscopes or transesophageal echo probes. If dislodged, the fixed partial dentures can enter the hypopharynx, esophagus or lungs and cause perforations with their sharp tines. Oral or esophageal perforation can lead to potentially fatal mediastinitis. We describe a case of a patient with a fixed partial denture who underwent cardiac surgery with intubation and transesophageal echocardiography (TEE). His partial denture was intact after the procedure. After extubation, he reported that his teeth were missing. Multiple procedures were required to remove his dislodged partial dentures. In sign-out reports, verbal descriptions of the patient's partial dentures were not adequate in this case. A picture of the patient's denture and oral pharynx pre-operatively would have provided a more accurate template for the post-operative team to refer to when caring for the patient. This may have avoided the multiple potentially risky procedures the patient had to undergo. We describe a suggested protocol utilizing a pre-operative photo to reduce the incidence of unrecognized partial denture dislodgement in the perioperative period. Because the population is aging, this will become a more frequent issue confronting practitioners. This protocol could mitigate this complication. PMID:25436029

  16. Alteration of the oral environment in patients undergoing esophagectomy during the perioperative period

    Directory of Open Access Journals (Sweden)

    Masami Yoshioka

    2013-04-01

    Full Text Available Objective: During the perioperative period, oral ingestion is changed considerably in esophagectomy patients. The aim of this study was to investigate oral environment modifications in patients undergoing esophageal cancer treatments due to changes in dietary intake and swallowing functions. Material and Methods: Thirty patients who underwent operation for removal of esophageal cancer in Tokushima University Hospital were enrolled in this study. Results: It was found that 1 the flow rate of resting saliva decreased significantly at postoperative period by deprived feeding for one week, although it did not recover several days after oral ingestion began, 2 the accumulation of dental plaque and the number of mutans streptococci in saliva decreased significantly after operation, while both increased relatively quick when oral ingestion began, and 3 the swallowing function decreased significantly in the postoperative period. Conclusions: These results suggest that dental professionals should emphasize the importance of oral health care and provide instructions on plaque control to patients during the perioperative period of esophageal cancer treatment.

  17. Relationship between perioperative glycemic control and postoperative infections

    OpenAIRE

    Hanazaki, Kazuhiro; Maeda, Hiromichi; Okabayashi, Takehiro

    2009-01-01

    Perioperative hyperglycemia in critically ill surgery patients increases the risk of postoperative infection (POI), which is a common, and often costly, surgical complication. Hyperglycemia is associated with abnormalities in leukocyte function, including granulocyte adherence, impaired phagocytosis, delayed chemotaxis, and depressed bactericidal capacity. These leukocyte deficiencies are the cause of infection and improve with tight glycemic control, which leads to fewer POIs in critically i...

  18. Benefits and harms of perioperative beta-blockade

    DEFF Research Database (Denmark)

    Wetterslev, Jørn; Juul, Anne Benedicte

    2006-01-01

    randomized trials. However, confidence intervals of the intervention effects in the meta-analyses are wide, leaving room for both benefits and harms. The largest observational study performed suggests that perioperative beta-blockade is associated with higher mortality in patients with low cardiac risk...

  19. Fluvastatin and perioperative events in patients undergoing vascular surgery

    NARCIS (Netherlands)

    O. Schouten (Olaf); H. Boersma (Eric); S.E. Hoeks (Sanne); R. Benner (Robbert); H. van Urk (Hero); M.R.H.M. van Sambeek (Marc); H.J.M. Verhagen (Hence); N.A. Khan (Nisar Ahmed); M. Dunkelgrun (Martin); J.J. Bax (Jeroen); D. Poldermans (Don)

    2009-01-01

    textabstractBACKGROUND: Adverse cardiac events are common after vascular surgery. We hypothesized that perioperative statin therapy would improve postoperative outcomes. METHODS: In this double-blind, placebo-controlled trial, we randomly assigned patients who had not previously been treated with a

  20. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Science.gov (United States)

    Donnino, Michael W; Andersen, Lars W; Berg, Katherine M; Reynolds, Joshua C; Nolan, Jerry P; Morley, Peter T; Lang, Eddy; Cocchi, Michael N; Xanthos, Theodoros; Callaway, Clifton W; Soar, Jasmeet

    2016-01-01

    For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document.

  1. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Science.gov (United States)

    Donnino, Michael W; Andersen, Lars W; Berg, Katherine M; Reynolds, Joshua C; Nolan, Jerry P; Morley, Peter T; Lang, Eddy; Cocchi, Michael N; Xanthos, Theodoros; Callaway, Clifton W; Soar, Jasmeet

    2016-01-01

    For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document. PMID:26449873

  2. Perioperative medicine. The surgeons point of view

    DEFF Research Database (Denmark)

    Kehlet, H

    2001-01-01

    A satisfactory postoperative outcome goes through the control of several factors, to ensure well-being and free-pain state. A multi-disciplinary effort is necessary to achieve this goal, and the adjustment of postoperative surgical care is as important as the supply of anesthesiological techniques....

  3. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2011-01-01

    Full Text Available An osteo-odonto-keratoprosthesis (OOKP procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson′s syndrome (SJS (7 and chemical burn (1. Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure.

  4. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study.

    Science.gov (United States)

    Garg, Rakesh; Khanna, Puneet; Sinha, Renu

    2011-05-01

    An osteo-odonto-keratoprosthesis (OOKP) procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males) underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson's syndrome (SJS) (7) and chemical burn (1). Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure. PMID:21808400

  5. Future accelerators (?)

    Energy Technology Data Exchange (ETDEWEB)

    John Womersley

    2003-08-21

    I describe the future accelerator facilities that are currently foreseen for electroweak scale physics, neutrino physics, and nuclear structure. I will explore the physics justification for these machines, and suggest how the case for future accelerators can be made.

  6. A protocol for a systematic review for perioperative pregabalin use

    Directory of Open Access Journals (Sweden)

    Eipe Naveen

    2012-09-01

    Full Text Available Abstract Background Perioperative pain management has recently been revolutionized with the recognition of novel mechanisms and introduction of newer drugs. Many randomized trials have studied the use of the gabapentinoid anti-epileptic, pregabalin, in acute pain. Published systematic reviews suggest that using pregabalin for perioperative pain management may decrease analgesic requirements and pain scores, at the expense of troublesome side effects. A major limitation of the extant reviews is the lack of rigorous investigation of clinical characteristics that would maximize the benefit harms ratio in favor of surgical patients. We posit that effects of pregabalin for perioperative pain management vary by the type of surgical pain model and propose this systematic review protocol to update previous systematic reviews and investigate the heterogeneity in findings across subgroups of surgical pain models. Methods/Design Using a peer-reviewed search strategy, we will search key databases for clinical trials on perioperative pregabalin use in adults. The electronic searches will be supplemented by scanning the reference lists of included studies. No limits of language, country or year will be imposed. Outcomes will include pain; use of co-analgesia, particularly opioids; enhanced recovery; and drug-related harms. We will focus on the identification of surgical models and patient characteristics that have shown benefit and adverse effects from pregabalin. Two clinical experts will independently screen the studies for inclusion using eligibility criteria established a priori. Data extracted by the reviewers will then be verified. Publication bias will be assessed, as will risk of bias using the Cochrane Risk of Bias tool. Meta-analysis and meta-regression are planned if the studies are deemed statistically, methodologically and clinically homogenous. Evidence will be graded for its strength for a select number of outcomes. Discussion We will explore

  7. Technological advances in perioperative monitoring: Current concepts and clinical perspectives.

    Science.gov (United States)

    Chilkoti, Geetanjali; Wadhwa, Rachna; Saxena, Ashok Kumar

    2015-01-01

    Minimal mandatory monitoring in the perioperative period recommended by Association of Anesthetists of Great Britain and Ireland and American Society of Anesthesiologists are universally acknowledged and has become an integral part of the anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, transesophageal echocardiography, advanced neurological monitoring, improved alarm system and technological advancement in objective pain assessment. Various factors that need to be considered with the use of improved monitoring techniques are their validation data, patient outcome, safety profile, cost-effectiveness, awareness of the possible adverse events, knowledge of technical principle and ability of the convenient routine handling. In this review, we will discuss the new monitoring techniques in anesthesia, their advantages, deficiencies, limitations, their comparison to the conventional methods and their effect on patient outcome, if any.

  8. Peri-operative warming devices: performance and clinical application.

    Science.gov (United States)

    John, M; Ford, J; Harper, M

    2014-06-01

    Since the adverse consequences of accidental peri-operative hypothermia have been recognised, there has been a rapid expansion in the development of new warming equipment designed to prevent it. This is a review of peri-operative warming devices and a critique of the evidence assessing their performance. Forced-air warming is a common and extensively tested warming modality that outperforms passive insulation and water mattresses, and is at least as effective as resistive heating. More recently developed devices include circulating water garments, which have shown promising results due to their ability to cover large surface areas, and negative pressure devices aimed at improving subcutaneous perfusion for warming. We also discuss the challenge of fluid warming, looking particularly at how devices' performance varies according to flow rate. Our ultimate aim is to provide a guide through the bewildering array of devices on the market so that clinicians can make informed and accurate choices for their particular hospital environment. PMID:24720346

  9. A systematic review of peri-operative melatonin

    DEFF Research Database (Denmark)

    Andersen, L P H; Werner, M U; Rosenberg, J;

    2014-01-01

    We systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction......; and safety. Compared with placebo, melatonin reduced the standardised mean difference (95% CI) pre-operative anxiety score by 0.88 (0.44-1.33) and postoperative pain score by 1.06 (0.23-1.88). The magnitude of effect was unreliable due to substantial statistical heterogeneity, with I(2) 87% and 94......%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements....

  10. Perioperative Management of Multiple Noncardiac Implantable Electronic Devices.

    Science.gov (United States)

    Ramos, Juan A; Brull, Sorin J

    2015-12-01

    The number of patients with noncardiac implantable electronic devices is increasing, and the absence of perioperative management standards, guidelines, practice parameters, or expert consensus statements presents clinical challenges. A 69-year-old woman presented for latissimus dorsi breast reconstruction. The patient had previously undergone implantation of a spinal cord stimulator, a gastric pacemaker, a sacral nerve stimulator, and an intrathecal morphine pump. After consultation with device manufacturers, the devices with patient programmability were switched off. Bipolar cautery was used intraoperatively. Postoperatively, all devices were interrogated to ensure appropriate functioning before home discharge. Perioperative goals include complete preoperative radiologic documentation of device component location, minimizing electromagnetic interference, and avoiding mechanical damage to implanted device components. PMID:26588030

  11. Using YouTube in perioperative nursing education.

    Science.gov (United States)

    Logan, Rebecca

    2012-04-01

    Educators today need innovative teaching strategies to meet the learning needs of the multigenerational population of perioperative nurses. Emerging technologies, such as YouTube, the world's largest video-sharing web site, can be used as a component of an active learning strategy that can appeal to a broad group of nurses along the novice-to-expert proficiency continuum. Using video clips can be a useful method to engage learners and promote critical thinking, decision making, and creativity. YouTube videos can be used to teach skills or as a platform for discussion. Learners also can create and upload their own videos to educate others. Increased engagement and active learning can lead the perioperative nurse to a deeper understanding of the educational material.

  12. Evaluating Enhancements to a Perioperative Nurse Liaison Program.

    Science.gov (United States)

    Hanson-Heath, Cathy Ann; Muller, Linda M; Cunningham, Maureen F

    2016-04-01

    The impetus for the perioperative nurse liaison (PNL) program at our cancer center was to reduce anxiety for family members of patients undergoing surgery by improving communication between the family and the perioperative team. The purpose of our quality improvement project was to increase contact with family members during the patient's surgery and to support families and surgeons during the postoperative family consult when findings were unexpected. After implementing process changes, the PNLs evaluated the program using a short survey given to families after the postoperative consult. Families reported a reduction in stress and anxiety when intraoperative updates were received either in person or by telephone. In addition, when the PNL accompanied family members to the postoperative consult, the family felt supported when receiving unexpected findings. Further, family contact with the PNL increased from 77% to 98%, and the number of consults with surgeons that included the PNL rose from an average of 254 to 500 per year. PMID:27004504

  13. Realization of CARE and EuCARD Projects in ISE-WUT, Accelerator and FEL Research, Development and Applications in Europe

    OpenAIRE

    Romaniuk, R.

    2009-01-01

    There are described coordinating actions of the accelerator science in Europe in 2003-2009. The actions embrace basic science, as well as development and applications. The accelerator research was not coordinated in Europe at a global scale but was rather concentrated in a few centers owning large infrastructure. These centers include: CERN, DESY, GSI, INFN, LAL, PSI etc. Such coordinating actions enable a lot of positive processes including new possibilities for research centers in this coun...

  14. Perioperative visual loss in ocular and nonocular surgery

    OpenAIRE

    Lee, Michael

    2010-01-01

    Kathleen T Berg, Andrew R Harrison, Michael S LeeDepartment of Ophthalmology, University of Minnesota, Minneapolis, MN, USAAbstract: Incidence estimates for perioperative vision loss (POVL) after nonocular surgery range from 0.013% for all surgeries up to 0.2% following spine surgery. The most common neuro-ophthalmologic causes of POVL are the ischemic optic neuropathies (ION), either anterior (AION) or posterior (PION). We identified 111 case reports of AION following nonocular surgery in th...

  15. Nursing team stress in the perioperative period: an integrative review

    OpenAIRE

    Dafne Eva Corrêa Brandão; Cristina Maria Galvão

    2013-01-01

    This integrative review aimed at analyzing evidences available in literature regarding stress levels in nursing teams during the perioperative period. Primary studies were searched in the following databases: PubMed, CINAHL and LILACS. Included studies were grouped into the following thematic categories: stress level in the workplace and stress factors (n=8) and stress coping strategies used by the nursing staff (n=6). Evidence suggests that stress in the workplace worsens the health of the n...

  16. Fluvastatin and perioperative events in patients undergoing vascular surgery

    OpenAIRE

    Schouten, Olaf; Boersma, Eric; Hoeks, Sanne; Benner, Robbert; Urk, Hero; Sambeek, Marc; Verhagen, Hence; Khan, Nisar Ahmed; Dunkelgrun, Martin; Bax, Jeroen; Poldermans, Don

    2009-01-01

    textabstractBACKGROUND: Adverse cardiac events are common after vascular surgery. We hypothesized that perioperative statin therapy would improve postoperative outcomes. METHODS: In this double-blind, placebo-controlled trial, we randomly assigned patients who had not previously been treated with a statin to receive, in addition to a beta-blocker, either 80 mg of extended-release fluvastatin or placebo once daily before undergoing vascular surgery. Lipid, interleukin-6, and C-reactive protein...

  17. Perioperative Management of Patients with Obstructive Sleep Apnoea - A Review

    Directory of Open Access Journals (Sweden)

    Fauzia A Khan

    2008-01-01

    The anaesthetic implications include the presence of comorbidities like cardiovascular, respiratory and cerebrovascular sequelae. Obesity is a commonly associated condition. Effects of sedatives, hypnotics and other anaesthetic drugs are of major concern and there are potential complications associated with the postoperative period. The purpose of this review is to update the readers on the recent literature available on the topic. The American Society of Anesthesiologists has recently suggested guidelines on the perioperative management of these patients.

  18. Laboratory Studies of Perioperative Abdominal Aortic Aneurysm Repair

    Directory of Open Access Journals (Sweden)

    Manabu Shiraishi

    2013-04-01

    Conclusions: Both elective open repair and EVAR can be safely performed in patients with an infrarenal AAA. EVAR has perioperative advantages of reduced blood loss and blood transfusions as well as a decreased duration of stay in hospital. In particular, we identified specific independent relative factors of laboratory values for major morbidity, duration of stay in hospital, renal insufficiency, and endoleakage. and #8195; [Arch Clin Exp Surg 2013; 2(2.000: 71-79

  19. Anaphylactic and anaphylactoid reactions during the perioperative period

    OpenAIRE

    Lagopoulos, V; Gigi, E

    2011-01-01

    Anaphylactic reactions in the peri-operative period are often serious and potentially life-threatening conditions, involving multiple organ systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils. Anaphylaxis is an immune mediated type I allergic reaction following the massive release of mediators from mast cells and basophils as a response to an allergen. Anaphylactoid reactions are defined as those reactions that p...

  20. Anesthesia for opioid addict: Challenges for perioperative physician

    Directory of Open Access Journals (Sweden)

    Rohit Goyal

    2013-01-01

    Full Text Available Opioid addiction is on a rise globally. Such a patient presents to an anesthesiologist as well as to the surgeon with an array of challenges. We present the case of an opioid addict (pentazocine who presented for debridement and grafting of eschars and old healed scars. Initially he was medically managed for opioid addiction followed by a planned anesthesia. We hereby discuss the challenges faced during perioperative period.

  1. Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery

    Directory of Open Access Journals (Sweden)

    Siriphuwanun V

    2014-09-01

    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Mueang District, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine the incidence of and factors associated with perioperative cardiac arrest within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: This retrospective cohort study was approved by the ethical committee of Maharaj Nakorn Chiang Mai Hospital, Thailand. We reviewed the data of 44,339 patients receiving anesthesia for emergency surgery during the period from January 1, 2003 to March 31, 2011. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA physical status classification, anesthesia information, location of anesthesia performed, and outcomes. Data of patients who had received topical anesthesia or monitoring anesthesia care were excluded. Factors associated with cardiac arrest were identified by univariate analyses. Multiple regressions for the risk ratio (RR and 95% confidence intervals (CI were used to determine the strength of factors associated with cardiac arrest. A forward stepwise algorithm was chosen at a P-value <0.05. Results: The incidence (within 24 hours of perioperative cardiac arrest in patients receiving anesthesia for emergency surgery was 163 per 10,000. Factors associated with 24-hour perioperative cardiac arrest in emergency surgery were age of 2 years or younger (RR =1.46, CI =1.03–2.08, P=0.036, ASA physical status classification of 3–4 (RR =5.84, CI =4.20–8.12, P<0.001 and 5–6 (RR =33.98, CI =23.09–49.98, P<0.001, the anatomic site of surgery (upper intra-abdominal, RR =2.67, CI =2.14–3.33, P<0.001; intracranial, RR =1.74, CI =1.35–2.25, P<0.001; intrathoracic, RR =2.35, CI =1.70–3

  2. Survival in sensitized lung transplant recipients with perioperative desensitization.

    Science.gov (United States)

    Tinckam, K J; Keshavjee, S; Chaparro, C; Barth, D; Azad, S; Binnie, M; Chow, C W; de Perrot, M; Pierre, A F; Waddell, T K; Yasufuku, K; Cypel, M; Singer, L G

    2015-02-01

    Donor-specific HLA antibodies (DSA) have an adverse effect on short-term and long-term lung transplant outcomes. We implemented a perioperative strategy to treat DSA-positive recipients, leading to equivalent rejection and graft survival outcomes. Pretransplant DSA were identified to HLA-A, B, C, DR and DQ antigens. DSA-positive patients were transplanted if panel reactive antibody (PRA) ≥30% or medically urgent and desensitized with perioperative plasma exchange, intravenous immune globulin, antithymocyte globulin (ATG), and mycophenolic acid (MPA). PRA-positive/DSA-negative recipients received MPA. Unsensitized patients received routine cyclosporine, azathioprine and prednisone without ATG. From 2008-2011, 340 lung-only first transplants were performed: 53 DSA-positive, 93 PRA-positive/DSA-negative and 194 unsensitized. Thirty-day survival was 96 %/99%/96% in the three groups, respectively. One-year graft survival was 89%/88%/86% (p = 0.47). DSA-positive and PRA-positive/DSA-negative patients were less likely to experience any ≥ grade 2 acute rejection (9% and 9% vs. 18% unsensitized p = 0.04). Maximum predicted forced expiratory volume (1 s) (81%/74%/76%, p = NS) and predicted forced vital capacity (81%/77%/78%, respectively, p = NS) were equivalent between groups. With the application of this perioperative treatment protocol, lung transplantation can be safely performed in DSA/PRA-positive patients, with similar outcomes to unsensitized recipients. PMID:25612494

  3. A Systematic Approach to Creation of a Perioperative Data Warehouse.

    Science.gov (United States)

    Hofer, Ira S; Gabel, Eilon; Pfeffer, Michael; Mahbouba, Mohammed; Mahajan, Aman

    2016-06-01

    Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. This structure allows centralized definitions with simplified reporting by a large number of individuals who access only the Reporting Schemas. In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users.

  4. Hyperglycemia and Acute Kidney Injury During the Perioperative Period.

    Science.gov (United States)

    Mendez, Carlos E; Der Mesropian, Paul J; Mathew, Roy O; Slawski, Barbara

    2016-01-01

    Hyperglycemia and acute kidney injury (AKI) are frequently observed during the perioperative period. Substantial evidence indicates that hyperglycemia increases the prevalence of AKI as a surgical complication. Patients who develop hyperglycemia and AKI during the perioperative period are at significantly elevated risk for poor outcomes such as major adverse cardiac events and all-cause mortality. Early observational and interventional trials demonstrated that the use of intensive insulin therapy to achieve strict glycemic control resulted in remarkable reductions of AKI in surgical populations. However, more recent interventional trials and meta-analyses have produced contradictory evidence questioning the renal benefits of strict glycemic control. Although the exact mechanisms through which hyperglycemia increases the risk of AKI have not been elucidated, multiple pathophysiologic pathways have been proposed. Hypoglycemia and glycemic variability may also play a significant role in the development of AKI. In this literature review, the complex relationship between hyperglycemia and AKI as well as its impact on clinical outcomes during the perioperative period is explored.

  5. A Systematic Approach to Creation of a Perioperative Data Warehouse.

    Science.gov (United States)

    Hofer, Ira S; Gabel, Eilon; Pfeffer, Michael; Mahbouba, Mohammed; Mahajan, Aman

    2016-06-01

    Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. This structure allows centralized definitions with simplified reporting by a large number of individuals who access only the Reporting Schemas. In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users. PMID:27195633

  6. The effect of perioperative esmolol infusion on the postoperative nausea, vomiting and pain after laparoscopic appendectomy

    OpenAIRE

    Lee, Sang-Jun; Lee, Jong-Nam

    2010-01-01

    Background Perioperative opioid administration results in postoperative nausea and vomiting (PONV) and acute opioid tolerance that manifests in increased postoperative pain. Esmolol is an ultra short acting cardioselective β1-adrenergic receptor antagonist, and it has been successfully used for perioperative sympatholysis and it reduces the opioid requirement during total intravenous anesthesia. We tested the hypothesis that perioperative esmolol administration results in decreased PONV and p...

  7. Accelerating Value Creation with Accelerators

    DEFF Research Database (Denmark)

    Jonsson, Eythor Ivar

    2015-01-01

    accelerator programs. Microsoft runs accelerators in seven different countries. Accelerators have grown out of the infancy stage and are now an accepted approach to develop new ventures based on cutting-edge technology like the internet of things, mobile technology, big data and virtual reality. It is also...... with the traditional audit and legal universes and industries are examples of emerging potentials both from a research and business point of view to exploit and explore further. The accelerator approach may therefore be an Idea Watch to consider, no matter which industry you are in, because in essence accelerators...

  8. Perioperative smoking cessation in vascular surgery

    DEFF Research Database (Denmark)

    Kehlet, M.; Heesemann, Sabine; Tonnesen, H.;

    2015-01-01

    Background: The effect of intensive smoking cessation programs on postoperative complications has never before been assessed in soft tissue surgery when smoking cessation is initiated on the day of surgery. Methods: A single-blinded randomized clinical trial conducted at two vascular surgery...... departments in Denmark. The intervention group was offered the Gold Standard Program (GSP) for smoking cessation intervention. The control group was offered the departments' standard care. Inclusion criteria were patients with planned open peripheral vascular surgery and who were daily smokers. According...... intervention and 21 as controls. There was no difference in 30-day complication rates or 6-week abstinence rates between the two groups. Conclusions: A trial assessing the effect of smoking cessation on postoperative complications on the day of soft tissue surgery is still needed. If another trial...

  9. Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order

    Directory of Open Access Journals (Sweden)

    Bryan G. Maxwell

    2014-01-01

    Full Text Available Background. Do-not-resuscitate (DNR orders are often active in patients with multiple comorbidities and a short natural life expectancy, but limited information exists as to how often these patients undergo high-risk operations and of the perioperative outcomes in this population. Methods. Using comprehensive inpatient administrative data from the Public Discharge Data file (years 2005 through 2010 of the California Office of Statewide Health Planning and Development, which includes a dedicated variable recording DNR status, we identified cohorts of DNR patients who underwent major cardiac or thoracic operations and compared themto age- and procedure-matched comparison cohorts. The primary study outcome was in-hospital mortality. Results. DNR status was not uncommon in cardiac (n = 2,678, 1.1% of all admissions for cardiac surgery, age 71.6 ± 15.9 years and thoracic (n = 3,129, 3.7% of all admissions for thoracic surgery, age 73.8 ± 13.6 years surgical patient populations. Relative to controls, patients who were DNR experienced significantly greater inhospital mortality after cardiac (37.5% vs. 11.2%, p < 0.0001 and thoracic (25.4% vs. 6.4% operations. DNR status remained an independent predictor of in-hospital mortality onmultivariate analysis after adjustment for baseline and comorbid conditions in both the cardiac (OR 4.78, 95% confidence interval 4.21–5.41, p < 0.0001 and thoracic (OR 6.11, 95% confidence interval 5.37–6.94, p < 0.0001 cohorts. Conclusions. DNR status is associated with worse outcomes of cardiothoracic surgery even when controlling for age, race, insurance status, and serious comorbid disease. DNR status appears to be a marker of substantial perioperative risk, and may warrant substantial consideration when framing discussions of surgical risk and benefit, resource utilization, and biomedical ethics surrounding end-of-life care.

  10. Construction of Perioperative Anesthesia Management Security System%围术期手术麻醉管理安全体系的构建

    Institute of Scientific and Technical Information of China (English)

    詹莎莎; 刘炳信

    2016-01-01

    Perioperative patients require anesthesia, as medical technology continues to progress, after anesthesia, the pa-tient's safety are increasing, but the management of security perioperative anesthesia still faces many challenges. With the change of medical model to improve the quality of care, reduce health care costs become the primary purpose. Thus, in ad-dition to the initiative to change, regulate medical practices, the anesthesiologist should strengthen perioperative anesthesia safety management system in order to build a safer surgical patients throughout the medical procedure in anesthesia manage-ment.%患者在围术期需要进行手术麻醉,随着医学技术不断进步,在麻醉后,患者的安全性也不断增加,但围术期的麻醉管理安全仍然面临多项挑战。伴随着医疗模式的改变,提高医疗质量、降低医疗成本成为了首要目的。因此,除了主动改变,规范医疗行为,麻醉医师还应加强患者的围术期麻醉的安全管理,从而构建患者在整个手术医疗过程中麻醉管理的安全体系。

  11. Laser accelerator

    OpenAIRE

    Vigil, Ricardo

    2014-01-01

    Approved for public release; distribution is unlimited In 1979,W. B. Colson and S. K. Ride proposed a new kind of electron accelerator using a uniform magnetic field in combination with a circularly-polarized laser field. A key concept is to couple the oscillating electric field to the electron’s motion so that acceleration is sustained. This dissertation investigates the performance of the proposed laser accelerator using modern high powered lasers and mag-netic fields that are significan...

  12. Caring for the Jehovah's Witness Parturient.

    Science.gov (United States)

    Mason, C LaToya; Tran, Connie K

    2015-12-01

    Caring for the Jehovah's Witness parturient is a complex task that presents a number of ethical, medical, and legal concerns because many Jehovah's Witnesses refuse allogeneic blood transfusion. Childbirth and its surrounding events may be associated with significant blood loss. Given their significant role in the intraoperative administration of blood products, anesthesia providers should be familiar with factors that must be considered in the perioperative care of Jehovah's Witness parturients. Several pharmacologic therapies, anesthetic techniques, and operative interventions aimed at blood conservation may be useful in the care of such patients. Aside from their refusal of transfusion, each Witness makes a personal decision on the acceptability of derivatives of plasma or cellular blood components and autologous blood management. Therefore, the patient-physician relationship must ensure that the individual patient's desires are accurately communicated, respected, and documented in the patient's medical record. The Perioperative Surgical Home model is appropriate for use in caring for Jehovah's Witness patients because it allows for the early and continuing coordination of care and communication between the patient and a multidisciplinary team. In this article, we present a focused review of concepts important to the provision of anesthetic care of parturients who are Jehovah's Witnesses and introduce an algorithmic perioperative approach that may be applied to the care of the Jehovah's Witness parturient undergoing an operative procedure. PMID:26579658

  13. 腹腔镜前列腺癌根治术的围手术期护理%The perioperative nursing of laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    程范华; 郑红娟; 潘翠青

    2013-01-01

    目的 探讨腹腔镜前列腺癌根治术治疗前列腺癌患者的临床疗效及围手术期的护理要点.方法 对10例前列腺癌患者采用腹腔镜前列腺癌根治术切除前列腺及行膀胱颈尿道吻合,并通过改进围手术期的护理方法,有效地促进患者恢复.结果 所有患者手术均获成功并痊愈出院.结论 腹腔镜前列腺癌根治术治疗前列腺癌,手术成功率高;加强围手术期的护理,尤其是重视术前心理疏导、术中配合及术后妥善处理好各种引流管等,有助于减少前列腺癌患者围手术期并发症的发生.%Objectives This pedicled investigates the therapeutic effects of which laparoscopic radical prostatectomy for treatment of prostate cancer patients and perioperative care elements.Methods 10 cases of prostate cancer patients,with introduction of laparoscopic radical prostatectomy for prostate,bladder neck-urethral anastomosis and through improving the perioperative nursing,promoting fistula healing and increasing the cure rate.Results ALL the operations were successfully completed fully recouered.Conclusions The laparoscopic radical prostatectomy for treatment of prostate cancer,which can improve the success rate of operation.Intensive perioperative care,with particular attention to psychological intervention,intraoperative cooperation and properly handle the various drainage tubes,etc,which are help to reduce perioperative complications.

  14. LIBO accelerates

    CERN Multimedia

    2002-01-01

    The prototype module of LIBO, a linear accelerator project designed for cancer therapy, has passed its first proton-beam acceleration test. In parallel a new version - LIBO-30 - is being developed, which promises to open up even more interesting avenues.

  15. 关节镜下膝关节复合骨折内固定术36例围术期护理配合%Perioperative nursing care in the treatment of 30 patients with composite fracture of knee joint by arthroscopic internal fixation

    Institute of Scientific and Technical Information of China (English)

    孙波; 洪钦政; 于洁; 乌晓辉

    2012-01-01

    To explore the perioperative nursing methods in the treatment of patients with composite; fracture of knee joint by arthroscopic internal fixation. Methods:36 patients with composite fracture of knee joint were treated with arthroscopic internal fixation and preoperative,intraoperative nursing coordination was provided. Results:By following up for 10 to 22 months,no complications like infection, joint stiffness and bonc; nonunion occurred in any patients;fracture healing time was from 4 to 8 months; the; excellent and good rate; was 86. 1% according to Rasmmsse function scoring standard. Conclusion: The; arthroscopic internal fixation has the; advantages of little; trauma and less complication in the; tre;atme;nt of patie;nts with e'omposite; fracture; of kne;e; joint; skille;d and orde;rly nursing e'oordination ean shorte;n the; operation time;; e;arly postoperative; exe;re'ise; ean e;nsure; the; joint fune'tieonal re;e'erve;ry erf kne;e; joint as soon as possible;.%目的:探讨关节镜下膝关节复合骨折内固定术患者围术期护理方法.方法:对36例膝关节复合骨折患者进行膝关节镜下膝关节复合骨折内固定术,给予术前、术中及关节镜护理配合.结果:随访10~22个月,患者无手术感染、关节僵硬、骨不连等并发症发生;骨折愈合时间为4~8个月;按Rasmmsse功能评分标准,优良率86.1%.结论:关节镜引导下手术治疗膝关节复合骨折创伤小,并发症少;熟练有序的护理配合可以缩短手术时间;术后早期关节功能练习可保证关节功能尽快恢复.

  16. Perioperative Predictors of Extubation Failure and the Effect on Clinical Outcome After Infratentorial Craniotomy.

    Science.gov (United States)

    Cai, Ye-Hua; Wang, Hai-Tang; Zhou, Jian-Xin

    2016-07-12

    BACKGROUND The purpose of the study was to analyze the risk factors for failed extubation in subjects submitted to infratentorial craniotomy. MATERIAL AND METHODS Patients aged over 18 years who received infratentorial craniotomy for brain tumor resection were consecutively included in this study. Perioperative variables were collected and analyzed. Univariate analyses and multiple logistic regression were used to derive factors related to failed extubation. Patients had follow-up care until either out of hospital or death. RESULTS Throughout the course of the study, 2118 patients were eligible and 94 (4.4%) suffered from extubation failure at some point during their hospital stay. Five factors were recognized as independent risk factors for postoperative failed extubation: craniotomy history, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in blood pressure (BP) during the operation. Failed extubation was related to a higher incidence rate of pneumonia, mortality, unfavorable Glasgow Outcome Scale score, longer stay in the neuro-intensive care unit (ICU) and hospitalization, and higher hospitalization costs compared with successful extubation. CONCLUSIONS History of craniotomy, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in BP during the operation were independent risk factors related to postoperative failed extubation in patients submitted to infratentorial craniotomy. Extubation failure raises the incidences of postoperative pneumonia, mortality, and higher hospitalization costs, and prolongs neuro-ICU and postoperative length of stay.

  17. A national survey into perioperative anesthetic management of patients with a fractured neck of femur

    Directory of Open Access Journals (Sweden)

    Soinikoski Mirka

    2012-07-01

    Full Text Available Abstract Background We made a survey among Finnish anesthesiologists concerning the current perioperative anesthetic practice of hip fracture patients for further development in patient care. Methods All members of the Finnish Society of Anesthesiologists with a known e-mail address (786 were invited to participate in an internet-based survey. Results The overall response rate was 55% (423 responses; 298 respondents participated in the care of hip fracture patients. Preoperative analgesia was mostly managed with oxycodone and paracetamol; every fifth respondent applied an epidural infusion. Most respondents (98% employed a spinal block with or without an epidural catheter for intraoperative anesthesia. Midazolam, propofol and/or fentanyl were used for additional sedation. General anesthesia was used rarely. Postoperatively, paracetamol and non-steroidal anti-inflammatory drugs and occasionally peroral oxycodone, were prescribed in addition to epidural analgesia. Conclusions The survey suggests that the impact of more individualised analgesia regimens, both preoperatively and postoperatively, should be investigated in further studies.

  18. Perioperative physiotherapy in patients undergoing lung cancer resection.

    Science.gov (United States)

    Rodriguez-Larrad, Ana; Lascurain-Aguirrebena, Ion; Abecia-Inchaurregui, Luis Carlos; Seco, Jesús

    2014-08-01

    Physiotherapy is considered an important component of the perioperative period of lung resection surgery. A systematic review was conducted to assess evidence for the effectiveness of different physiotherapy interventions in patients undergoing lung cancer resection surgery. Online literature databases [Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, SCOPUS, PEDro and CINAHL] were searched up until June 2013. Studies were included if they were randomized controlled trials, compared 2 or more perioperative physiotherapy interventions or compared one intervention with no intervention, included only patients undergoing pulmonary resection for lung cancer and assessed at least 2 or more of the following variables: functional capacity parameters, postoperative pulmonary complications or length of hospital stay. Reviews and meta-analyses were excluded. Eight studies were selected for inclusion in this review. They included a total of 599 patients. Seven of the studies were identified as having a low risk of bias. Two studies assessed preoperative interventions, 4 postoperative interventions and the remaining 2 investigated the efficacy of interventions that were started preoperatively and then continued after surgery. The substantial heterogeneity in the interventions across the studies meant that it was not possible to conduct a meta-analysis. The most important finding of this systematic review is that presurgical interventions based on moderate-intense aerobic exercise in patients undergoing lung resection for lung cancer improve functional capacity and reduce postoperative morbidity, whereas interventions performed only during the postoperative period do not seem to reduce postoperative pulmonary complications or length of hospital stay. Nevertheless, no firm conclusions can be drawn because of the heterogeneity of the studies included. Further research into the efficacy and effectiveness of perioperative respiratory physiotherapy in

  19. Alveolar recruitment maneuver and perioperative ventilatory support in obese patients undergoing abdominal surgery

    OpenAIRE

    Forgiarini Júnior, Luiz Alberto; Rezende, Juliana Castilhos; Forgiarini, Soraia Genebra Ibrahim

    2013-01-01

    The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the imple...

  20. Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients.

    LENUS (Irish Health Repository)

    O'Brien, Frank J

    2012-06-01

    It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival.

  1. Strategies to improve tolerance to peri-operative enteral feeding

    Directory of Open Access Journals (Sweden)

    B. Ravinder Reddy

    2016-01-01

    Full Text Available A major surgical procedure results in injury resulting in systemic response resulting in a negative nitrogen balance. The conventional management of a patient in the peri-operative period involves pre- and post-operative fasting, which potentiates the caloric deficit. Early feeding has been shown to result in a positive clinical outcome. How-ever, the physiologic response to surgery impedes successful initiation of early enteral feeds. This article discusses the various strategies to improve tolerance to early enteral feeds in the immediate post-operative period. [J Med Allied Sci 2016; 6(1: 3-7

  2. Approaches and perioperative management in periacetabular osteotomy surgery

    DEFF Research Database (Denmark)

    Søballe, Kjeld; Troelsen, Anders

    2012-01-01

    , or any surgical procedure, should be characterized by few complications, minimized surgical trauma, and no compromise of long-term surgical results. A minimally invasive transsartorial approach using fluoroscopy and an approximately 7-cm skin incision has been developed for performing PAO. No muscles.......9 to 8.1 years) of 209 PAOs performed using this approach have shown Kaplan-Meier survivorship rates of 94.7% at 5 years and 88.6% at 8.1 years, with conversion to total hip arthroplasty as the end point. Perioperative management includes a patient education program, optimized pain treatment strategies...

  3. Clinical and diagnostic features of perioperative hypersensitivity to cefuroxime

    DEFF Research Database (Denmark)

    Christiansen, I S; Krøigaard, M; Mosbech, H;

    2015-01-01

    patients reacted in 15 minutes versus only 38/58 (65.5%) of negative patients. CONCLUSION: All patients with confirmed hypersensitivity to cefuroxime reacted within 15 minutes of administration, but so did 65.5% of cefuroxime negative patients, making timing of administration an unreliable predictor...... of causation in the perioperative setting. Provocations were always positive when carried out in skin test positive patients; however 8 patients had positive provocations only, highlighting the need for provocation in skin test negative patients. This article is protected by copyright. All rights reserved....

  4. Role of Esmolol in Perioperative Analgesia and Anesthesia: A Literature Review.

    Science.gov (United States)

    Harless, Megan; Depp, Caleb; Collins, Shawn; Hewer, Ian

    2015-06-01

    Use of opioids to provide adequate perioperative analgesia often leads to respiratory depression, nausea, vomiting, urinary retention, pruritus, and opioid-induced hyperalgesia, with the potential to increase length of stay in the hospital. In an effort to reduce perioperative opioid administration yet provide appropriate pain relief, researchers began to study the use of esmolol beyond its well-known cardiovascular effects. Perioperative esmolol has been shown to reduce anesthetic requirements, decrease perioperative opioid use, decrease the incidence of postoperative nausea and vomiting, lead to an earlier discharge, and increase patient satisfaction. This article provides a review of the literature on the use of esmolol as an adjunct for perioperative analgesia and anesthesia. PMID:26137757

  5. Accelerator Experiments for Astrophysics

    OpenAIRE

    Ng, Johnny S. T.

    2003-01-01

    Many recent discoveries in astrophysics involve phenomena that are highly complex. Carefully designed experiments, together with sophisticated computer simulations, are required to gain insights into the underlying physics. We show that particle accelerators are unique tools in this area of research, by providing precision calibration data and by creating extreme experimental conditions relevant for astrophysics. In this paper we discuss laboratory experiments that can be carried out at the S...

  6. Accelerating the development of an information ecosystem in health care, by stimulating the growth of safe intermediate processing of health information (IPHI

    Directory of Open Access Journals (Sweden)

    Harshana Liyanage

    2013-03-01

    Full Text Available Health care, in common with many other industries, is generating large amounts of routine data, data that are challenging to process, analyse or curate, so-called ‘big data’. A challenge for health informatics is to make sense of these data. Part of the answer will come from the development of ontologies that support the use of heterogeneous data sources and the development of intermediate processors of health information (IPHI. IPHI will sit between the generators of health data and information, often the providers of health care, and the managers, commissioners, policy makers, researchers, and the pharmaceutical and other healthcare industries. They will create a health ecosystem by processing data in a way that stimulates improved data quality and potentially health care delivery by providers of health care, and by providing greater insights to legitimate users of data. Exemplars are provided of how a health ecosystem might be encouraged and developed to promote patient safety and more efficient health care. These are in the areas of how to integrate data around the unsafe use of alcohol and to explore vaccine safety. A challenge for IPHI is how to ensure that their processing of data is valid, safe and maintains privacy. Development of the healthcare ecosystem and IPHI should be actively encouraged internationally. Governments, regulators and providers of health care should facilitate access to health data and the use of national and international comparisons to monitor standards. However, most importantly, they should pilot new methods of improving quality and safety through the intermediate processing of health data.

  7. Perioperative Nutrition in Abdominal Surgery: Recommendations and Reality

    Directory of Open Access Journals (Sweden)

    Yannick Cerantola

    2011-01-01

    Full Text Available Introduction. Preoperative malnutrition is a major risk factor for increased postoperative morbidity and mortality. Definition and diagnosis of malnutrition and its treatment is still subject for controversy. Furthermore, practical implementation of nutrition-related guidelines is unknown. Methods. A review of the available literature and of current guidelines on perioperative nutrition was conducted. We focused on nutritional screening and perioperative nutrition in patients undergoing digestive surgery, and we assessed translation of recent guidelines in clinical practice. Results and Conclusions. Malnutrition is a well-recognized risk factor for poor postoperative outcome. The prevalence of malnutrition depends largely on its definition; about 40% of patients undergoing major surgery fulfil current diagnostic criteria of being at nutritional risk. The Nutritional Risk Score is a pragmatic and validated tool to identify patients who should benefit from nutritional support. Adequate nutritional intervention entails reduced (infectious complications, hospital stay, and costs. Preoperative oral supplementation of a minimum of five days is preferable; depending on the patient and the type of surgery, immune-enhancing formulas are recommended. However, surgeons' compliance with evidence-based guidelines remains poor and efforts are necessary to implement routine nutritional screening and nutritional support.

  8. [Perioperative myocardial ischemia in patients with peripheral arterial occlusive diseases].

    Science.gov (United States)

    Rapp, H J; Buselmeier, P; Gasteiger, P; Hoberg, E; Striebel, J P

    1990-04-01

    Patients with peripheral vascular disease (PVD) often have coronary artery disease (CAD) which means an increased risk during anesthesia. The prevalence of CAD is nearly 50% among such patients. Owing to claudication, diagnostic stress tests can rarely be performed in PVD patients. In order to evaluate the frequency of transient perioperative myocardial ischemia, Holter monitoring was performed in 30 consecutive PVD patients with ASA II-III and AVK scale (Fontaine) II-IV who were undergoing femoropopliteal bypass surgery. Patients who had left bundle branch block and left ventricular hypertrophy or were taking digitalis medication were excluded from Holter monitoring. The ST-segment analysis of the frequency modulated recordings (n = 19) revealed episodes of myocardial ischemia in 26% of the patients. Most (75%) of the episodes occurred preoperatively, and 25%, during or after the anesthesia or during preparation for it. Risk factors for CAD were more often found in patients with ST segment alterations than in patients without ST segment deviations, even though the preoperative antianginal medication administered was comparable in the two subgroups. It is concluded that in a considerable subset of PVD patients silent myocardial ischemia occurs, which can be related to the different perioperative intervals by means of ST segment analyses of Holter recordings. The ST segment may allow a better insight into the cardiac state of PVD patients. Further studies are necessary in larger populations to test our suspicion.

  9. Multimodal analgesia for perioperative pain in three cats.

    Science.gov (United States)

    Steagall, Paulo V M; Monteiro-Steagall, Beatriz P

    2013-08-01

    Adequate pain relief is usually achieved with the simultaneous use of two or more different classes of analgesics, often called multimodal analgesia. The purpose of this article is to highlight the use of perioperative multimodal analgesia and the need to individualize the treatment plan based on the presenting condition, and to adjust it based on the response to analgesia for a given patient. This case series presents the alleviation of acute pain in three cats undergoing different major surgical procedures. These cases involved the administration of different classes of analgesic drugs, including opioids, non-steroidal anti-inflammatory drugs, tramadol, ketamine, gabapentin and local anesthetics. The rationale for the administration of analgesic drugs is discussed herein. Each case presented a particular challenge owing to the different cause, severity, duration and location of pain. Pain management is a challenging, but essential, component of feline practice: multimodal analgesia may minimize stress while controlling acute perioperative pain. Individual response to therapy is a key component of pain relief in cats. PMID:23382595

  10. Evaluation of the appropriate perioperative antibiotic prophylaxis in Italy.

    Directory of Open Access Journals (Sweden)

    Francesco Napolitano

    Full Text Available BACKGROUND: The appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy and the factors associated with a poor adherence. METHODS: A sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected. RESULTS: Perioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin. CONCLUSIONS: Educational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.

  11. 感染性心内膜炎患者瓣膜置换围术期护理配合分析%Perioperative Nursing Coordination for Patients With Infective Endocarditis Valve Replacement

    Institute of Scientific and Technical Information of China (English)

    李丽

    2015-01-01

    目的:探讨感染性心内膜炎患者瓣膜置换围术期护理配合效果。方法对照组患者采用常规护理模式予以护理,观察组患者实施围术期护理。结果观察组患者的护理效果与总满意度均要优于对照组。结论对于感染性心内膜炎患者瓣膜置换的围术期配合有效的护理措施,是有效改善病情,降低并发症发生率,保证手术成功的重要手段。%Objective To investigate the effect of perioperative nursing in patients with infective endocarditis valve replacement.Methods The control group were treated with routine care model, the observation group were treated with perioperative care.Results The overall satisfaction with care results was better in observation group than the control group. Conclusion For patients with infective endocarditis valve replacement, effective perioperative care measures is effective in improving the condition and reduce the incidence of complications, it is an important means to ensure the success of surgery.

  12. Perioperative nursing of patients with advanced pancreatic carcinoma underwent thermal coagulation%热凝固治疗晚期胰体尾癌的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    陆瑶; 周峥

    2010-01-01

    目的 总结热凝固治疗晚期胰体尾癌的围手术期护理体会.方法 精心的术前、术后护理,合理的健康教育,给予个体化的出院指导,并加强手术前后的心理护理.结果 本组27例患者均行射频消融或微波固化治疗,无围手术期死亡病例,1例患者出现胰瘘,无护理并发症发生.结论 加强热凝固治疗晚期胰体尾癌围手术期的护理,可大大提高患者围手术期的生活质量.%Objective To summarize the nursing experience during perioperative period of thermal coagulation therapy for patients with advanced pancreatic carcinoma. Methods Intensive perioperative nursing care, proper health education and individual discharge guidance performed for 27 cases. Results All patients underwent radiofrequency ablation or microwave coagulation therapy, no perioperative deaths case appeared.Only 1 case of pancreatic fistula occurred but no complications appeared. Conclusions Enhancing the perioperative nursing of thermal ablation can dramatically improve the quality of life for patients with advanced pancreatic carcinoma.

  13. Evaluation of a hands-free wireless communication device in the perioperative environment.

    Science.gov (United States)

    Jacques, Paul St; France, Daniel J; Pilla, Michael; Lai, Eric; Higgins, Michael S

    2006-02-01

    The objective of this study was to evaluate the efficiency and reliability of a hands-free voice over Internet protocol (VOIP) communication system in the perioperative environment. Two surveys were administered to anesthesiologists and operating room (OR) nurses working at an academic medical center. Providers were queried by alphanumeric pages or VOIP queries during OR work shifts to measure communication response times. Providers, responding to the query, were asked to verbally complete a system performance survey to capture information regarding their workload and work environment at the time of the query. A user feedback survey was independently administered in writing to a convenience sample of OR providers to obtain information regarding provider communication preferences, concerns, and recommendations. OR providers responded to communication queries four times faster when using VOIP compared to alphanumeric pagers. Providers found VOIP to be much less reliable than conventional pager-telephone systems. Dead spots in the 802.11b network and errors in speaker recognition were frequently cited as sources of system failures. Providers also expressed concern in maintaining confidentiality of patient data or other clinical data communicated using this system. The results of this study suggest that VOIP is still a developing technology but one that is currently viable in the clinical setting. The technology can be used efficiently and securely in health care if users are given the proper training its functions and capabilities. PMID:16478412

  14. Intensification of anxiety and depression, and personal resources among women during the peri-operative period

    Directory of Open Access Journals (Sweden)

    Magdalena Lewicka

    2014-03-01

    Full Text Available Aim. Surgical treatment of women due to gynaecological disorders is the cause of stress and may lead to psychological changes. Studies concerning human response to stress emphasize the importance of the effect of the level of the sense of coherence, anxiety, depression, dispositional optimism and skills of expressing emotions on the quality of feelings and experiences in difficult situations. Materials and methods. The study covered 232 women who had undergone gynaecological surgery due to various causes. Permission to conduct the research was obtained from the Bioethical Commission at the Medical University in Lublin. The study was carried out with the use of the State-Trait Anxiety Inventory (STAI, the Beck Depression Inventory, Courtauld Emotional Control Scale (CECS, and Life Orientation Test – Revised (LOT-R. Results and conclusions. The study showed that investigations of the sense of coherence, level of anxiety and depression, and personal resources allow determination of the characteristics of patients who should be covered with special psychoprophylactic care during the peri-operative period. In addition, the results of own studies obtained may be used for the development of adequate principles of psycho-prophylactic management in the course of the diagnostic-treatment proces with respect to women who had undergone surgical treatment due to gynaecological disorders.

  15. Novel Oral Anticoagulants: Recommendations for Patient Evaluation, Treatment Initiation, Follow-up and Perioperative Management.

    Science.gov (United States)

    Baumann, Stefan; Huseynov, Aydin; El-Battrawy, Ibrahim; Renker, Matthias; Akin, Ibrahim

    2015-01-01

    New oral anticoagulants (NOACs) are becoming available as alternatives to vitamin K antagonists (VKAs) to prevent systemic embolism in patients with non-valvular atrial fibrillation for the prevention and treatment of venous thromboembolism and pulmonary embolism. A comprehensive understanding of the basic concepts of hemostaseology, the underlying pharmacology, drug interactions and management of potential complications is essential for the selection of suitable patients to receive NOACs, for correct prescription and for optimal patient treatment. Furthermore, the use of NOACs in a perioperative setting is crucial, as it requires knowledge of time and dose of last intake of drug, current renal function and the planned procedure in order to assess the overall risk of bleeding. Although no antidote exists to reverse the effects of these novel drugs, selective substitution of coagulation factors and dialysis may be necessary. Therefore, choosing the most beneficial alternative to VKAs on an individual basis can be challenging for physicians. In conclusion, the recent introduction of NOACs represents an opportunity for anticoagulative treatment regimes, while the benefits, risks and limitations should be reflected carefully. The purpose of this systematic review is to highlight features and to provide practical guidance of NOACs in comparison with VKAs that should be considered in a multifaceted decision making process to improve efficacy and safety. PMID:26666330

  16. [Perioperative Challenges and Strategies for Patent Foramen Ovale Patients Undergoing Non-cardiac Surgery].

    Science.gov (United States)

    Wang, Tian; Zhu, Bin

    2015-08-01

    The close relationship between patent foramen ovale(PFO)and cryptogenic ischemic cerebrovascular disease and migraine has been concerned for years. However,in the field of non-cardiac surgery and anesthesiology, PFO and related clinical problems are less recognized. Under perioperative circumstances,PFO may generate many challenges such as paradoxical systematic embolism and severe hypoxemia. This article briefly introduces the epidemiology, paradoxical embolism, and detection methods of PFO and discribes the perioperative complications and corresponding perioperative strategies for prevention and cure. PMID:26564467

  17. Perioperative Glycemic Control in Plastic Surgery: Review and Discussion of an Institutional Protocol.

    Science.gov (United States)

    Dortch, John D; Eck, Dustin L; Ladlie, Beth; TerKonda, Sarvam P

    2016-07-01

    Perioperative hyperglycemia is a well-known risk factor for surgical morbidity such as wound healing, infection, and prolonged hospitalization. This association has been reported for a number of surgical subspecialties, including plastic surgery. Specialty-specific guidelines have become increasingly available in the literature. Currently, glucose management guidelines for plastic surgery are lacking. Recognizing that multiple approaches exist for perioperative glucose, protocol-based models provide the necessary structure and guidance for approaching glycemic control. In this article, we review the influence of diabetes on outcomes in plastic surgery patients and propose a practical approach to perioperative blood glucose management based on current Endocrine Society and Mayo Clinic institutional guidelines. PMID:27301370

  18. Policy recommendations on accelerating coordinated care delivery%加快实施分级诊疗工作的政策建议

    Institute of Scientific and Technical Information of China (English)

    赵琨; 肖月

    2015-01-01

    我国分级诊疗工作面临诸多挑战,如何加快分级诊疗工作,实现资源、服务和患者下沉,解决困扰居民的看病难和看病贵问题,是卫生决策者面临的重大决策问题。本研究分析了我国分级诊疗工作的难点,并基于分析对分级诊疗体系的建设提出了近期和中远期政策建议,包括构建更加科学合理的医疗服务体系,分步实施分级诊疗,建立相关的激励和约束机制,加强社会宣传和医患教育等。%Coordinated care delivery is faced with various challenges to carry out in China,which are major decisions to make for decision makers,including how to push forward,how to deliver resources, services and patients to primary institutions,and how to ease the difficulties and affordability of seeing doctors.Based on analysis of roadblocks in coordinated care delivery in China,the authors provided near-term and long-term policy recommendations on the system,including how to build a scientific and reasonable healthcare delivery system,coordinated care delivery by stages,building incentives and constraint mechanisms,and enhancing public awareness and patient-doctor education.

  19. Nursing team stress in the perioperative period: an integrative review

    Directory of Open Access Journals (Sweden)

    Dafne Eva Corrêa Brandão

    2013-09-01

    Full Text Available This integrative review aimed at analyzing evidences available in literature regarding stress levels in nursing teams during the perioperative period. Primary studies were searched in the following databases: PubMed, CINAHL and LILACS. Included studies were grouped into the following thematic categories: stress level in the workplace and stress factors (n=8 and stress coping strategies used by the nursing staff (n=6. Evidence suggests that stress in the workplace worsens the health of the nursing team, provoking undesirable effects both in the professional and personal lives of these professionals. The assessment of working conditions to identify the main stressing factors and the implementation of individual and organizational measures to reduce nursing teams stress may increase productivity and workers’ satisfaction, improving the assistance quality offered to surgical patients.

  20. The role of perioperative radiotherapy in gastric cancer

    Directory of Open Access Journals (Sweden)

    Thales Paulo Batista

    2012-12-01

    Full Text Available Gastric cancer is one of the most common neoplasms and a main cause of cancer-related mortality worldwide. Surgery remains the mainstay for cure and is considered for all patients with potentially curable disease. However, despite the fact that surgery alone usually leads to favorable outcomes in early stage disease, late diagnosis usually means a poor prognosis. In these settings, multimodal therapy has become the established treatment for locally advanced tumors, while the high risk of locoregional relapse has favored the inclusion of radiotherapy in the comprehensive therapeutic strategy. We provide a critical, non-systematic review of gastric cancer and discuss the role of perioperative radiation therapy in its treatment.

  1. A perioperative education program for pediatric patients and their parents.

    Science.gov (United States)

    Adams, Holly A

    2011-04-01

    Preparing pediatric patients for surgery is crucial to positive patient and parent experiences. Through preoperative screening, observation, and postoperative feedback, clinical staff nurses at the Yellowstone Surgery Center (YSC) in Billings, Montana, identified a need to provide increased information to pediatric patients and their parents regarding the surgical process and postoperative expectations for recovery. The director of nursing developed a program for patients that includes preoperative education and a hands-on experience. The YSC Kids program is a customizable program that includes nine initiatives designed specifically for children. The program has been shown to successfully educate pediatric patients and their parents about the entire perioperative process, thus easing their anxiety about an unfamiliar situation.

  2. Brugada syndrome and its relevance in the perioperative period

    Directory of Open Access Journals (Sweden)

    Dan Sorajja

    2015-01-01

    Full Text Available Brugada syndrome is an autosomal dominant genetic disorder associated with an increased risk of sudden cardiac death, as well as ventricular tachyarrhythmias.The defective cardiac sodium channels result in usual electrocardiographic findings of a coved-type ST elevation in precordial leads V1 to V3. The majority of patients have uncomplicated courses with anesthesia, surgery, and invasive procedures. However there is risk of worsening ST elevation and ventricular arrhythmias due to perioperative medications, surgical insult, electrolyte abnormalities, fever, autonomic nervous system tone, as well as other perturbations. Given the increasing numbers of patients with inherited conduction disorders presenting for non-cardiac surgery that are at risk of sudden cardiac death, safe anesthetic management depends upon a detailed knowledge of these conditions.

  3. [Role of anesthesiologist in prevention of perioperative infection].

    Science.gov (United States)

    Shime, Nobuaki

    2014-03-01

    Perioprative infection has a significant impact on outcome of surgical patients. Anesthesiologists have roles in reducing infection by application of appropriate prophylactic measures. Hand hygiene is a prerequisite when contacting patients in the operating room. Bundled-preventive approaches should be applied during insertion of intravascular lines, specifically central venous lines. Application of appropriate skin preparation and/or dressings with antiseptics is important. Appropriate selection of antimicrobials depending on surgeries and patients' background, and avoidance of periopeative hypothermia are significant preventive measures for surgical wound infection. To reduce postoperative pneumonia including ventilator-associated pneumonia, avoidance of aspiration during intubation process or mechanical ventilation is necessary. Tracheal tube with a subglottic secretion drainage port might be applied in patients anticipated to receive longer period of postoperative mechanical ventilation and to have a greater risk of postoperative pneumonia.

  4. Perioperative glucocorticoids in hip and knee surgery - benefit vs. harm?

    DEFF Research Database (Denmark)

    Lunn, T H; Kehlet, H

    2013-01-01

    with local glucocorticoid. All studies were small-sized and none sufficiently powered to meaningfully evaluate uncommon adverse events. Most of the local administration studies had poor scientific quality (high risk of bias). Due to clinical heterogeneity and poor scientific quality, no meta-analysis......Glucocorticoids are frequently used to prevent post-operative nausea and vomiting (PONV), and may be part of multimodal analgesic regimes. The objective of this review was to evaluate the overall benefit vs. harm of perioperative glucocorticoids in patients undergoing hip or knee surgery. A wide...... was performed. In conclusion, in addition to PONV reduction with low-dose systemic glucocorticoid, this review supports high-dose systemic glucocorticoid to ameliorate post-operative pain after hip and knee surgery. However, large-scale safety and dose-finding studies are warranted before final recommendations....

  5. Accelerator operations

    International Nuclear Information System (INIS)

    This section is concerned with the operation of both the tandem-linac system and the Dynamitron, two accelerators that are used for entirely different research. Developmental activities associated with the tandem and the Dynamitron are also treated here, but developmental activities associated with the superconducting linac are covered separately because this work is a program of technology development in its own right

  6. Advanced accelerators

    International Nuclear Information System (INIS)

    This report discusses the suitability of four novel particle acceleration technologies for multi-TeV particle physics machines: laser driven linear accelerators (linac), plasma beat-wave devices, plasma wakefield devices, and switched power and cavity wakefield linacs. The report begins with the derivation of beam parameters practical for multi-TeV devices. Electromagnetic field breakdown of materials is reviewed. The two-beam accelerator scheme for using a free electron laser as the driver is discussed. The options recommended and the conclusions reached reflect the importance of cost. We recommend that more effort be invested in achieving a self-consistent range of TeV accelerator design parameters. Beat-wave devices have promise for 1-100 GeV applications and, while not directly scalable to TeV designs, the current generation of ideas are encouraging for the TeV regime. In particular, surfatrons, finite-angle optical mixing devices, plasma grating accelerator, and the Raman forward cascade schemes all deserve more complete analysis. The exploitation of standard linac geometry operated in an unconventional mode is in a phase of rapid evolution. While conceptual projects abound, there are no complete designs. We recommend that a fraction of sponsored research be devoted to this approach. Wakefield devices offer a great deal of potential; trades among their benefits and constraints are derived and discussed herein. The study of field limitation processes has received inadequate attention; this limits experiment designers. The costs of future experiments are such that investment in understanding these processes is prudent. 34 refs., 12 figs., 3 tabs

  7. Comunicação terapêutica no cuidado pré-operatório de mastectomia Comunicación terapéutica en la atención pre-operatoria de mastectomía Therapeutic communication in perioperative care of mastectomy

    Directory of Open Access Journals (Sweden)

    Miria Conceição Lavinas Santos

    2010-08-01

    that the practice of therapeutic communication becomes a favorable practice, because establish the nurse-patient relationship, with patient producing his own care. Understanding the fragility of the patient at this stage, the nurse takes commitment to predefine the nursing care in partnership, in order to meet the patient needs, aiming to, mainly, the autonomy of care. In this way, the authors present a proposal for nursing managed care based on a mutal relationship, human and participatory care.

  8. Quality-of-care initiative in patients treated surgically for perforated peptic ulcer

    DEFF Research Database (Denmark)

    Møller, Morten Hylander; Larsson, Heidi Jeanet; Rosenstock, Steffen Jais;

    2013-01-01

    Mortality and morbidity are considerable after treatment for perforated peptic ulcer (PPU). Since 2003, a Danish nationwide quality-of-care (QOC) improvement initiative has focused on reducing preoperative delay, and improving perioperative monitoring and care for patients with PPU. The present...

  9. Risk stratification, perioperative and periprocedural management of the patient receiving anticoagulant therapy.

    Science.gov (United States)

    Oprea, Adriana D; Noto, Christopher J; Halaszynski, Thomas M

    2016-11-01

    As a result of the aging US population and the subsequent increase in the prevalence of coronary disease and atrial fibrillation, therapeutic use of anticoagulants has increased. Perioperative and periprocedural management of anticoagulated patients has become routine for anesthesiologists, who frequently mediate communication between the prescribing physician and the surgeon and assess the risks of both thromboembolic complications and hemorrhage. Data from randomized clinical trials on perioperative management of antithrombotic therapy are lacking. Therefore, clinical judgment is typically needed regarding decisions to continue, discontinue, bridge, or resume anticoagulation and regarding the time points when these events should occur in the perioperative period. In this review, we will discuss the most commonly used anticoagulants used in outpatient settings and discuss their management in the perioperative period. Special considerations for regional anesthesia and interventional pain procedures will also be reviewed. PMID:27687455

  10. Perioperative factors related to prognosis of regular hepatectomy in comparison with irregular hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Feng Zhiqiang; Li Hongqi; Zhang Jinqian; Xu Lining; Xiao Mei; Huang Zhiqiang; Zhang Hongyi

    2014-01-01

    Background The aim of this research was to analyze the perioperative factors of regular hepatectomy and irregular hepatectomy.The superiority of the clinical application of the two methods was compared in the perioperative period.Methods From 1986 to 2011,1798 patients underwent consecutive liver resections with regular hepatectomy and irregular hepatectomy at the Air Force General Hospital of People's Liberation Army and the General Hospital of Chinese People's Liberation Army.Their medical documentation was investigated retrospectively.Results In patients on whom regular hepatectomy and irregular hepatectomy were performed,there was no significant difference in perioperative blood loss,complications,in-hospital mortality,hospital stay,and so on.But in regular hepatectomy,operating time was an independent risk factor (P <0.001,OR=1.004).Conclusions There was no significant difference between the perioperative risk of regular hepatectomy and that of irregular hepatectomy.

  11. Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy.

    LENUS (Irish Health Repository)

    Burke, Siun M

    2010-04-01

    Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain.

  12. Development of a New Graduate Perioperative Nursing Program at an Urban Pediatric Institution.

    Science.gov (United States)

    Gorgone, Pamela D; Arsenault, Loretta; Milliman-Richard, Yolanda J; Lajoie, Debra L

    2016-07-01

    In 2012, perioperative personnel from Boston Children's Hospital began the process of planning for perioperative staff member attrition and retirement by developing a new graduate perioperative nursing program geared toward our pediatric urban academic institution. We selected two cohorts of new graduate nurses to begin the program in 2013. To date, two cohorts of six graduate nurses have completed the program and have been hired. Our new perioperative nurse retention rate is 100%. All of these nurses are currently practicing in the main OR at our facility. In one year, we recovered the initial program costs, which included the expenses incurred by hiring 12 full-time employees to replace more highly paid tenured RNs lost to attrition or retirement and training costs for new graduates. We believe the program has reduced overall long-term staffing costs and has prevented disruption to services as a result of unexpected vacancies from retirements and resignations. PMID:27350352

  13. Perioperative Risk Factors Related to Lumbar Spine Fusion Surgery in Korean Geriatric Patients

    OpenAIRE

    Lee, Jung-Hyun; Chun, Hyoung-Joon; Yi, Hyeong-Joong; Bak, Koang Hum; Ko, Yong; Lee, Yoon Kyoung

    2012-01-01

    Objective Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complic...

  14. Perioperative Statin Therapy Is Not Associated With Reduced Risk of Anastomotic Leakage After Colorectal Resection

    DEFF Research Database (Denmark)

    Bisgård, Anne Sofie; Noack, Morten Westergaard; Klein, Mads;

    2013-01-01

    Anastomotic leakage is a serious complication of colorectal surgery. Several studies have demonstrated the beneficial pleiotropic effects of statins, and preliminary studies have suggested that perioperative statin treatment may be associated with reduced risk of anastomotic leakage.......Anastomotic leakage is a serious complication of colorectal surgery. Several studies have demonstrated the beneficial pleiotropic effects of statins, and preliminary studies have suggested that perioperative statin treatment may be associated with reduced risk of anastomotic leakage....

  15. Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery

    OpenAIRE

    Mebazaa, A; Pitsis, AA; Rudiger, A.; Toller, W; Longrois, D; Ricksten, SE; Bobek, I.; De Hert, S; Wieselthaler, G; Schirmer, U; von Segesser, LK; Sander, M; Poldermans, D; Ranucci, M.; Karpati, PCJ

    2010-01-01

    Acute cardiovascular dysfunction occurs perioperatively in more than 20% of cardiosurgical patients, yet current acute heart failure (HF) classification is not applicable to this period. Indicators of major perioperative risk include unstable coronary syndromes, decompensated HF, signifi cant arrhythmias and valvular disease. Clinical risk factors include history of heart disease, compensated HF, cerebrovascular disease, presence of diabetes mellitus, renal insufficiency and high-risk surgery...

  16. Increased long-term mortality after a high perioperative inspiratory oxygen fraction during abdominal surgery

    DEFF Research Database (Denmark)

    Meyhoff, Christian Sylvest; Jorgensen, Lars N; Wetterslev, Jørn;

    2012-01-01

    A high perioperative inspiratory oxygen fraction (80%) has been recommended to prevent postoperative wound infections. However, the most recent and one of the largest trials, the PROXI trial, found no reduction in surgical site infection, and 30-day mortality was higher in patients given 80% oxygen....... In this follow-up study of the PROXI trial we assessed the association between long-term mortality and perioperative oxygen fraction in patients undergoing abdominal surgery....

  17. Alveolar recruitment maneuver and perioperative ventilatory support in obese patients undergoing abdominal surgery.

    Science.gov (United States)

    Forgiarini Júnior, Luiz Alberto; Rezende, Juliana Castilhos; Forgiarini, Soraia Genebra Ibrahim

    2013-01-01

    The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the implementation of alveolar recruitment maneuvers in obese patients undergoing abdominal surgery are described. PMID:24553513

  18. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study

    OpenAIRE

    Rakesh Garg; Puneet Khanna; Renu Sinha

    2011-01-01

    An osteo-odonto-keratoprosthesis (OOKP) procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males) underwent t...

  19. KEKB accelerator

    International Nuclear Information System (INIS)

    KEKB, the B-Factory at High Energy Accelerator Research Organization (KEK) recently achieved the luminosity of 1 x 1034 cm-2s-1. This luminosity is two orders higher than the world's level at 1990 when the design of KEKB started. This unprecedented result was made possible by KEKB's innovative design and technology in three aspects - beam focusing optics, high current storage, and beam - beam interaction. Now KEKB is leading the luminosity frontier of the colliders in the world. (author)

  20. Accelerating networks

    International Nuclear Information System (INIS)

    Evolving out-of-equilibrium networks have been under intense scrutiny recently. In many real-world settings the number of links added per new node is not constant but depends on the time at which the node is introduced in the system. This simple idea gives rise to the concept of accelerating networks, for which we review an existing definition and-after finding it somewhat constrictive-offer a new definition. The new definition provided here views network acceleration as a time dependent property of a given system as opposed to being a property of the specific algorithm applied to grow the network. The definition also covers both unweighted and weighted networks. As time-stamped network data becomes increasingly available, the proposed measures may be easily applied to such empirical datasets. As a simple case study we apply the concepts to study the evolution of three different instances of Wikipedia, namely, those in English, German, and Japanese, and find that the networks undergo different acceleration regimes in their evolution

  1. Normal carcinoembryonic antigen indicates benefit from perioperative chemotherapy to gastric carcinoma patients

    Institute of Scientific and Technical Information of China (English)

    Shi Chen; Ying-Bo Chen; Yuan-Fang Li; Xing-Yu Feng; Zhi-Wei Zhou; Xiu-Hong Yuan; Chao-Nan Qian

    2012-01-01

    AIM:To evaluate pretreatment serum carcinoembryonic antigen (CEA) as a predictor of survival for patients with locally advanced gastric cancer receiving perioperative chemotherapy.METHODS:We retrospectively studied a cohort of 228gastric cancer patients who underwent D2 gastrectomy combined with chemotherapy at the Sun Yat-sen University Cancer Center between January 2005 and December 2009.Among them,168 patients received 6-12 cycles of oxaliplatin-based adjuvant (post-operative) chemotherapy,while 60 received perioperative chemotherapy (2 cycles of FOLFOX6 or XELOX before surgery and 4-10 cycles after surgery).Serum CEA was measured using an enzyme immunoassay.The followup lasted until December 2010.RESULTS:In the group that had elevated serum CEA,the difference in survival time between patients receiving perioperative chemotherapy and those receiving adjuvant chemotherapy had no statistical significance (P >0.05).However,in the group that had normal serum CEA,patients receiving perioperative chemotherapy had a longer survival time.In multivariate analysis,T staging and lymph node metastatic rate were independent prognostic factors for the patients.Perioperative chemotherapy improved the overall survival of patients who had a normal pretreatment CEA level (P =0.070).CONCLUSION:Normal pretreatment serum CEA is a predictor of survival for patients receiving perioperative chemotherapy.

  2. Collaborating With Music Therapists to Improve Patient Care.

    Science.gov (United States)

    Palmer, Jaclyn Bradley; Lane, Deforia; Mayo, Diane

    2016-09-01

    Collaboration between perioperative nurses and music therapists can be beneficial in providing a safe, cost-effective means of managing patients' anxiety and pain and reducing the need for pharmacologic intervention in the perioperative setting. The use of a board-certified music therapist may help to improve patient outcomes, ease nurse workload, and serve as an adjunct therapeutic modality that is enjoyable for both patients and staff members. We conducted a two-year, randomized controlled trial to determine how to best implement a music therapy program, navigate its challenges, and collaborate with nurse colleagues to bring its benefits to surgical patients. This article offers suggestions for alliances between perioperative nursing and music therapy staff members and describes the potential of music therapists to help provide optimal patient care.

  3. Collaborating With Music Therapists to Improve Patient Care.

    Science.gov (United States)

    Palmer, Jaclyn Bradley; Lane, Deforia; Mayo, Diane

    2016-09-01

    Collaboration between perioperative nurses and music therapists can be beneficial in providing a safe, cost-effective means of managing patients' anxiety and pain and reducing the need for pharmacologic intervention in the perioperative setting. The use of a board-certified music therapist may help to improve patient outcomes, ease nurse workload, and serve as an adjunct therapeutic modality that is enjoyable for both patients and staff members. We conducted a two-year, randomized controlled trial to determine how to best implement a music therapy program, navigate its challenges, and collaborate with nurse colleagues to bring its benefits to surgical patients. This article offers suggestions for alliances between perioperative nursing and music therapy staff members and describes the potential of music therapists to help provide optimal patient care. PMID:27568531

  4. ACCELERATION PHYSICS CODE WEB REPOSITORY.

    Energy Technology Data Exchange (ETDEWEB)

    WEI, J.

    2006-06-26

    In the framework of the CARE HHH European Network, we have developed a web-based dynamic accelerator-physics code repository. We describe the design, structure and contents of this repository, illustrate its usage, and discuss our future plans, with emphasis on code benchmarking.

  5. Accelerators and the Accelerator Community

    Energy Technology Data Exchange (ETDEWEB)

    Malamud, Ernest; Sessler, Andrew

    2008-06-01

    In this paper, standing back--looking from afar--and adopting a historical perspective, the field of accelerator science is examined. How it grew, what are the forces that made it what it is, where it is now, and what it is likely to be in the future are the subjects explored. Clearly, a great deal of personal opinion is invoked in this process.

  6. [Perioperative analgesia in adults : The concept of balanced analgesia.].

    Science.gov (United States)

    Jage, J

    1993-09-01

    The spectrum of perioperative pain treatment is discussed in the present review. The analgesic efficacy of various drugs and the dosage methods of administration and side effects reported for them in such reference works as the practical guide on the management of acute pain recently published by the International Association for the Study of Pain (IASP) are described. Effective postoperative analgesia can diminish stress reactions following surgery. Recovery and physical mobilization are improved as the result of adequate treatment. Results obtained in recent studies have demonstrated that primary adaptive hyperalgesia in the peripheral nociceptive area may develop into secondary maladaptive hypersensibility with a high degree of nociceptive excitability and pain. Chronic pain can develop following acute alterations. Increasing nociceptive activity of primary afferents induces alterations in the dorsal horn of the spinal cord. These alterations imply an increase in the excitability of nociceptive neurons, which has been described as neuronal plasticity. Clinical results have demonstrated prevention or delay of acute postoperative pain after injection of local anaesthetics, analgesic premedication or epidural injection of opioids just before the start of surgery. Continuous perioperative spinal analgesia has contributed significantly to the prevention of phantom limb pain in patients undergoing amputation of extremities. The development of pain memory may be prevented as a result of effective acute pain treatment. Several changes to the terminology of acute pain treatment for animal and clinical studies have recently been proposed, including such new terms as preemptive analgesia and pain prevention, which indicate new strategies in the treatment of postoperative pain. The concept of balanced analgesia refers to a strategy for the improvement of analgesic efficacy as a result of a combination of drugs with different local actions on nociception. The combination of

  7. Can Perioperative Chemotherapy for Advanced Gastric Cancer Be Recommended on the Basis of Current Research? A Critical Analysis

    OpenAIRE

    Bauer, Katrin; Porzsolt, Franz; Henne-Bruns, Doris

    2014-01-01

    Purpose According to current guidelines, perioperative chemotherapy is an integral part of the treatment strategy for advanced gastric cancer. Randomized controlled studies have been conducted in order to determine whether perioperative chemotherapy leads to improved R0 resection rates, fewer recurrences, and prolonged survival. The aim of our project was to critically appraise three major studies to establish whether perioperative chemotherapy for advanced, potentially resectable gastric can...

  8. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery.

    Science.gov (United States)

    Smith, Justin S; Klineberg, Eric; Lafage, Virginie; Shaffrey, Christopher I; Schwab, Frank; Lafage, Renaud; Hostin, Richard; Mundis, Gregory M; Errico, Thomas J; Kim, Han Jo; Protopsaltis, Themistocles S; Hamilton, D Kojo; Scheer, Justin K; Soroceanu, Alex; Kelly, Michael P; Line, Breton; Gupta, Munish; Deviren, Vedat; Hart, Robert; Burton, Douglas C; Bess, Shay; Ames, Christopher P

    2016-07-01

    OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82

  9. accelerating cavity

    CERN Multimedia

    On the inside of the cavitytThere is a layer of niobium. Operating at 4.2 degrees above absolute zero, the niobium is superconducting and carries an accelerating field of 6 million volts per metre with negligible losses. Each cavity has a surface of 6 m2. The niobium layer is only 1.2 microns thick, ten times thinner than a hair. Such a large area had never been coated to such a high accuracy. A speck of dust could ruin the performance of the whole cavity so the work had to be done in an extremely clean environment.

  10. Advocating for Grade-Based Acceleration

    Science.gov (United States)

    Guilbault, Keri M.

    2014-01-01

    Parents often struggle with the decision to accelerate their child and may worry about social and emotional issues, although research indicates positive effects on the social and emotional adjustment of carefully selected accelerants. As children's advocates, parents can work effectively with a school system to secure an appropriate academic…

  11. The impact of peripheral nerve blocks on perioperative outcome in hip and knee arthroplasty-a population-based study.

    Science.gov (United States)

    Memtsoudis, Stavros G; Poeran, Jashvant; Cozowicz, Crispiana; Zubizarreta, Nicole; Ozbek, Umut; Mazumdar, Madhu

    2016-10-01

    The role of anesthesia techniques on perioperative outcomes on a population level has recently gained widespread interest. Although mainly neuraxial vs general anesthesia has been addressed, population-level data on the impact of peripheral nerve blocks (PNBs) are still lacking. Therefore, we investigated the association between PNB use and outcomes using retrospective data on 1,062,152 recipients of hip and knee arthroplasties (total hip arthroplasty [THA]/total knee arthroplasty [TKA]) from the national Premier Perspective database (2006-2013). Multilevel multivariable logistic regression models measured associations between PNB use and outcomes. Complications included cardiac, pulmonary, gastrointestinal and renal complications, cerebrovascular events, infections, wound complications, thromboembolic complications, inpatient falls, and mortality. Resource utilization variables included blood transfusions, intensive care unit admissions, opioid consumption, cost, and length of stay. Overall, 12.5% of patients received a PNB, with an increase over time particularly among TKAs. Peripheral nerve block use was associated with lower odds for most adverse outcomes mainly among patients with THA. Notable beneficial effects were seen for wound complications (odds ratio 0.60 [95% confidence interval, 0.49-0.74]) among THA recipients and pulmonary complications (odds ratio 0.83 [95% confidence interval, 0.72-0.94]) in patients with TKA. Peripheral nerve block use was significantly (P < 0.0001) associated with a -16.2% and -12.7% reduction in opioid consumption for patients with THA and TKA, respectively. In conclusion, our results indicate that PNBs might be associated with superior perioperative population-level outcomes. In light of the inability to establish a causal relationship and the presence of residual confounding, we strongly advocate for further prospective investigation, ideally in multicenter, randomized trials, to establish the potential impact of PNBs on

  12. Application of electron accelerator worldwide

    Energy Technology Data Exchange (ETDEWEB)

    Machi, Sueo [Japan Atomic Industrial Forum, Inc., Tokyo (Japan)

    2003-02-01

    Electron accelerator is an important radiation source for radiation technology, which covers broad fields such as industry, health care, food and environmental protection. There are about 1,000 electron accelerators for radiation processing worldwide. Electron accelerator has advantage over Co-60 irradiator in term of high dose rate and power, assurance of safety, and higher economic performance at larger volume of irradiation. Accelerator generating higher energy in the range of 10 MeV and high power electron beam is now commercially available. There is a trend to use high-energy electron accelerator replacing Co-60 in case of large through-put of medical products. Irradiated foods, in particular species, are on the commercial market in 35 countries. Electron accelerator is used efficiently and economically for production of new or modified polymeric materials through radiation-induced cross-linking, grafting and polymerization reaction. Another important application of electron beam is the curing of surface coatings in the manufacture of products. Electron accelerators of large capacity are used for cleaning exhaust gases in industrial scale. Economic feasibility studies of this electron beam process have shown that this technology is more cost effective than the conventional process. It should be noted that the conventional limestone process produce gypsum as a by-product, which cannot be used in some countries. By contrast, the by-product of the electron beam process is a valuable fertilizer. (Y. Tanaka)

  13. Application of electron accelerator worldwide

    International Nuclear Information System (INIS)

    Electron accelerator is an important radiation source for radiation technology, which covers broad fields such as industry, health care, food and environmental protection. There are about 1,000 electron accelerators for radiation processing worldwide. Electron accelerator has advantage over Co-60 irradiator in term of high dose rate and power, assurance of safety, and higher economic performance at larger volume of irradiation. Accelerator generating higher energy in the range of 10 MeV and high power electron beam is now commercially available. There is a trend to use high-energy electron accelerator replacing Co-60 in case of large through-put of medical products. Irradiated foods, in particular species, are on the commercial market in 35 countries. Electron accelerator is used efficiently and economically for production of new or modified polymeric materials through radiation-induced cross-linking, grafting and polymerization reaction. Another important application of electron beam is the curing of surface coatings in the manufacture of products. Electron accelerators of large capacity are used for cleaning exhaust gases in industrial scale. Economic feasibility studies of this electron beam process have shown that this technology is more cost effective than the conventional process. It should be noted that the conventional limestone process produce gypsum as a by-product, which cannot be used in some countries. By contrast, the by-product of the electron beam process is a valuable fertilizer. (Y. Tanaka)

  14. Esophageal Carcinoma Histology Affects Perioperative Morbidity Following Open Esophagogastrectomy

    Directory of Open Access Journals (Sweden)

    Charles E. Woodall

    2008-01-01

    Full Text Available Background. Esophagectomy for esophageal cancer is being practiced routinely with favorable results at many centers. We sought to determine if tumor histology is a powerful surrogate marker for perioperative morbidity. Methods. Seventy three consecutive patients managed operatively were reviewed from our prospectively maintained database. Results. Adenocarcinoma (AC was present in 52 (71% and squamous cell (SCC in 21 (29%. The use of neoadjuvant therapy was similar for the AC (34.62% and SCC (42.86% groups. The SCC group had a higher incidence of prior pulmonary disease than the AC group (23.8% versus 5.8%, resp.; =.03. SCC patients were more likely to have a prolonged ICU stay than AC patients (=.004 despite similar complication rates, EBL, and prognostic nutritional index. The SCC group did, however, experience higher grades of complications (=.0053. Conclusions. Presence of SCC was the single best predictor of prolonged ICU stay and more severe complications as defined by this study. Only a past history of pulmonary disease was different between the two histologic subgroups.

  15. Perioperative tranexamic acid in day-case paediatric tonsillectomy

    Science.gov (United States)

    Thorning, G

    2014-01-01

    Introduction Tranexamic acid has been used for many years to minimise blood loss during surgery and, more recently, to reduce morbidity after major trauma. While small studies have confirmed reduction in blood loss during tonsillectomy with its use, the rate of primary haemorrhage following tonsillectomy has not been reported. In the UK, less than 50% of children having a tonsillectomy are managed as day cases, partly because of concerns about bleeding during the initial 24 hours following surgery. Methods A retrospective review of clinical records between January 2007 and January 2013 produced 476 children between the ages of 3 and 16 years who underwent Coblation™ tonsillectomy, with or without adenoidectomy and/or insertion of ventilation tubes. All children were ASA (American Society of Anesthesiologists) grade 1 or 2 and anaesthetised using a standard day surgery protocol. Following induction of anaesthesia, all received intravenous tranexamic acid at a dose of 10–15mg/kg. Results Two children (0.4%) had minor bleeding within two hours of surgery. Both returned to theatre for haemostasis and were discharged home later the same day with no further complications. The expected rate for primary haemorrhage in the UK using this technique for tonsillectomy is 1%. Conclusions Perioperative tranexamic acid in a single, parenteral dose might reduce the incidence of primary haemorrhage following paediatric tonsillectomy, facilitating discharge on the day of surgery. The results from this observational study indicate a potential benefit and need for a large, prospective, multicentre, randomised controlled trial. PMID:24780670

  16. Determinants of perioperative morbidity and mortality after pneumonectomy

    International Nuclear Information System (INIS)

    A total of 197 consecutive patients undergoing pneumonectomy at the M.D. Anderson Cancer Center from 1982 to 1987 were reviewed. Sixty-five variables were analyzed for the predictive value for perioperative risk. The operative mortality rate was 7% (14/197). Patients having a right pneumonectomy (n = 95) had a higher operative mortality rate (12%) than patients having a left pneumonectomy (1%, p less than 0.05). The extent of resection correlated with the operative mortality rate (chest wall resection or extrapleural pneumonectomy, n = 39, 15%; versus simple or intrapericardial pneumonectomy, n = 158, 5%; p less than 0.05). Patients whose predicted postoperative pulmonary function, by spirometry and xenon 133 regional pulmonary function studies, was a forced expiratory volume in 1 second greater than 1.65 L, forced expiratory volume in 1 second greater than 58% of the preoperative value, forced vital capacity greater than 2.5 L, or forced vital capacity greater than 60% of the preoperative value had a lower operative mortality rate (p less than 0.05). Atrial arrhythmia was the most common postoperative complication (23%). Xenon 133 regional pulmonary function studies are useful in predicting the risks of pneumonectomy

  17. Linac transport and acceleration

    International Nuclear Information System (INIS)

    The acceleration of intense bunches maintaining high brightness is limited both by single-particle effects, e.g., misalignments, injection errors, and rf-steering, and collective phenomena, where the effects of the longitudinal and transverse wakefield on particles within a single bunch are the most severe. The working group has considered both problems and potentials of linac acceleration from ∼50 MeV to 1 GeV for free electron laser (FEL) applications, as well as from a few Gev to 1 TeV for linear colliders. The outlook for free electron lasers is bright: no fundamental problems seem to arise in the acceleration of peak currents in excess of 100 A with small emittance and low momentum spread. The situation of linear colliders is more complex and more difficult. Two examples, one operating at 11.4 GHz, the other at 30 GHz, are used to illustrate some of the difficulties and the exceedingly tight tolerances required. Both examples are based on round beams, and thus neither benefit from the advantages of flat beams nor address the increased care required in transporting beams of very small emittance in one plane. The working group acknowledges, but did not explore, promising concepts for colliders based on RF superconductivity

  18. Analysis on Clinical Nursing of Patient with Pneumothorax During Perioperative Period%气胸围手术期的患者临床护理分析

    Institute of Scientific and Technical Information of China (English)

    蔡艳玲

    2014-01-01

    Objective Clinical treatment effects and analysis of the patients with pneumothorax during perioperative period are to be investigated. Methods Systematic plan is needed for nursing of the patients with pneumothorax during perioperative period. Results After the surgery treatment of the patients with pneumothorax,there is a significant effect of clinical nursing. Conclusion The surgery treatment should be conducted for the patient with pneumothorax with postoperative drainage and rational usage of antibiotics,which can reduce the adverse reactions of patients effectively and the incidence of complications to accelerate the patients to get wel soon.%目的:探讨气胸围手术期的患者临床护理效果及分析。方法有计划的针对气胸围手术期的患者进行护理。结果对气胸患者实施手术治疗,临床护理效果显著,结论针对气胸患者实施手术治疗,术后充分引流,合理使用抗生素。有效降低患者不良反应及并发症的发生率,促进患者早日康复。

  19. Preoperative interscalene brachial plexus block aids in perioperative temperature management during arthroscopic shoulder surgery

    Science.gov (United States)

    Lim, Se Hun; Lee, Wonjin; Park, JaeGwan; Kim, Myoung-hun; Cho, Kwangrae; Lee, Jeong Han; Cheong, Soon Ho

    2016-01-01

    Background Hypothermia is common during arthroscopic shoulder surgery under general anesthesia, and anesthetic-impaired thermoregulation is thought to be the major cause of hypothermia. This prospective, randomized, double-blind study was designed to compare perioperative temperature during arthroscopic shoulder surgery with interscalene brachial plexus block (IBPB) followed by general anesthesia vs. general anesthesia alone. Methods Patients scheduled for arthroscopic shoulder surgery were randomly allocated to receive IBPB followed by general anesthesia (group GB, n = 20) or general anesthesia alone (group GO, n = 20), and intraoperative and postoperative body temperatures were measured. Results The initial body temperatures were 36.5 ± 0.3℃ vs. 36.4 ± 0.4℃ in group GB vs. GO, respectively (P = 0.215). The body temperature at 120 minutes after induction of anesthesia was significantly higher in group GB than in group GO (35.8 ± 0.3℃ vs. 34.9 ± 0.3℃; P < 0.001). The body temperatures at 60 minutes after admission to the post-anesthesia care unit were 35.8 ± 0.3℃ vs. 35.2 ± 0.2℃ in group GB vs. GO, respectively (P < 0.001). The concentrations of desflurane at 0, 15, and 120 minutes after induction of anesthesia were 6.0 vs. 6.0% (P = 0.330), 5.0 ± 0.8% vs. 5.8 ± 0.4% (P = 0.001), and 3.4 ± 0.4% vs. 7.1 ± 0.9% (P < 0.001) in group GB vs. GO, respectively. Conclusions The present study demonstrated that preoperative IBPB could reduce both the intraoperative concentration of desflurane and the reduction in body temperature during and after arthroscopic shoulder surgery.

  20. The use of relaxation techniques in the perioperative management of proctological patients: preliminary results.

    Science.gov (United States)

    Renzi, C; Peticca, L; Pescatori, M

    2000-11-01

    Relaxation techniques positively affect the psychosomatic pattern of patients undergoing surgical treatment. Among these techniques guided imaging (GI) has been reported to improve outcome following colorectal surgery. This study assessed the effects of GI on the postoperative course in proctological patients. We carried out a prospective randomized trial in a group of patients operated on for anorectal diseases in our coloproctology unit. Patients were randomized into group 1 (n = 43) with standard care and group 2 (n = 43) with relaxation techniques; they listened to a GI tape with music and relaxing text before, during, and after surgery. The following parameters were evaluated by a questionnaire (a) postoperative pain measured by visual analogue score, (b) the quality of sleep measured by a similar score, and (c) the nature of first micturition, evaluated as normal or difficult. Groups were similar in age and sex distribution, type of disease, and operation performed. The pain score was 3.2 +/- 1.4 in GI patients and 4.1 +/- 2.1 in controls (P = 0.07). The quality of sleep score was 4.8 +/- 2.9 in GI patients and 6.4 +/- 2.7 in controls (P = 0.01). The first micturition was painful in 10.3% of GI patients and in 27.3% of controls (P = 0.09). Perioperative relaxation techniques thus showed a trend to reducing pain following anorectal surgery and significantly improving the quality of sleep; a decrease in anxiety and a consequent muscle relaxation may be involved. Therefore GI, a low cost and noninvasive procedure, can be recommended as an helpful tool in this type of surgery. PMID:11151436

  1. The Emory University Perioperative Algorithm for the Management of Hyperglycemia and Diabetes in Non-cardiac Surgery Patients.

    Science.gov (United States)

    Duggan, Elizabeth W; Klopman, Matthew A; Berry, Arnold J; Umpierrez, Guillermo

    2016-03-01

    Hyperglycemia is a frequent manifestation of critical and surgical illness, resulting from the acute metabolic and hormonal changes associated with the response to injury and stress (Umpierrez and Kitabchi, Curr Opin Endocrinol. 11:75-81, 2004; McCowen et al., Crit Care Clin. 17(1):107-24, 2001). The exact prevalence of hospital hyperglycemia is not known, but observational studies have reported a prevalence of hyperglycemia ranging from 32 to 60 % in community hospitals (Umpierrez et al., J Clin Endocrinol Metab. 87(3):978-82, 2002; Cook et al., J Hosp Med. 4(9):E7-14, 2009; Farrokhi et al., Best Pract Res Clin Endocrinol Metab. 25(5):813-24, 2011), and 80 % of patients after cardiac surgery (Schmeltz et al., Diabetes Care 30(4):823-8, 2007; van den Berghe et al., N Engl J Med. 345(19):1359-67, 2001). Retrospective and randomized controlled trials in surgical populations have reported that hyperglycemia and diabetes are associated with increased length of stay, hospital complications, resource utilization, and mortality (Frisch et al., Diabetes Care 33(8):1783-8, 2010; Kwon et al., Ann Surg. 257(1):8-14, 2013; Bower et al., Surgery 147(5):670-5, 2010; Noordzij et al., Eur J Endocrinol. 156(1):137-42, 2007; Mraovic et al., J Arthroplasty 25(1):64-70, 2010). Substantial evidence indicates that correction of hyperglycemia reduces complications in critically ill, as well as in general surgery patients (Umpierrez et al., J Clin Endocrinol Metab. 87(3):978-82, 2002; Clement et al., Diabetes Care 27(2):553-97, 2004; Pomposelli et al., JPEN J Parented Enteral Nutr. 22(2):77-81, 1998). This manuscript reviews the pathophysiology of stress hyperglycemia during anesthesia and the perioperative period. We provide a practical outline for the diagnosis and management of preoperative, intraoperative, and postoperative care of patients with diabetes and hyperglycemia. PMID:26971119

  2. The Emory University Perioperative Algorithm for the Management of Hyperglycemia and Diabetes in Non-cardiac Surgery Patients.

    Science.gov (United States)

    Duggan, Elizabeth W; Klopman, Matthew A; Berry, Arnold J; Umpierrez, Guillermo

    2016-03-01

    Hyperglycemia is a frequent manifestation of critical and surgical illness, resulting from the acute metabolic and hormonal changes associated with the response to injury and stress (Umpierrez and Kitabchi, Curr Opin Endocrinol. 11:75-81, 2004; McCowen et al., Crit Care Clin. 17(1):107-24, 2001). The exact prevalence of hospital hyperglycemia is not known, but observational studies have reported a prevalence of hyperglycemia ranging from 32 to 60 % in community hospitals (Umpierrez et al., J Clin Endocrinol Metab. 87(3):978-82, 2002; Cook et al., J Hosp Med. 4(9):E7-14, 2009; Farrokhi et al., Best Pract Res Clin Endocrinol Metab. 25(5):813-24, 2011), and 80 % of patients after cardiac surgery (Schmeltz et al., Diabetes Care 30(4):823-8, 2007; van den Berghe et al., N Engl J Med. 345(19):1359-67, 2001). Retrospective and randomized controlled trials in surgical populations have reported that hyperglycemia and diabetes are associated with increased length of stay, hospital complications, resource utilization, and mortality (Frisch et al., Diabetes Care 33(8):1783-8, 2010; Kwon et al., Ann Surg. 257(1):8-14, 2013; Bower et al., Surgery 147(5):670-5, 2010; Noordzij et al., Eur J Endocrinol. 156(1):137-42, 2007; Mraovic et al., J Arthroplasty 25(1):64-70, 2010). Substantial evidence indicates that correction of hyperglycemia reduces complications in critically ill, as well as in general surgery patients (Umpierrez et al., J Clin Endocrinol Metab. 87(3):978-82, 2002; Clement et al., Diabetes Care 27(2):553-97, 2004; Pomposelli et al., JPEN J Parented Enteral Nutr. 22(2):77-81, 1998). This manuscript reviews the pathophysiology of stress hyperglycemia during anesthesia and the perioperative period. We provide a practical outline for the diagnosis and management of preoperative, intraoperative, and postoperative care of patients with diabetes and hyperglycemia.

  3. Extended Perioperative Antibiotic Coverage in Conjunction with Intraoperative Bile Cultures Decreases Infectious Complications after Pancreaticoduodenectomy

    Science.gov (United States)

    Fathi, Amir H.; Jackson, Terence; Barati, Mehdi; Eghbalieh, Babak; Siegel, Kelly A.; Siegel, Christopher T.

    2016-01-01

    Background. Bile contamination from the digestive tract is a well-known risk factor for postoperative complications. Despite the literature concerning prevalence of bacterobilia and fungobilia in patients with biliary pathologies, there are no specific recommendations for perioperative antimicrobial coverage for biliary/pancreatic procedures. We evaluated the effect of at least 72 hours of perioperative broad spectrum antibiotic coverage on outcomes of pancreaticoduodenectomy (PD). Materials and Methods. A retrospective review of all patients at Case Medical Center of Case Western Reserve University undergoing PD procedure, from 2006 to 2011, was performed (n = 122). Perioperative data including demographics, comorbidities, biliary instrumentation, antibiotic coverage, culture results, and postoperative outcomes were analyzed. Propensity score matching method was used to match the patients according to duration of antibiotic coverage into two groups: 72 hours (A72) and 24 hours (A24). Results. Longer broad spectrum antibiotic coverage in group A72 resulted in significantly less surgical site infections after PD, compared to routine 24 hours of perioperative antibiotics in group A24. This study did not reveal a statistically significant decrease in postoperative fungal infections in patients receiving preoperative antifungals. Conclusion. Prolonged perioperative antibiotic therapy in conjunction with intraoperative bile cultures decreases the short-term infectious complications of PD, with no significant increase in Clostridium difficile colitis incidence. PMID:27147813

  4. Perioperative core body temperatures effect on outcome after colorectal resections.

    Science.gov (United States)

    Geiger, Timothy M; Horst, Sara; Muldoon, Roberta; Wise, Paul E; Enrenfeld, Jesse; Poulose, Ben; Herline, Alan J

    2012-05-01

    The World Health Organization has set a standard of maintaining a core body temperature above 36°C in the perioperative period. The purpose of this study was to examine the relationship between both intraoperative temperature (IOT) and immediate postop core body temperature as it relates to postop complications. A retrospective analysis of a prospective database of patients who underwent an elective segmental colectomy without a stoma, for 3 diagnoses was performed. Six postoperative outcomes were examined: length of stay (LOS), placement of a nasogastric tube, return to the operating room, placement of an interventional drain, diagnosed leak, and surgical site infection (SSI). Statistics were calculated using a two-sample Wilcoxon rank-sum (Mann-Whitney) test. Seventy-nine patients met the inclusion criteria and there were no preoperative differences between the groups (those with a postop complication vs without). LOS > 9 days (36.64°C vs 35.98°C; P = 0.011) and clinical leak (37.06°C vs 35.99°C; P = 0.005) both had a statistically higher average IOT than those who did not. Patients with SSI trended to a higher IOT (36.44°C vs 35.99°C; P = 0.062). When the last IOT recorded was compared with the six outcomes, again length of stay and leak both were statistically significant (P = 0.018, P = 0.012) showing a higher temperature related to a higher complication rate. No other complications were related to IOT, nor did postop temperature relate to complication. In our data, relatively lower IOTs were protective for LOS and clinical leaks, with a trend of lower SSI rates. Further research is needed to fully endorse or refute the absolute recommendations for core body temperature.

  5. Does surgical resection of hepatocellular carcinoma accelerate cancer dissemination?

    Institute of Scientific and Technical Information of China (English)

    I-Shyan Sheen; Yi-Chun Tsai; Tsu-Yen Wu; Kuo-Shyang Jeng; Shou-Chuan Shih; Po-Chuan Wang; Wen-Hsiung Chang; Horng-Yuan Wang; Li-Rung Shyung; Shee-Chan Lin; Chin-Roa Kao

    2004-01-01

    recurrence (58% vs.39%, P=0.093). The correlation between perioperative hAFP mRNA positivity and recurrence related mortality had no statistical significance (P=0.836).CONCLUSION: From our study, perioperative detection of hAFP mRNA in peripheral blood of patients has no clinical relevance and significant role in the prediction of HCC recurrence. Surgical resection itself may not accelerate cancer dissemination and does not increase postoperative recurrence significantly either.

  6. Risk factors for perioperative major cardiac events in Chinese elderly patients with coronary heart disease undergoing noncardiac surgery

    Institute of Scientific and Technical Information of China (English)

    LIU Zi-jia; YU Chun-hua; XU Li; HAN Wei; JIANG Jing-mei; HUANG Yu-guang

    2013-01-01

    Background Few studies have investigated perioperative major adverse cardiac events (MACEs) in elderly Chinese patients with coronary heart disease (CHD) undergoing noncardiac surgery.This study examined the incidence and risk factors for perioperative MACE in elderly patients who underwent noncardiac surgery,and established a risk stratification system.Methods This retrospective observational clinical study included 482 patients aged >60 years with CHD who underwent elective major noncardiac surgery at the Peking Union Medical College Hospital.The primary outcome was MACE within 30 days after surgery.Risk factors were evaluated using multivariate Logistic regression analysis.Results Perioperative MACE occurred in 61(12.66%) of the study patients.Five independent risk factors for perioperative MACE were identified:history of heart failure,preoperative arrhythmia,preoperative diastolic blood pressure <75 mmHg,American Society of Anesthesiologists grade 3 or higher,and intraoperetive blood transfusion.The area under the receiver operating characteristic curve for the risk-index score was 0.710±0.037.Analysis of the risk stratification system showed that the incidence of perioperative MACE increased significantly with increasing levels of risk.Conclusions Elderly Chinese patients with CHD who undergo noncardiac surgery have a high risk of perioperative MACE.Five independent risk factors for perioperative MACE were identified.Our risk stratification system may be useful for assessing perioperative cardiac risk in elderly patients undergoing noncardiac surgery.

  7. USE OF BETA-BLOCKERS IN THE PERIOPERATIVE PERIOD: HOW STRONG ARE THE EVIDENCES?

    Directory of Open Access Journals (Sweden)

    V. V. Samoylenko

    2015-09-01

    Full Text Available Optimization of the pharmacotherapy in preoperative period is the cornerstone of the concept of risk modification of cardiovascular complications in the perioperative period. Therefore, special attention has recently been focused on the use of beta-blockers in the postoperative period. Nowadays convincing evidence base for the use of this class of drugs in the perioperative period that was the basis for the development of clinical guidelines is accumulated. Moreover, results of large randomized trials of beta-blockers are controversial. This has resulted in significant differences in the classes of recommendations and levels of evidence.Analysis of the results of basic researches and the provisions of recommendations of the international and national professional medical societies on the use of beta-blockers in patients with cardiovascular disease to reduce the risk of cardiac complications in the perioperative period for planned extracardiac surgical procedures is presented.

  8. Measurement of perioperative flexion-extension mechanics of the knee joint.

    Science.gov (United States)

    Giori, N J; Giori, K L; Woolson, S T; Goodman, S B; Lannin, J V; Schurman, D J

    2001-10-01

    Perioperative knee mechanics currently are evaluated Perioperative knee mechanics currently are evaluated by measuring range of motion. This is an incomplete measurement, however, because the torque applied to achieve the motion is not measured. We hypothesized that a custom goniometer and force transducer could measure the torque required to passively flex a knee through its full range of motion. This measurement was done in the operating room immediately before and after surgery in 20 knees having total knee arthroplasty and 9 having surgery on another limb. Surgery changed the mechanics of 8 knees, whereas unoperated knees remained unchanged. This measurement technique is safe, easy, and repeatable. It improves on the current standard of perioperative knee measurement and can be applied to investigate the effects of surgery and rehabilitation on ultimate knee motion.

  9. Rheumatoid Arthritis vs Osteoarthritis in Patients Receiving Total Knee Arthroplasty: Perioperative Outcomes

    Science.gov (United States)

    Stundner, Ottokar; Danninger, Thomas; Chiu, Ya-Lin; Sun, Xuming; Goodman, Susan M; Russell, Linda A; Figgie, Mark; Mazumdar, Madhu; Memtsoudis, Stavros G

    2013-01-01

    There is a paucity of data available on perioperative outcomes of patients undergoing total knee arthroplasty (TKA) for rheumatoid arthritis (RA). We determined differences in demographics and risk for perioperative adverse events between patients suffering from osteoarthritis (OA) versus RA using a population-based approach. Of 351,103 entries for patients who underwent TKA, 3.4% had a diagnosis of RA. RA patients were on average younger [RA: 64.3 years vs OA: 66.6 years; p<0.001] and more likely female [RA: 79.2% vs OA: 63.2%; P<0. 001]. The unadjusted rates of mortality and most major perioperative adverse events were similar in both groups, with the exception of infection [RA: 4.5% vs. OA: 3.8%; P<0.001]. RA was not associated with increased adjusted odds for combined adverse events. PMID:23764034

  10. Perioperative thirst: an analysis from the perspective of the Symptom Management Theory

    Directory of Open Access Journals (Sweden)

    Marilia Ferrari Conchon

    2015-02-01

    Full Text Available A theoretical study aimed to analyze the existing knowledge in the literature on the perioperative thirst symptom from the perspective of Symptom Management Theory, and supplemented with the experience of the study group and thirst research. Thirst is described as a very intense symptom occurring in the perioperative period, and for this reason it cannot be ignored. The Symptom Management Theory is adequate for understanding the thirst symptom and is a deductive theory, focused on the domains of the Person, Environment and Health / Illness Status, as well as on the dimensions of Experience, Management Strategies and Symptom Outcomes. Using the theory leads us to consider perioperative thirst in its multifactorial aspects, analyzing the interrelation of its domains and dimensions in order to draw attention to this symptom that has been insufficiently valued, recorded and treated in clinical practice.

  11. [Significance of Multi-center Obstetrics Perioperative Team Training Including Various Medical Staffs].

    Science.gov (United States)

    Komasawa, Nobuyasu; Fujita, Daisuke; Nakayama, Mai; Fujiwara, Shunsuke; Mihara, Ryosuke; Okada, Daisuke; Omoto, Haruka; Tanaka, Motoshige; Nishihara, Isao; Minami, Toshiaki

    2016-02-01

    We report the development of a multi-center/multispecialist obstetrics perioperative team training program. Participants were members of the team, including anesthesiologists, obstetricians, and operation nurses. A questionnaire survey was conducted prior to course participation to clarify any questions team members had. The courses included a lecture and simulation training with scenario-based discussions or the use of a simulator. Scenarios included massive bleeding during cesarean section, massive bleeding after vaginal delivery, and emergency cesarean section for premature placental abruption. After each course, participants discussed problems associated with obstetrics medical safety in the context of each theme. Simulation-based perioperative team training with anesthesiologists, obstetricians, and operation nurses may serve as a vehicle to promote perioperative obstetrics patient safety.

  12. Clinical guidance on the perioperative use of targeted agents in solid tumor oncology.

    Science.gov (United States)

    Mellor, James D; Cassumbhoy, Michelle; Jefford, Michael

    2011-06-01

    The use of targeted anti-cancer agents is increasing. It is common to utilize a multi-modal treatment approach towards solid tumors, often including surgical resection, and it has become apparent that some targeted agents can impair wound healing or cause an increased risk of perioperative complications. This article reviews targeted agents used in solid tumor oncology with an emphasis on clinically relevant details. Overall, the evidence of targeted agents causing surgical complications is limited. The greatest amount of evidence exists for bevacizumab causing perioperative complications, possibly due to its extended half-life. There are limited data for cetuximab, sorafenib and sunitinib and very little for other solid tumor targeted agents. Our findings suggest that there should be heightened pharmacovigilence around targeted agents with respect to perioperative complications and increased post-surgical support for patients to aid early detection of postoperative complications until definitive data become available. PMID:21585689

  13. Perioperative pharmacological management of pulmonary hypertensive crisis during congenital heart surgery.

    Science.gov (United States)

    Brunner, Nathan; de Jesus Perez, Vinicio A; Richter, Alice; Haddad, François; Denault, André; Rojas, Vanessa; Yuan, Ke; Orcholski, Mark; Liao, Xiaobo

    2014-03-01

    Pulmonary hypertensive crisis is an important cause of morbidity and mortality in patients with pulmonary arterial hypertension secondary to congenital heart disease (PAH-CHD) who require cardiac surgery. At present, prevention and management of perioperative pulmonary hypertensive crisis is aimed at optimizing cardiopulmonary interactions by targeting prostacyclin, endothelin, and nitric oxide signaling pathways within the pulmonary circulation with various pharmacological agents. This review is aimed at familiarizing the practitioner with the current pharmacological treatment for dealing with perioperative pulmonary hypertensive crisis in PAH-CHD patients. Given the life-threatening complications associated with pulmonary hypertensive crisis, proper perioperative planning can help anticipate cardiopulmonary complications and optimize surgical outcomes in this patient population.

  14. [Development and Hosting of a Perioperative Advanced Life Support Training Course for Anesthesiologists].

    Science.gov (United States)

    Komasawa, Nobuyasu; Fujiwara, Shunsuke; Haba, Masanori; Ueshima, Hironobu; Okada, Daisuke; Minami, Toshiaki

    2015-05-01

    Participation in the American Heart Association advanced cardiac life support provider course is a prerequisite for taking the anesthesiology specialist examination in Japan. The course teaches fundamental resuscitation methods for different types of cardiac arrest. However, crisis in the perioperative period can result from airway trouble, central venous catheter displacement, or massive hemorrhage. We report our experience of holding a problem- and learning-based perioperative advanced life support training course, Advanced Life Support for Operation (ALS-OP). Main contents of the course included circulation management, airway management central venous catheters, and pain clinic-related complications. ALS-OP simulation training may be beneficial for educating anesthesiologist and promoting perioperative patient safety. PMID:26422971

  15. The association of perioperative dexamethasone, smoking and alcohol abuse with wound complications after laparotomy

    DEFF Research Database (Denmark)

    Dahl, Rikke M; Wetterslev, Jørn; Jorgensen, Lars N;

    2014-01-01

    BACKGROUND: A number of perioperative risk factors may suppress the immune system and contribute to the development of post-operative complications. The association between surgical site infection (SSI) and other wound-related complications resulting from immunosuppression through either perioper......BACKGROUND: A number of perioperative risk factors may suppress the immune system and contribute to the development of post-operative complications. The association between surgical site infection (SSI) and other wound-related complications resulting from immunosuppression through either......, smoking status and alcohol abuse with the primary outcome, being a composite of SSI, anastomotic leak, wound dehiscence, burst abdomen and 30-day mortality. RESULTS: The primary outcome occurred in 21% of patients receiving dexamethasone versus 28% of patients not receiving dexamethasone...... was not significantly associated with SSI or other wound-related complications. Conversely, smoking and alcohol abuse were both significant predictors of the primary outcome consisting of wound-related complications and mortality....

  16. The relevance of hemodynamic factors to perioperative ischemic complications in childhood moyamoya disease.

    Science.gov (United States)

    Iwama, T; Hashimoto, N; Yonekawa, Y

    1996-06-01

    Of 124 children younger than 15 years who underwent surgery for moyamoya disease, 21 (16.9%) experienced perioperative ischemic complications that could not be unequivocally attributed to the surgery. Eleven of the 21 patients experienced infarctions, and 10 experienced reversible ischemic neurological deficits without new lesions, as revealed by computed tomographic scans. An examination of the patients' perioperative clinical and laboratory data revealed that the mean values of intra- and postoperative minimum arterial carbon dioxide pressure, maximum arterial carbon dioxide pressure, and mean arterial pressure were similar in patients with and without ischemic complications. However, in patients with perioperative complications, the incidence of preoperative transient ischemic attacks (TIAs) and intra- and postoperative hypercapnia (maximum arterial carbon dioxide pressure > 45 mm Hg) was significantly higher. In addition, 7 of the 11 perioperative infarctions occurred in patients with frequent preoperative TIAs and intra- and postoperative hypercapnia. Cerebral blood flow studies with preoperative acetazolamide loading showed that the new infarctions were located in areas in which the cerebral blood flow had been compromised. Our results suggest that the occurrence of frequent preoperative TIA is an important indicator of the instability of the cerebral hemodynamics and of the risk of perioperative ischemic complications. To prevent these complications, preoperative management aimed at stabilizing the hemodynamic status is very important. Children who have moyamoya disease and who experience frequent preoperative TIAs are at risk for ischemic brain damage caused by hypercapnia as well as hypocapnia and hypotension. The establishment and maintenance of normocapnia with normotension are highly desirable for the perioperative management of moyamoya disease in children.

  17. Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Han-Cheng Liu; Yan-Bing Zhou; Dong Chen; Zhao-Jian Niu; Yang Yu

    2012-01-01

    AIM:To investigate the effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing radical distal gastrectomy.METHODS:Within 24 h of intensive care unit management,patients with gastric cancer were enrolled after written informed consent and randomized to the intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or the conventional insulin therapy (CIT) group to keep levels less than 10 mmol/L.Resting energy expenditure (REE),respiratory quotient (RQ),resting energy expenditure per kilogram (REE/kg),and the lipid oxidation rate were monitored by the indirect calorimeter of calcium citrate malate nutrition metabolism investigation system.The changes in body composition were analyzed by multi-frequency bioimpedance analysis.Blood fasting glucose and insulin concentration were measured for assessment of Homeostasis model assessment of insulin resistance.RESULTS:Sixty patients were enrolled.Compared with preoperative baseline,postoperative REE increased by over 22.15% and 11.07%; REE/kg rose up to 27.22 ± 1.33 kcal/kg and 24.72 ± 1.43 kcal/kg; RQ decreased to 0.759 ± 0.034 and 0.791 ± 0.037; the lipid oxidation ratio was up to 78.25% ± 17.74% and 67.13% ± 12.76% supported by parenteral nutrition solutions from 37.56% ± 11.64% at the baseline; the level of Ln-HOMA-IR went up dramatically (P < 0.05,respectively) on postoperative days 1 and 3 in the IIT group.Meanwhile the concentration of total protein,albumin and triglyceride declined significantly on postoperative days 1 and 3 compared with pre-operative levels (P < 0.05,respectively).Compared with the CIT group,IIT reduced the REE/kg level (27.22 ± 1.33 kcal/kg vs 29.97 ± 1.47 kcal/kg,P =0.008; 24.72 ± 1.43 kcal/kg vs 25.66 ± 1.63 kcal/kg,P =0.013); and decreased the Ln-HOMA-IR score (P =0.019,0.028) on postoperative days 1 and 3; IIT decreased the level of CRP on postoperative days 1 and 3 (P

  18. [Risk assessment and management of exodontia perioperative patients with cardiovascular diseases].

    Science.gov (United States)

    Wang, W Y

    2016-07-01

    The number of tooth extraction patients with cardiovascular disease in our country is increasing year by year. Safety is essential for those patients and there is no uniform standard of risk assessment and management for tooth extraction patients with cardiovascular disease during perioperative period. By referring to literatures and with the clinical experience, the author summarized the risk assessment methods for tooth extraction patients with cardiovascular disease during perioperative period. Blood pressure control, cardiac function determination, arrhythmia recognition, blood glucose management, oral antiplatelet or anticoagulant medicine use, etc, were proposed in this article. PMID:27480428

  19. Perioperative spinal cord infarction in nonaortic surgery: report of three cases and review of the literature.

    Science.gov (United States)

    Hobai, Ion A; Bittner, Edward A; Grecu, Loreta

    2008-06-01

    Paraplegia caused by a spinal cord infarction (SCI) is a devastating perioperative complication, most often associated with aortic and spine surgery. We present two other clinical scenarios in which perioperative SCI may occur. They happened during surgical procedures performed with epidural anesthesia, in the presence of several specific risk factors such as spinal stenosis, vascular disease, intraoperative hypotension, or the use of epinephrine in the local anesthetic solution. Second, SCI may occur during episodes of postoperative hypotension in patients with a history of aortic aneurysms.

  20. Perioperative Colonic Evaluation in Patients with Rectal Cancer; MR Colonography Versus Standard Care

    DEFF Research Database (Denmark)

    Achiam, Michael Patrick; Løgager, Vibeke; Lund Rasmussen, Vera;

    2015-01-01

    postoperatively. RESULTS: Twenty-eight patients were randomized to group A and 28 to group B. Complete preoperative colonic evaluation with CC was achieved in 39% patients in group A and 93% for group B (Fisher's exact test, P < .001). PCE with CC was achieved in 64% and 93% in groups A and B, respectively...

  1. Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies).

    Science.gov (United States)

    Ichai, Carole; Vinsonneau, Christophe; Souweine, Bertrand; Armando, Fabien; Canet, Emmanuel; Clec'h, Christophe; Constantin, Jean-Michel; Darmon, Michaël; Duranteau, Jacques; Gaillot, Théophille; Garnier, Arnaud; Jacob, Laurent; Joannes-Boyau, Olivier; Juillard, Laurent; Journois, Didier; Lautrette, Alexandre; Muller, Laurent; Legrand, Matthieu; Lerolle, Nicolas; Rimmelé, Thomas; Rondeau, Eric; Tamion, Fabienne; Walrave, Yannick; Velly, Lionel

    2016-12-01

    Acute kidney injury (AKI) is a syndrome that has progressed a great deal over the last 20 years. The decrease in urine output and the increase in classical renal biomarkers, such as blood urea nitrogen and serum creatinine, have largely been used as surrogate markers for decreased glomerular filtration rate (GFR), which defines AKI. However, using such markers of GFR as criteria for diagnosing AKI has several limits including the difficult diagnosis of non-organic AKI, also called "functional renal insufficiency" or "pre-renal insufficiency". This situation is characterized by an oliguria and an increase in creatininemia as a consequence of a reduction in renal blood flow related to systemic haemodynamic abnormalities. In this situation, "renal insufficiency" seems rather inappropriate as kidney function is not impaired. On the contrary, the kidney delivers an appropriate response aiming to recover optimal systemic physiological haemodynamic conditions. Considering the kidney as insufficient is erroneous because this suggests that it does not work correctly, whereas the opposite is occurring, because the kidney is healthy even in a threatening situation. With current definitions of AKI, normalization of volaemia is needed before defining AKI in order to avoid this pitfall. PMID:27230984

  2. Perioperative nursing of augmentation mammoplasty with silicone implant through armpit incision%经腋下切口硅胶置入隆乳术的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    谭文娟; 熊燕; 田诗政

    2012-01-01

    Objective To investigate the hospital via the armpit incision implantation of silicone augmentation mammoplasty surgery perioperative nursing. Methods December 2008 to October 2011,24 patients were taken before surgery, intraoperative and postoperative care to observe the perioperative care of patients undergoing augmentation, mammoplasty role of clinical care. Results 24 regular silicone implants augmentation mammmoplasty through armpit incision surgery after surgery, were successful plant income, type of milk after implantation full symmetry, no degeneration, inflammation and other adverse reactions, surgical success rate was 100%. Conclusion Complete perioperative care can help patients resume this morning to help the rehabilitation of patients.%目的:探讨我院行经腋下切口硅胶置入隆乳术的围手术期护理.方法:选择我院2008年12月~2011年10月在我院行硅胶置入隆乳术的患者24例,分别采取术前、术中以及术后护理,观察围手术期护理对隆乳术患者的临床护理作用;结果:24例行经腋下切口硅胶置入隆乳术的女性经手术后,均成功置入,置入后乳型丰满对称,无变性、炎症等不良反应,手术成功率100%;结论:完善的围手术期护理可以帮助患者今早的恢复,有助于患者的康复.

  3. Perioperative Nursing for patients with the combination therapy of liposuction and abdominoplasty%脂肪抽吸联合腹壁整形术的围术期护理

    Institute of Scientific and Technical Information of China (English)

    吴健红

    2013-01-01

    Objective To explore the perioperative nursing measures for the patients with the combination therapy of liposuction and abdominoplasty in order to reduce the incidence rate of postoperative complications. Methods 12 patients were treated with the combination therapy of liposuction and abdominoplasty, and all of them were conducted with careful perioperative nursing. Results Abdominal morphology of patients was improved significantly, the scars of surgical incisions were tiny and rarely observed. No patient had severe complications such as hematoma, fat liquefaction and fat embolism. Conclusion Perioperative nursing is the important factor for the success of combination operation of liposuction and abdominoplasty.%目的 探讨脂肪抽吸联合腹壁整形术的围术期护理措施,降低术后并发症的发生率.方法 将肿胀吸脂术和腹壁整形术联合应用于12例患者,并在围术期进行精心护理.结果 患者腹部形态明显改善,手术切口疤痕细小、隐蔽,无血肿发生,无脂肪液化、脂肪栓塞等严重并发症发生.结论 围术期的护理过程是影响脂肪抽吸联合腹壁整形术手术成败的重要因素.

  4. 4例精囊恶性肿瘤老年患者行根治性切除术的护理%Perioperative nursing of four elderly patients undergoing pelvic exenteration for treatment of seminal vesicle carcinoma

    Institute of Scientific and Technical Information of China (English)

    关健仪; 马雪霞; 陈凯嘉

    2011-01-01

    This paper summarizes the perioperative nursing experiences in four patients who underwent pelvic exenteration for treatment of seminal vesicle carcinoma and pelvic metastasis. The key points in perioperative nursing were close observation of patients' condition,effective psychological support,prevention and control of postoperative complications,management of various drainage tubes and stoma care. These measures ensure the patients safety in perioperative period.%报告了4例行根治性切除术治疗精囊恶性肿瘤盆腔广泛转移老年患者的护理.严密观察病情,针对老年患者机体功能下降、合并症多、心理压力大、引流管道多、回结肠双造口难自理等问题,实施相应的心理支持、并发症护理、多管道管理、专人专科造口护理等措施,使患者顺利渡过围手术期.

  5. Perioperative nursing of cervical cancer patients with diabetes mellitus%宫颈癌合并糖尿病患者围手术期的护理

    Institute of Scientific and Technical Information of China (English)

    张网萍

    2011-01-01

    目的 探讨宫颈癌合并糖尿病患者围手术期的护理方法,以提高手术的成功率.方法 观察并总结对32例宫颈癌合并糖尿病患者手术治疗围手术期的护理.结果 通过心理护理、饮食管理、运动指导、血糖控制、并发症预防提高了手术的成功率.术后发生心律失常1例,低血糖反应2例,切口感染1例,经合理治疗和精心护理均治愈出院.结论 规范而得当的护理是保证宫颈癌合并糖尿病患者手术成功的关键之一.%Objective To investigate the perioperative nursing approach to improving the success rate of surgery on cervical cancer patients with diabetes mellitus. Methods Perioperative nursing of thirty- two cases of cervical cancer surgical treatment of patients with diabetes mellitus was observed. Results Through psychological care, diet management, exercise guidance, glycemial control, prevention of complications, the success rate of surgery can be improved. One case of post- operative arrhythmias, 2 cases with low blood sugar reactions, 1 case with wound infection,after appropriate treatment and careful nursing, were cured. Conclusion Normative nursing care is one of the key factors to successful operation on patients with diabetes mellitus cervical cancer.

  6. Linear Accelerator (LINAC)

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Linear Accelerator A linear accelerator (LINAC) customizes high energy x-rays to ... ensured? What is this equipment used for? A linear accelerator (LINAC) is the device most commonly used ...

  7. 子宫癌患者围手术期进行心理护理的调查研究%Uterine cancer patients in the perioperative period of psychological nursing research

    Institute of Scientific and Technical Information of China (English)

    王丰松; 牟宗梅; 郑玉秀; 孙衍伟

    2010-01-01

    Objective To investigate the perioperative period in patients with uterine cancer, psychological problems and related factors, the implementation of proper care, to alleviate the psychological distress degree. Methods 65 cases of uterine cancer patients in the perioperative period to conduct a questionnaire survey, and psychological care. Results After being accepted psychological care, the number of patients subjected to psychological distress significantly reduced ( P < 0. 05 ). Conclusion All patients with uterine cancer have different degrees of psychological problems, the implementation of psychological care significantly reduced the degree of psychological distress.%目的 调查子宫癌患者围手术期间存在的心理问题及相关因素,实施正确护理,以减轻心理困扰程度.方法 对65例子宫癌患者在围手术期进行问卷调查,并进行心理护理.结果 进行心理护理后,遭受心理困扰的患者人数明显减少(P<0.05).结论 所有子宫癌患者都有不同程度的心理问题,实施心理护理后心理困扰程度明显降低.

  8. Psychological nursing research of breast cancer patients in the perioperative period%乳腺癌患者围术期进行心理护理的调查研究

    Institute of Scientific and Technical Information of China (English)

    王宏; 张丽

    2011-01-01

    目的 调查乳腺癌患者围术期期间存在的心理问题及相关因素,实施正确护理,减轻心理困扰程度.方法 对65例乳腺癌患者在围手术期进行问卷调查,并进行心理护理.结果 进行心理护理后遭受心理困扰的患者人数明显减少(P<0.05).结论 所有乳腺癌患者都有不同程度的心理问题,实施心理护理后心理困扰程度明显降低.%Objective To investigate the psychological problems and related factors, the implementation of proper care of patients with breast cancer in perioperative period, to alleviate the psychological distress degree. Methods Sixty-five cases of breast cancer in the perioperative period to conduct a questionnaire survey, and accepted psychological care. Results After being accepted psychological care, the number of patients subjected to psychological distress significantly reduced(P<0.05).Conclusions All patients with breast cancer have different degrees of psychological problems, the implementation of psychological care significantly reduced the degree of psychological distress.

  9. Prospective, multidisciplinary recording of perioperative errors in cerebrovascular surgery: is error in the eye of the beholder?

    Science.gov (United States)

    Michalak, Suzanne M; Rolston, John D; Lawton, Michael T

    2016-06-01

    OBJECT Surgery requires careful coordination of multiple team members, each playing a vital role in mitigating errors. Previous studies have focused on eliciting errors from only the attending surgeon, likely missing events observed by other team members. METHODS Surveys were administered to the attending surgeon, resident surgeon, anesthesiologist, and nursing staff immediately following each of 31 cerebrovascular surgeries; participants were instructed to record any deviation from optimal course (DOC). DOCs were categorized and sorted by reporter and perioperative timing, then correlated with delays and outcome measures. RESULTS Errors were recorded in 93.5% of the 31 cases surveyed. The number of errors recorded per case ranged from 0 to 8, with an average of 3.1 ± 2.1 errors (± SD). Overall, technical errors were most common (24.5%), followed by communication (22.4%), management/judgment (16.0%), and equipment (11.7%). The resident surgeon reported the most errors (52.1%), followed by the circulating nurse (31.9%), the attending surgeon (26.6%), and the anesthesiologist (14.9%). The attending and resident surgeons were most likely to report technical errors (52% and 30.6%, respectively), while anesthesiologists and circulating nurses mostly reported anesthesia errors (36%) and communication errors (50%), respectively. The overlap in reported errors was 20.3%. If this study had used only the surveys completed by the attending surgeon, as in prior studies, 72% of equipment errors, 90% of anesthesia and communication errors, and 100% of nursing errors would have been missed. In addition, it would have been concluded that errors occurred in only 45.2% of cases (rather than 93.5%) and that errors resulting in a delay occurred in 3.2% of cases instead of the 74.2% calculated using data from 4 team members. Compiled results from all team members yielded significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays (p = 0

  10. Without tension in elderly inguinal hernia repair perioperative nursing%老年腹股沟疝无张力修补术围手术期护理

    Institute of Scientific and Technical Information of China (English)

    张静

    2014-01-01

    总结了156例无张力疝修补术患者的围手术期护理,包括术前心理护理及准备、术中护理、术后严密病情观察、饮食护理及积极预防并发症等。认为老年腹股沟疝行无张力疝修补术治疗效果确切,做好护理工作可减少并发症的发生,促进患者康复。%Summary summarizes the 156 cases of patients with tension-free hernia repair perioperative care,including pre-surgery psychological care and preparation,intraoperative care,after close obG servation of the disease,diet care and actively prevent complications.Considered elderly inguinal hernia tension-free hernia repair definite therapeutic ef ect,good care can reduce the incidence of complicaG tions,and promote the rehabilitation of patients.

  11. Pharmacogenetics and anaesthetic drugs: Implications for perioperative practice

    OpenAIRE

    Arash Behrooz

    2015-01-01

    Pharmacogenetics seeks to elucidate the variations in individual's genetic sequences in order to better understand the differences seen in pharmacokinetics, drug metabolism, and efficacy between patients. This area of research is rapidly accelerating, aided by the use of novel and more economical molecular technologies. A substantial evidence base is being generated with the hopes that in the future it may be used to generate personalised treatment regimens in order to improve patient comfort...

  12. The Progress of Perioperative Therapy with Integrative Medicine in the Field of Cardiac Surgery

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ In the 1960s,a number of integrative Chinese and Western medicine (ICWM)surgeons (such as Prof.WU Xian-zhong) first started the application of traditional Chinese medicine (TCM) in acute abdominal surgery,and thus they became the pioneers of perioperative therapy with ICWM.

  13. Psychotropic drugs and the perioperative period : A proposal for a guideline in elective surgery

    NARCIS (Netherlands)

    Huyse, FJ; Touw, DJ; Van Schijndel, RS; De Lange, JJ; Slaets, JPJ

    2006-01-01

    Evidence-based guidelines for the perioperative management of psychotropic drugs are lacking. The level of evidence is low and is based on case reports, open trials, and non-systematic reviews. However, the interactions and effects mentioned indicate that patients who use psychotropics and require s

  14. Systematic Review of Peri-Operative Nutritional Supplementation in Patients Undergoing Pancreaticoduodenectomy

    OpenAIRE

    Kolitha Sanjaya Goonetilleke; Ajith Kumar Siriwardena

    2006-01-01

    Background: Although nutritional supplementation is established in surgicalpractice, studies on feeding patients undergoing pancreaticoduodenectomy utilize widely disparate protocols, include small numbers of patients and have disparate endpoints. The aim of this study is to carry out a systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy in order to identify consistent themes. Methods :Searches of the MEDLINE and EMBASE databases yie...

  15. Is There a Role for Perioperative Nutritional Support in Liver Resection?

    OpenAIRE

    Albert Bothe; Glenn Steele

    1997-01-01

    Background: Resection of hepatocellular carcinoma is associated with high rates of morbidity and mortality. Since intensive nutritional support can reduce the catabolic response and improve protein synthesis and liver regeneration, we performed a prospective study to investigate whether perioperative nutritional support could improve outcome in patients undergoing hepatectomy for hepatocellular carcinoma. Methods: We studied 124 patients undergoing resection of hepatocellular carcinoma. Sixty...

  16. Influence of Perioperative Blood Transfusion on Prognosis in Patients with Colon Cancer

    Institute of Scientific and Technical Information of China (English)

    LIANG Han; WANG Xiaona; WANG Baogui; PAN Yuan; LIU Ning; WANG Dianchang; HAO Xishan

    2006-01-01

    Objective: To explore the influence of perioperative blood transfusion on the postoperative survival of patients with colon cancer. Methods: Univariate and multivariate retrospective analyses were performed on the survival in a total of 723 colon cancer patients which were treated surgically during a period of 10 years. Results: Kaplan-Meicr estimates showed that more than 800 mL perioperative blood transfusion was the survival predictor. Blood transfusion influenced significantly the prognosis of patients 40 years old and younger, those undergoing helicoloectomy left side, those with papillary adenocarcinoma,those with big tumors (diameter ≥8 em), those with stage I tumors, those with lymphatic node metastases and those without liver metastases. In multivariate analysis only the tumor location, radicality of operation, lymphatic invasion, liver metastasis, depth of tumor invasion and TNM stage retained their significance. Conclusion: Perioperative blood transfusion is the prognostic factor for patients with colon cancer to some extent. The indication of blood transfusion must be restricted strictly, specially in patients younger than 40 years old, with right side lesion, papillary adenocarcinoma, big tumors (diameter ≥8 em), stage I tumors and lymphatic node metastases or without liver metastases. But perioperative blood transfusion may not be deleterious for patients with staging Ⅳ disease and with distant metastases.

  17. Perioperative Endocrine Therapy for Patients with Cushing's Syndrome Undergoing Retroperitoneal Laparoscopic Adrenalectomy

    Directory of Open Access Journals (Sweden)

    Xiaobo Cui

    2012-01-01

    Full Text Available Objectives. To investigate the efficacy and safety of perioperative endocrine therapy (PET for patients with Cushing’s syndrome (CS undergoing retroperitoneal laparoscopic adrenalectomy (RLA. Methods. The novel, simplified PET modality of 82 patients who underwent RLA procedures for CS were studied. Clinical manifestations were observed for all patients on days 1 and 5 postoperatively, and clinical data, such as blood pressure (BP, levels of serum cortisol, adrenocorticotropin (ACTH, blood glucose, and electrolytes, were acquired and analyzed. Results. Supraphysiological doses of glucocorticoid were administered during the perioperative period, and the dosage was reduced gradually. In all 82 cases, the RLAs were performed successfully without any perioperative complication, such as steroid withdrawal symptoms. The patient’s symptoms and signs were improved quickly and safely during the hospital days. The serum cortisol and potassium levels were rather stable on days 1 and 5 postoperatively, and most were within the normal range. The clinical manifestations, serum levels of cortisol, ACTH, and potassium in most patients restored to normal gradually after several months (mean, 6.7 ± 1.2 months, except for one patient undergoing bilateral adrenalectomy. Conclusions. This perioperative endocrine therapy for patients with Cushing’s syndrome (mainly for adrenocortical adenoma undergoing retro-laparoscopic adrenalectomy is both effective and safe.

  18. Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

    OpenAIRE

    Skovrlj, Branko; Belton, Patrick; Zarzour, Hekmat; Qureshi, Sheeraz A.

    2015-01-01

    AIM: To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS).

  19. Perioperative blood transfusion does not decrease survival after surgical treatment of spinal metastases

    DEFF Research Database (Denmark)

    Clausen, Caroline; Lönn, Lars; Morgen, Søren Schmidt;

    2014-01-01

    at surgery, gender, preoperative hemoglobin, revised Tokuhashi score and no. of instrumented levels. RESULTS: Perioperative allogenic blood transfusion of 1-2 units was associated with increased 12-month survival [p = 0.049, odds ratio 2.619 (confidence interval 1.004-6.831)], but not with 3-month survival...

  20. Overview of the Perioperative Management of Lung Volume Reduction Surgery Patients

    OpenAIRE

    Sharafkhaneh, Amir; Falk, Jeremy A; Minai, Omar A.; Lipson, David A.

    2008-01-01

    This article reviews management strategies that may improve the outcome of thoracic surgery and particularly lung volume reduction surgery (LVRS) in patients with severe emphysema. Maximal preoperative pharmacologic therapy includes bronchodilators and inhaled corticosteroids to attain peak lung function at the time of surgery. Nonpharmacologic measures include smoking cessation and pulmonary rehabilitation. Mechanical ventilation during the perioperative period should ensure adequate oxygena...

  1. [Current status and prospect of perioperative thrombus management in gastrointestinal cancer].

    Science.gov (United States)

    Qin, X Y

    2016-03-01

    Thanks to the progress of surgical theory and skills, as well as the application of modern medical devices in general surgery, both the occurrence of perioperative complications and mortality of gastrointestinal surgery have significantly reduced recently. However, it is still far from optimal in terms of the perioperative venous thromboembolism (VTE) management in gastrointestinal cancer, and what is responsible for that? This paper aims at finding out the reasons contributing to the current status, giving suggestions for how to make improvement at both disease level and hospital management level. At the same time, while paying attention for the prophylaxis of VTE, there have been more and more patients receiving antithrombotic treatment require elective or emergent surgery in clinical practice, due to aging and increased incidence of cardiovascular disease year by year. How to balance the bleeding and thrombosis risk for these patients during perioperative periods is also a question we are going to discuss. In conclusion, as to the issue of the management of perioperative thrombosis, there will be a long way for Chinese doctors to go. Our peers should pay more attention to this problem and take more efforts, so that the thrombotic complications in surgical patients can be reduced. PMID:26932880

  2. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries

    DEFF Research Database (Denmark)

    Lassen, K; Hannemann, P; Ljungqvist, O;

    2005-01-01

    no bowel preparation, epidural anaesthesia/analgesia continued for one to two days postoperatively, no nasogastric decompression tube postoperatively, intravenous fluid/saline restriction, and free oral intake from postoperative day one. 1 - 5 This survey aimed to characterise perioperative practice...

  3. Central neuraxial anaesthesia presenting with spinal myoclonus in the perioperative period: a case series

    Directory of Open Access Journals (Sweden)

    Bamgbade Olumuyiwa A

    2009-06-01

    Full Text Available Abstract Introduction Perioperative spinal myoclonus is extremely rare. Many anaesthetists and perioperative practitioners may not diagnose or manage this complication appropriately when it occurs. This case report of unusual acute spinal myoclonus following regional anaesthesia highlights certain aspects of this rare complication that have not previously been published. Case presentations A series of four consecutive patients who developed acute lower-limb myoclonus following spinal or epidural anaesthesia are described. The case series occurred at three different hospitals and involved four anaesthetists over a 3-year period. Two Caucasian men, aged 90-years-old and 67-years-old, manifested unilateral myoclonus. Two Caucasian women, aged 64-years-old and 53-years-old, developed bilateral myoclonus. Myoclonus was self-limiting in one patient, treated with further regional anaesthesia in one patient and treated with intravenous midazolam in two patients. The overall outcome was good in all patients, with no recurrence or sequelae in any of the patients. Conclusion This case series emphasizes that spinal myoclonus following regional anaesthesia is rare, has diverse pathophysiology and can have diverse presentations. The treatment of perioperative spinal myoclonus should be directed at the aetiology. Anaesthetists and perioperative practitioners who are unfamiliar with this rare complication should be reassured that it may be treated successfully with midazolam.

  4. The peri-operative cytokine response in infants and young children following major surgery

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Tønnesen, Else Kirstine; Andersen, J B;

    1998-01-01

    The peri-operative cytokine response was studied in 13 infants and young children undergoing major surgery. All children were anaesthetized with a combined general and epidural anaesthetic technique, followed by post-operative epidural analgesia with bupivacaine and fentanyl. Blood samples were...

  5. Up in flames: a flammability assessment of alcohol-based hand sanitizers on common perioperative materials

    Directory of Open Access Journals (Sweden)

    Samuel Almengor

    2015-01-01

    Full Text Available Introduction: The objective of this study was to perform a flammability assessment of alcohol-based hand sanitizers on common perioperative materials. There is an estimated 550–650 surgical fires that occur nationally each year, an instance comparable to that of wrong-site surgery, yet only about 100 operating room fires are reported each year.  The median cost of an OR fire settlement claim is $120,166.  Generation of fire requires the presence of three components, known as the “fire triad”: (1 an oxidizer, (2 an ignition source, and (3 fuel. Methods: The flammability of five common perioperative materials was assessed (conform stretch gauze, surgical drape, foam headrest, OR towels, and lap sponges.  The flammability of these materials was assessed alone and with six test liquids (Purell Advanced, Germ-X, generic hand sanitizer, spray hand sanitizer, ChloraPrep, and sterile water.  The assessments with the test liquids were conducted immediately after application and after five minutes.  The ignition sources used were a lighter and two spark generators (piezo-electric and battery-powered spark generator. Results: Two of the five perioperative materials were easily ignitable (OR towels and lap sponges, while the others exhibited flame retardant properties, which manifested itself as “melting” when an ignition source was applied (conform stretch gauze, surgical drape, and foam headrest.  ChloraPrep served as the positive control and sterile water served as the negative control.  When alcohol-based hand sanitizers and ChloraPrep were added to these materials, the flammability increased.  The addition of sterile water to the perioperative materials rendered the material nonflammable. The piezo-electric spark generator did not elicit any combustion of perioperative materials with or without test liquids, but the battery-powered spark generator did. Conclusion: Commonly used alcohol-based hand sanitizers are flammable.  When

  6. Nursing Observation of Peptic Ulcer Perforation Acute Perioperative%探析消化性溃疡急性穿孔围手术期的护理效果观察

    Institute of Scientific and Technical Information of China (English)

    王雅秋

    2015-01-01

    目的:探讨消化性溃疡急性穿孔围手术期的护理效果。方法选取本院收治的消化性溃疡急性穿孔手术患者84例,比较围手术期护理干预与常规护理的效果。结果干预组患者的并发症发生率明显低于对照组,护理满意度明显高于对照组,P<0.05,具有统计学意义。结论对消化性溃疡急性穿孔患者进行围手术期护理干预,可以有效减少术后并发症,提高患者痊愈率和治疗效果,提高患者的护理满意度,值得临床广泛应用。%Objective To investigate the acute peptic ulcer perforation effect of perioperative nursing. Methods Select our hospital with acute peptic ulcer perforation 84 cases of surgical patients, comparing perioperative nursing intervention and usual care results. Results Complications in patients in the intervention group were signiifcantly lower than the control group, Significantly higher satisfaction with care, P<0.05, statistically significant. Conclusion Patients with peptic ulcer perforation acute perioperative nursing intervention can effectively reduce postoperative complications. Improve the cure rate and treatment of patients, improve patient care and satisfaction, is worthy of wider application.

  7. Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfusion

    Directory of Open Access Journals (Sweden)

    Michael Mazzeffi

    2012-01-01

    Full Text Available Deep hypothermia, which is used during thoracic aortic surgery for neuroprotection, is associated with coagulation abnormalities in animal and in vitro models. However, there is a paucity of data regarding the impact of deep hypothermia duration on perioperative bleeding. The objective of the current study was to examine the relationship between the duration of deep hypothermia and perioperative bleeding. A retrospective review of 507 consecutive thoracic aortic surgery patients who had surgery with deep hypothermic circulatory arrest was performed. The degree of bleeding and coagulopathy was estimated using perioperative transfusion. Log linear modeling with Poisson regression was used to analyze the relationship between deep hypothermia duration and perioperative bleeding, while controlling for other preselected variables. There was a significant association between deep hypothermia duration and RBC transfusion (P = 0.001. There was no significant association between deep hypothermia duration and FFP and platelet transfusion (P = 0.18 and P = 0.06. The association between deep hypothermia duration and the amount of bleeding (RBC transfusion was dependent on total CPB time. In general, for shorter CPB times (approximately 120 to 180 minutes there was an upward sloping line or positive relationship between deep hypothermia duration and bleeding. However, for cases with longer CPB times (300 to 360 minutes, there was no such relationship. The relationship between deep hypothermia duration and perioperative bleeding is dependent on CPB time. For surgeries with short CPB times (120 to 180 minutes, prolonged deep hypothermia is associated with increased post-operative bleeding, as estimated by RBC transfusion. For cases with longer CPB times (300 to 360 minutes, there appears to be no relationship.

  8. Perioperative management of endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Objective: To summarize the clinical experience of perioperative management in performing endovascular abdominal aortic aneurysm repair (EVAR). Methods: EVAR was performed in 22 patients with abdominal aortic aneurysm. The clinical data were retrospectively analyzed. Before treatment the functions of main organs were evaluated and certain measures were adopted in order to protect them. Useful parameters, including the length, diameter, angle and configuration of the proximal and distal aneurysmal neck, the relationship of the aneurysm to aortic branches, the distance from the lowest renal artery to the bifurcation of abdominal aorta, and the quality of access vessels (such as diameter, tortuosity and calcification degree) were determined and assessed with CTA. According to the parameters thus obtained, the suitable stent-graft with ideal diameter and length was selected, and the optimal surgery pattern was employed. Local anesthesia was employed in 20 patients, among them the local anesthesia had to be changed to general anesthesia in one. Epidural anesthesia was carried out in one patient through the surgically-reconstructed iliac artery access,and general anesthesia was employed in one patient who had Stanford type A aortic dissection. The lowest renal artery must be accurately localized before deployment of stent-graft was started. At least one patent internal iliac artery should be reserved when bilateral internal iliac arteries needed to be covered, to be covered by stages or to be reconstructed. After stent-graft placement, angiography must be performed to find out if there was any endoleak and, if any, to determine the type of endoleak and to deal with it properly. Two cases had proximal type I endoleak, so balloon dilation was employed in one and cuff implantation in another one. Distal type I endoleak occurred in one case, but, unfortunately, the iliac artery ruptured when balloon dilation was employed, therefore the patient had to receive vascular repair

  9. Comparison of an Intraoperative Infusion of Dexmedetomidine, Fentanyl, and Remifentanil on Perioperative Hemodynamics, Sedation Quality, and Postoperative Pain Control.

    Science.gov (United States)

    Choi, Jin Woo; Joo, Jin Deok; Kim, Dae Woo; In, Jang Hyeok; Kwon, So Young; Seo, Kwonhui; Han, Donggyu; Cheon, Ga Young; Jung, Hong Soo

    2016-09-01

    We aimed to compare fentanyl, remifentanil and dexmedetomidine with respect to hemodynamic stability, postoperative pain control and achievement of sedation at the postanesthetic care unit (PACU). In this randomized double-blind study, 90 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive fentanyl (1.0 μg/kg) over 1 minute followed by a 0.4 μg/kg/hr infusion (FK group, n = 30), or remifentanil (1.0 μg/kg) over 1 minute followed by a 0.08 μg/kg/min infusion (RK group, n = 30), or dexmedetomidine (1 μg/kg) over 10 minutes followed by a 0.5 μg/kg/hr infusion (DK group, n = 30) initiating at the end of main procedures of the operation to the time in the PACU. A single dose of intravenous ketorolac (30 mg) was given to all patients at the end of surgery. We respectively evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs and the perioperative side effects to compare the efficacy of fentanyl, remifentanil and dexmedetomidine. Compared with other groups, the modified OAA/S scores were significantly lower in DK group at 0, 5 and 10 minutes after arrival at the PACU (P World Health Organization registry, KCT0001524). PMID:27510395

  10. A case of perioperative glucose control by using an artificial pancreas in a patient with glycogen storage disease.

    Science.gov (United States)

    Yatabe, Tomoaki; Nakamura, Ryu; Kitagawa, Hiroyuki; Munekage, Masaya; Hanazaki, Kazuhiro

    2016-03-01

    A 57-year-old woman was diagnosed with type I glycogen storage disease in her twenties. She had undergone hepatectomy under general anesthesia with epidural anesthesia. Fifty minutes after the induction of anesthesia, a 20-gauge venous catheter was inserted in the patient's right hand, and an artificial pancreas (STG-55, Nikkiso Co., Tokyo, Japan) was connected for continuous glucose monitoring and automatic glucose control. Insulin was infused when the blood glucose level reached 120 mg/dL or higher, and glucose was infused when the level fell to 100 mg/dL or lower. After the Pringle maneuver, the blood glucose level increased, and insulin was administered automatically via an artificial pancreas. Hypoglycemia did not occur during the operation. After total parenteral nutrition was started in the intensive care unit (ICU), the blood glucose level increased, and the artificial pancreas controlled the blood glucose level through automatic insulin administration. Thirty-four hours after admission to the ICU, the artificial pancreas was removed because the blood sampling failed. After the removal of the artificial pancreas, blood glucose level was measured every 2 h until extubation. During the ICU stay, hypoglycemia never occurred, with the average blood glucose level being 144 mg/dL. In conclusion, the use of an artificial pancreas for perioperative blood glucose management in a patient with glycogen storage disease had the beneficial effect of enabling the management of blood glucose levels without hypoglycemia.

  11. [A case report: perioperative management of adenotonsillectomy in a morbidly obese patient with severe obstructive sleep apnea syndrome].

    Science.gov (United States)

    Mine, Tomoko; Wada, Minori; Hashimoto, Ai; Minami, Kotaro; Nikai, Tetsuro; Imamachi, Noritaka; Saito, Yoji

    2014-11-01

    A male patient in his thirties was scheduled to undergo adenotonsillectomy due to dyspnea from bilateral tonsillar hypertrophy. He was morbidly obese (body mass index 56 kg x m(-2)) with severe obstructive sleep apnea syndrome (OSAS), and thus was evaluated with extreme risk for difficult ventilation and intubation. We planned awake intubation via video-assisted laryngoscopy and fiberoptic bronchoscopy under dexmedetomidine sedation, and the intubation was successfully performed. After adenotonsillectomy, upper airway obstruction due to hemorrhage and oropharyngeal swelling can be life-threatening requiring emergent airway management. Thus for postoperative airway management, due to the possibility of "cannot intubate, cannot ventilate" (CICV) and presumed difficult tracheotomy, we scheduled to perform tracheotomy during adenotonsillectomy, right after anesthetic induction and awake intubation. On postoperative day 1, he started walking with no need of sedative drugs. On day 4, after confirmation of minimal oropharyngeal swelling, tracheal cannulae was removed, and no further complications were observed in his postoperative course. We conclude that careful preoperative evaluation of the airway, retention of spontaneous breathing via awake intubation, and preventive tracheotomy for postoperative airway management are important points in perioperative management of a morbidly obese patient with severe obstructive sleep apnea syndrome. PMID:25731066

  12. Perioperative sleep apnea: a real problem or did we invent a new disease? [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Sebastian Zaremba

    2016-01-01

    Full Text Available Depending on the subpopulation, obstructive sleep apnea (OSA can affect more than 75% of surgical patients. An increasing body of evidence supports the association between OSA  and perioperative complications, but some data indicate important perioperative outcomes do not differ between patients with and without OSA. In this review we will provide an overview of the pathophysiology of sleep apnea and the risk factors for perioperative complications related to sleep apnea. We also discuss a clinical algorithm for the identification and management of OSA patients facing surgery.

  13. Acquired Factor XIII Inhibitor in Hospitalized and Perioperative Patients: A Systematic Review of Case Reports and Case Series.

    Science.gov (United States)

    Tone, Kira J; James, Tyler E; Fergusson, Dean A; Tinmouth, Alan; Tay, Jason; Avey, Marc T; Kilty, Shaun; Lalu, Manoj M

    2016-07-01

    Factor XIII (FXIII) cross-links fibrin monomers to support clot stabilization and wound healing. Acquired FXIII deficiency is caused by autoantibodies that inhibit FXIII and can result in bleeding despite normal routine coagulation test results. Given the rarity of this disease, large clinical studies are not feasible. We therefore conducted a systematic review of case reports and case series of acquired FXIII inhibitor to evaluate potential management and treatment strategies for acquired FXIII inhibitor in hospitalized and/or perioperative patients. A systematic search of MEDLINE, Embase, and Web of Science identified reports of hospitalized and perioperative patients with acquired FXIII deficiency. No restrictions were placed on language or publication type. Article screening and data extraction were performed independently by 2 abstractors. Completeness of reporting was evaluated according to modified elements from the CAse REport (CARE) guidelines. A total of 1028 citations were reviewed, with 36 case reports and 3 case series meeting eligibility criteria (63 patients total). The mean age was 60 (range, 9-87) years with balanced sex representation. At presentation, 48 patients (76%) had intramuscular or subcutaneous bleeding, and 34 patients (54%) had external or surgical bleeding. All cases were diagnosed by initially detecting a FXIII deficiency and then identifying the inhibitor. Clinical improvement in bleeding was seen in patients receiving FXIII concentrate (13/17 patients), cryoprecipitate (5/8), and plasma (10/18). Inhibitor reduction was seen in patients who received rituximab (6/6 patients), plasma exchange (2/2), intravenous immunoglobulin (4/5), steroid (15/20), and cyclophosphamide (10/15). Concurrent initiation of multiple therapies and obvious lack of control comparisons made direct association to outcomes difficult to establish. Outcomes were reported for 55 patients, with 25 patients (45%) having complete inhibitor eradication and 15 patients

  14. Nursing postoperative visit as a quality indicator for surgical patient care.

    Science.gov (United States)

    Silva, R; Martins, M M; Jardim, H G

    2016-06-01

    The postoperative visit as a quality indicator for surgical patient care, demands some consideration from perioperative nurses. We evaluated the nursing perioperative interventions on postoperative visits, and adjusted them to the needs of the patients with postoperative pain. Our study indicated that 73% of patients visited didn't have postoperative pain whereas 27% had pain. The pain is aggravated when the patient is mobilised, one of the most common signs and symptoms being gastrointestinal changes. Pharmacological and non-pharmacological measures were used in pain management. The results showed that the percentage of patients with postoperative visits needs to be improved. We aim to have high quality perioperative nursing interventions which raise levels of patient satisfaction. PMID:27498440

  15. Prognostic impact of clinical course-specific mRNA expression profiles in the serum of perioperative patients with esophageal cancer in the ICU: a case control study

    Directory of Open Access Journals (Sweden)

    Oshima Yoshiaki

    2010-10-01

    Full Text Available Abstract Background We previously reported that measuring circulating serum mRNAs using quantitative one-step real-time RT-PCR was clinically useful for detecting malignancies and determining prognosis. The aim of our study was to find crucial serum mRNA biomarkers in esophageal cancer that would provide prognostic information for post-esophagectomy patients in the critical care setting. Methods We measured serum mRNA levels of 11 inflammatory-related genes in 27 post-esophagectomy patients admitted to the intensive care unit (ICU. We tracked these levels chronologically, perioperatively and postoperatively, until the two-week mark, investigating their clinical and prognostic significance as compared with clinical parameters. Furthermore, we investigated whether gene expression can accurately predict clinical outcome and prognosis. Results Circulating mRNAs in postoperative esophagectomy patients had gene-specific expression profiles that varied with the clinical phase of their treatment. Multivariate regression analysis showed that upregulation of IL-6, VWF and TGF-β1 mRNA in the intraoperative phase (p = 0.016, 0.0021 and 0.009 and NAMPT and MUC1 mRNA on postoperative day 3 (p ®, Ono Pharmaceutical Co., Ltd. significantly correlated with MUC1 and NAMPT mRNA expression (p = 0.048 and 0.045. IL-6 mRNA correlated with hypercytokinemia and recovery from hypercytokinemia (sensitivity 80.9% and was a significant biomarker in predicting the onset of severe inflammatory diseases. Conclusion Chronological tracking of postoperative mRNA levels of inflammatory-related genes in esophageal cancer patients may facilitate early institution of pharamacologic therapy, prediction of treatment response, and prognostication during ICU management in the perioperative period.

  16. Critical paths: maximizing patient care coordination.

    Science.gov (United States)

    Spath, P L

    1995-01-01

    1. With today's emphasis on horizontal and vertical integration of patient care services and the new initiatives prompted by these challenges, OR nurses are considering new methods for managing the perioperative period. One such method is the critical path. 2. A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff members for a particular diagnosis or procedure, designed to better use resources, maximize quality of care, and minimize delays. 3. Hospitals implementing path-based patient care have reported cost reductions and improved team-work. Critical paths have been shown to reduce patient care costs by improving hospital efficiency, not merely by reducing physician practice variations.

  17. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial

    DEFF Research Database (Denmark)

    Vester-Andersen, Morten; Waldau, Tina; Wetterslev, Jørn;

    2013-01-01

    is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power. DISCUSSION: This trial evaluates the benefits and possible harm of intermediate care. The results may potentially....... The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.Methods and design: The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency...... laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure...

  18. Nursing care of patients receiving interventional therapy for hepatic artery stenosis after liver transplantation

    International Nuclear Information System (INIS)

    Objective: To discuss the perioperative nursing care of patients who is going to receive interventional therapy for hepatic artery stenosis after liver transplantation and to provide useful reference for reducing surgery-related complication and for improving the prognosis of patients. Methods: Based on the patient's condition and operative requirement,we provided effective nursing care for 20 patients who were admitted to receive the interventional therapy for hepatic artery stenosis after liver transplantation. The nursing care included preoperative preparation,postoperative nursing and medical guidance at the time of discharge. Results: Interventional therapy was successfully performed in all 20 cases, and no hemorrhagic tendency or acute thrombosis occurred. Marked symptomatic improvement was obtained in all patients. Conclusion: The interventional therapy is an effective treatment for hepatic artery stenosis after liver transplantation. Intensive perioperative nursing care can well prevent the occurrence of surgery-related complications and can surely improve the therapeutic results. (authors)

  19. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.

    LENUS (Irish Health Repository)

    Ali, M

    2010-03-01

    Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery.

  20. Repair of overheating linear accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Barkley, Walter; Baldwin, William; Bennett, Gloria; Bitteker, Leo; Borden, Michael; Casados, Jeff; Fitzgerald, Daniel; Gorman, Fred; Johnson, Kenneth; Kurennoy, Sergey; Martinez, Alberto; O’Hara, James; Perez, Edward; Roller, Brandon; Rybarcyk, Lawrence; Stark, Peter; Stockton, Jerry

    2004-01-01

    Los Alamos Neutron Science Center (LANSCE) is a proton accelerator that produces high energy particle beams for experiments. These beams include neutrons and protons for diverse uses including radiography, isotope production, small feature study, lattice vibrations and material science. The Drift Tube Linear Accelerator (DTL) is the first portion of a half mile long linear section of accelerator that raises the beam energy from 750 keV to 100 MeV. In its 31st year of operation (2003), the DTL experienced serious issues. The first problem was the inability to maintain resonant frequency at full power. The second problem was increased occurrences of over-temperature failure of cooling hoses. These shortcomings led to an investigation during the 2003 yearly preventative maintenance shutdown that showed evidence of excessive heating: discolored interior tank walls and coper oxide deposition in the cooling circuits. Since overheating was suspected to be caused by compromised heat transfer, improving that was the focus of the repair effort. Investigations revealed copper oxide flow inhibition and iron oxide scale build up. Acid cleaning was implemented with careful attention to protection of the base metal, selection of components to clean and minimization of exposure times. The effort has been very successful in bringing the accelerator through a complete eight month run cycle allowing an incredible array of scientific experiments to be completed this year (2003-2004). This paper will describe the systems, investigation analysis, repair, return to production and conclusion.

  1. Perioperative Psychological and Music Interventions in Elderly Patients Undergoing Spinal Anesthesia: Effect on Anxiety, Heart Rate Variability, and Postoperative Pain

    OpenAIRE

    Wang, Yisha; Dong, Youjing; Li, Yang

    2014-01-01

    Purpose The aim of this study was to evaluate the effects of perioperative psychological and music interventions in elderly patients undergoing elective surgery on anxiety, post-operative pain, and changes in heart rate variability (HRV) to ascertain if perioperative psychological and music interventions can affect overall anxiety levels. Materials and Methods Fourty elderly patients undergoing elective surgery were randomized to two groups; one group received psychological and music interven...

  2. 2014 CERN Accelerator Schools: Plasma Wake Acceleration

    CERN Multimedia

    2014-01-01

    A specialised school on Plasma Wake Acceleration will be held at CERN, Switzerland from 23-29 November, 2014.   This course will be of interest to staff and students in accelerator laboratories, university departments and companies working in or having an interest in the field of new acceleration techniques. Following introductory lectures on plasma and laser physics, the course will cover the different components of a plasma wake accelerator and plasma beam systems. An overview of the experimental studies, diagnostic tools and state of the art wake acceleration facilities, both present and planned, will complement the theoretical part. Topical seminars and a visit of CERN will complete the programme. Further information can be found at: http://cas.web.cern.ch/cas/PlasmaWake2014/CERN-advert.html http://indico.cern.ch/event/285444/

  3. The direction of acceleration

    Science.gov (United States)

    Wilhelm, Thomas; Burde, Jan-Philipp; Lück, Stephan

    2015-11-01

    Acceleration is a physical quantity that is difficult to understand and hence its complexity is often erroneously simplified. Many students think of acceleration as equivalent to velocity, a ˜ v. For others, acceleration is a scalar quantity, which describes the change in speed Δ|v| or Δ|v|/Δt (as opposed to the change in velocity). The main difficulty with the concept of acceleration therefore lies in developing a correct understanding of its direction. The free iOS app AccelVisu supports students in acquiring a correct conception of acceleration by showing acceleration arrows directly at moving objects.

  4. Impact of Laparoscopic Versus Open Hepatectomy on Perioperative Clinical Outcomes of Patients with Primary Hepatic Carcinoma

    Institute of Scientific and Technical Information of China (English)

    Hai-tao Jiang; Jing-yu Cao

    2015-01-01

    Objective To compare the perioperative outcomes of patients with primary hepatic carcinoma treated with laparoscopic hepatectomy (LH) with those treated with open hepatectomy (OH). Methods From January 2010 to August 2014, 100 patients with primary hepatic carcinoma were randomly divided into the LH group and OH group respectively, 50 patients in each group. And the incision length, blood loss, operative time, postoperative liver function, anus exhaust time, complications, length of postoperative hospital stay, and cost measures were compared. Results LH could achieve shorter incision length, less blood loss, more rapid recovery in liver function and gastrointestinal function, and shorter postoperative hospital stay length compared with OH for primary hepatic carcinoma patients (all P0.05). Conclusion Compared with OH, LH could improve perioperative outcomes of primary hepatic carcinoma patients.

  5. Perioperative changes of ventricular function and three indicators of myocardial injury during orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    HEI Zi-qing; LIU De-zhao; LUO Chen-fang; LI Shang-rong; MA Wu-hua; LUO Gang-jian

    2006-01-01

    @@ Patients undergoing orthotopic liver transplantation may develop significant haemodynamic instability, especially during anhepatic phase and immediately after reperfusion of the graft. The haemodynamic instability may be caused directly by myocardial depression due to pathogenic substances released from the liver, or by acute blood loss.1 Creatine kinase(CK) and its MB fraction (CK-MB) are sensitive and specific indicators to reflect myocardial damage.2 Cardiac troponin I (cTnl) is a specific and sensitive marker of myocardial necrosis.3 This study assessed perioperative cardiac function using three indicators (CK,CK-MB,and CTnl) to evaluate perioperative myocardial damage.$4This study was supported by grants from the National Natural Science Foundation of China (No. 30271254) and Guangdong Medical Development Foundation (No. 2004B35001005).

  6. Effect of Melatonin on Sleep in the Perioperative Period after Breast Cancer Surgery

    DEFF Research Database (Denmark)

    Madsen, Michael Tvilling; Voigt Hansen, Melissa; Andersen, Lærke Toftegård;

    2016-01-01

    significant differences for actigraphy determined sleep outcomes or subjective outcome parameters in the perioperative period were found between the groups. Overall, the patients sleep outcomes were within normal ranges and no participants had pathological sleep disturbances. CONCLUSIONS: Melatonin......STUDY OBJECTIVES: To investigate whether administration of an oral dose of 6 mg melatonin before bedtime perioperatively in breast cancer surgery could change sleep outcomes measured by actigraphy. METHODS: This paper reports secondary outcomes from a double-blind, placebo-controlled, randomized...... (VAS) for sleep, and the Karolinska Sleepiness Scale (KSS) each morning. RESULTS: Administration of 6 mg oral melatonin approximately 1 hour before bedtime resulted in significantly increased sleep efficiency and reduced wake after sleep onset for the entire 2-week postoperative period. No other...

  7. Standardized testing with chlorhexidine in perioperative allergy – a large single-centre evaluation

    DEFF Research Database (Denmark)

    Schjørring Opstrup, Morten; Malling, Hans-Jørgen; Krøigaard, Mogens;

    2014-01-01

    BACKGROUND: Perioperative allergic reactions to chlorhexidine are often severe and easily overlooked. Although rare, the prevalence remains unknown. Correct diagnosis is crucial, but no validated provocation model exists, and other diagnostic tests have never been evaluated. The aims were...... to estimate 1) the prevalence of chlorhexidine allergy and 2) the specificity and sensitivity for diagnostic tests for chlorhexidine allergy. METHODS: We included all patients investigated for suspected perioperative allergic reactions in the Danish Anaesthesia Allergy Centre during 2004-2012. The following...... tests were performed: specific IgE (Immunocap(®) , Phadia AB, Sweden), histamine release test (HR) (RefLab ApS, Denmark), skin prick test (SPT) and intradermal test (IDT). Positivity criteria: specific IgE > 0.35 kUA/l; HR class 1-12; SPT mean wheal diameter ≥ 3 mm; IDT mean wheal diameter ≥ twice...

  8. Perioperative treatment of femoral neck fracture with deep venous thrombosis: A case report

    Institute of Scientific and Technical Information of China (English)

    Ming Liu; Lei Liu; Fuguo Huang; Yue Fang; Gang Zhong; Zhou Xiang

    2015-01-01

    Deep venous thrombosis (DVT) is an important cause of disability and mortality after major orthopedic surgery.The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who require major surgery have not yet been well explored in Chinese clinical practice.Here we report a case of calf muscular venous thrombosis in a 55-year-old woman with femoral neck fracture before surgery.Preventive and treatment measures including the administration of heparin sodium, application of venous foot pump and placement of inferior vena cava filter were taken.The condition of the patient was stable during the perioperative period and the surgery was successful.Besides, postoperative examination showed that the femur healed well and the functional recovery was satisfactory.Our results suggest that femoral neck fracture patients combined with DVT can receive surgery after accurate preoperative assessment and proper preoperative treatment.

  9. Perioperative Tumor Cell Dissemination In Patients With Primary Or Metastatic Colorectal Cancer

    OpenAIRE

    Tralhão, J. G.; Hoti, E.; Serôdio, M.; Laranjeiro, P.; Paiva, A.; Abrantes, A.M.; Pais, M.L.; Botelho, M. F.; Sousa, F. Castro

    2010-01-01

    Abstract Introduction Although there is general correlation between TNM stage of colorectal cancer (CRC) and its prognosis, there is often significant variability of tumor behaviour and individual patient outcome, which is unaccounted for by pathologic factors alone. Our aim was to estimate the perioperative tumor cell dissemination in patients with primary or CRC liver metastases as a possible factor influencing the outcome. Methods Forty patients ...

  10. A practical approach to perioperative management of cardiac implantable electronic devices.

    Science.gov (United States)

    Chia, Pow-Li; Foo, David

    2015-10-01

    With the increased use of cardiac implantable electronic devices (CIEDs), it is increasingly important to recognise the unique challenges involved in the management of patients with CIEDs who are undergoing surgery. Practice advisories and consensus statements have been issued by the American Society of Anesthesiologists and the Heart Rhythm Society, advocating a multidisciplinary approach. This review discusses and presents a practical approach to perioperative CIED management in the Singapore context. PMID:26512144

  11. Lipid peroxidation - inhibitory effects of perioperatively used drugs associated with their membrane interactions.

    OpenAIRE

    Tsuchiya, Hironori

    2014-01-01

    Objective: Oxidative/nitrative stress, an imbalance between oxidant production and antioxidant defense in the biological system, is induced not only by various diseases but also by anesthesia and surgical trauma. Since the choice of drugs is expected to reduce oxidative/nitrative stress in the perioperative period, the lipid peroxidation inhibition by different drugs associated with surgery was studied together with investigating one of their possible mechanisms.Methods: Lipid peroxidation-in...

  12. Perioperative steroid administration inhibits angiogenic host tissue response to porous polyethylene (medpor®) implants

    OpenAIRE

    S Ehrmantraut; MW Laschke; Merkel, D.; Scheuer, C; Willnecker, V.; Meyer-Lindenberg, A; MD Menger; Naumann, A.

    2010-01-01

    Porous polyethylene (Medpor®) is an alloplastic biomaterial, which is commonly used in plastic and reconstructive surgery. In the present study, we analyzed the effect of perioperative steroid administration on the inflammatory and angiogenic host tissue response to implanted Medpor®. For this purpose, Medpor® was implanted into the dorsal skinfold chamber of prednisolone-treated and vehicle-treated (control) balb/c mice and analyzed by means of intravital fluorescence microscopy over a 14-da...

  13. Perioperative factors analysis in patients with aortic aneurysm and aortic dissection aneurysm

    Institute of Scientific and Technical Information of China (English)

    LIU Jian; LIU Xiao-li; XIAO Ying-bin; WANG Xue-feng; CHEN Lin

    2004-01-01

    This study was undertaken to analyze the perioperative factors and complications that influence the final outcome after deep hypothermic circulatory arrest and superficial hypothermia during operations on aortic aneurysms from Jan 2000 to Jun 2004. The results show that deep hypthermic circulatory arrest group provided a high risk of pulmonary insufficiency-hypoxemia and temporary neurological dysfunction in complication but not increased the risk of hospital mortality.

  14. Perioperative optic neuropathy in patients undergoing off-pump coronary artery bypass graft surgery

    OpenAIRE

    Rajani Battu; Apoorva Prasad; Muralidhar Kanchi

    2014-01-01

    Aims and Objectives: Perioperative optic neuropathy (PON) is a rare, but devastating complication following coronary artery bypass graft surgery (CABG). We performed a retrospective study of PON associated with off-pump CABG (OPCABG) to identify possible risk factors. Materials and Methods: 1442 patients underwent OPCABG over a 10-month period from October 2008 to August 2009; PON was identified in four (0.28%) patients. A retrospective review of the charts was done to identify the patient ch...

  15. Perioperative Statin Treatment: Can It Decrease Postsurgical Cardiac Event Risk in Noncardiac Surgery?

    Science.gov (United States)

    Spivey, Matthew G; Atwood, Jon; Fogel, Sandy L

    2016-08-01

    Cardiac events are an important cause of postsurgical morbidity and mortality. Statin drugs have been studied as potentially risk-modifying agents in perioperative medicine. They have been shown to confer a protective benefit in cardiac surgery, but the evidence available in noncardiac surgery patient populations remains less conclusive. We hypothesized that perioperative statin treatment would be associated with lower incidence of postsurgical cardiac events (PSCEs) after major noncardiac surgery. A retrospective cohort study included 21,637 major noncardiac surgeries. Statin treatment was the exposure of interest and PSCE was the primary outcome measure. Data collection included patient age, body mass index, smoking status, diabetic status, cardiac event history, statin treatment history, and PSCE diagnoses. Perioperative statin treatment occurred in 4176 cases (19.3%). PSCEs occurred in 50 cases (0.23%), 29 in the untreated control group (0.17%) and 21 in the statin treatment group (0.50%). Relative risk in the untreated group was 0.3303 (95% confidence interval = 0.1886, 0.5786). This implied that statin-treated patients had higher risk than the untreated group. However, a logistic regression model that accounted for observed cardiac disease risk factors showed statin treatment not to be a significant predictor of PSCE in this sample. Analysis repeated in high-risk subsets of the cohort yielded similar results. A propensity score matching method that minimized differences between study groups also failed to demonstrate a significant association between statin treatment and PSCE risk. Our study did not demonstrate a significant association between perioperative statin treatment and PSCEs after major noncardiac surgery. PMID:27657588

  16. Role of noninvasive ventilation in perioperative patients with neuromuscular disease: a clinical case

    Directory of Open Access Journals (Sweden)

    Ana Marinho

    2016-02-01

    Full Text Available The inclusion body myositis is an inflammatory myopathy that leads to chronic muscle inflammation associated with muscle weakness. It is characterized by a restrictive ventilatory syndrome requiring ventilatory support under non-invasive ventilation. The authors describe a clinical case and the anaesthetic management of a patient with inclusion body myopathy candidate for vertebroplasty, which highlights the importance of locoregional anaesthesia and of noninvasive ventilation and includes assisted cough techniques, maintained throughout the perioperative period.

  17. Are perioperative nonsteroidal anti-inflammatory drugs ulcerogenic in the short term?

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1992-01-01

    It is well documented that long term treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of peptic ulcer and that gastroduodenal mucosal erosions can be demonstrated in volunteers within 1 week of treatment initiation. However, long term studies in nonsurgical patients...... have not documented gastroduodenal complications within the first week of treatment. Cumulative data from controlled studies of perioperative (> or = 48 hours and perforation) within...

  18. Process Analysis and Monitoring in Complex Perioperative Environments: Health Operations Management

    OpenAIRE

    Seim, Andreas Røsland

    2009-01-01

     This thesis presents studies in perioperative environments at two large university hospitals, St. Olavs Hospital in Trondheim, Norway and Massachusetts General Hospital in Boston, USA. It is submitted in partial fulfillment of the requirements for the degree of PhD at the Norwegian University of Science and Technology.The thesis consists of two parts. First is an overarching, unifying discussion. Second is a collection of five papers, three published in international peer-reviewed journals a...

  19. A population pharmacokinetic model for perioperative dosing of factor VIII in hemophilia A patients

    Science.gov (United States)

    Hazendonk, Hendrika; Fijnvandraat, Karin; Lock, Janske; Driessens, Mariëtte; van der Meer, Felix; Meijer, Karina; Kruip, Marieke; Gorkom, Britta Laros-van; Peters, Marjolein; de Wildt, Saskia; Leebeek, Frank; Cnossen, Marjon; Mathôt, Ron

    2016-01-01

    The role of pharmacokinetic-guided dosing of factor concentrates in hemophilia is currently a subject of debate and focuses on long-term prophylactic treatment. Few data are available on its impact in the perioperative period. In this study, a population pharmacokinetic model for currently registered factor VIII concentrates was developed for severe and moderate adult and pediatric hemophilia A patients (FVIII levels hemophilia A patients by Bayesian adaptive dosing. PMID:27390359

  20. San Francisco Accelerator Conference

    International Nuclear Information System (INIS)

    'Where are today's challenges in accelerator physics?' was the theme of the open session at the San Francisco meeting, the largest ever gathering of accelerator physicists and engineers

  1. Improved plasma accelerator

    Science.gov (United States)

    Cheng, D. Y.

    1971-01-01

    Converging, coaxial accelerator electrode configuration operates in vacuum as plasma gun. Plasma forms by periodic injections of high pressure gas that is ionized by electrical discharges. Deflagration mode of discharge provides acceleration, and converging contours of plasma gun provide focusing.

  2. Standing wave linear accelerator

    International Nuclear Information System (INIS)

    Consideration is being given to standing wave linear accelerator containing generator, phase shifter, two accelerating resonator sections, charged particle injector and waveguide bridge. Its first arm is oined up with generator via the phase shifter, the second and the third ones-with accelerating sections and the fourth one - with HF-power absorber. HF-power absorber represents a section of circular diaphragmatic wavequide with transformer with input wave and intrawaveguide output load located between injector and the first accelerating section. The section possesses holes in side walls lying on accelerator axis. The distances between centers of the last cell of the fast accelerating section and the first cell of the second accelerating sectiOn equal (2n+3)lambda/4, where n=1, 2, 3..., lambda - wave length of generator. The suggested system enables to improve by one order spectral characteristics of accelerators as compared to the prototype in which magnetrons are used as generator

  3. Accelerator Technology Division

    Science.gov (United States)

    1992-04-01

    In fiscal year (FY) 1991, the Accelerator Technology (AT) division continued fulfilling its mission to pursue accelerator science and technology and to develop new accelerator concepts for application to research, defense, energy, industry, and other areas of national interest. This report discusses the following programs: The Ground Test Accelerator Program; APLE Free-Electron Laser Program; Accelerator Transmutation of Waste; JAERI, OMEGA Project, and Intense Neutron Source for Materials Testing; Advanced Free-Electron Laser Initiative; Superconducting Super Collider; The High-Power Microwave Program; (Phi) Factory Collaboration; Neutral Particle Beam Power System Highlights; Accelerator Physics and Special Projects; Magnetic Optics and Beam Diagnostics; Accelerator Design and Engineering; Radio-Frequency Technology; Free-Electron Laser Technology; Accelerator Controls and Automation; Very High-Power Microwave Sources and Effects; and GTA Installation, Commissioning, and Operations.

  4. High Energy Particle Accelerators

    CERN Multimedia

    Audio Productions, Inc, New York

    1960-01-01

    Film about the different particle accelerators in the US. Nuclear research in the US has developed into a broad and well-balanced program.Tour of accelerator installations, accelerator development work now in progress and a number of typical experiments with high energy particles. Brookhaven, Cosmotron. Univ. Calif. Berkeley, Bevatron. Anti-proton experiment. Negative k meson experiment. Bubble chambers. A section on an electron accelerator. Projection of new accelerators. Princeton/Penn. build proton synchrotron. Argonne National Lab. Brookhaven, PS construction. Cambridge Electron Accelerator; Harvard/MIT. SLAC studying a linear accelerator. Other research at Madison, Wisconsin, Fixed Field Alternate Gradient Focusing. (FFAG) Oakridge, Tenn., cyclotron. Two-beam machine. Comments : Interesting overview of high energy particle accelerators installations in the US in these early years. .

  5. Anesthesia Strategies and Perioperative Optimization for Patients with Ankylosing Spondylitis Undergoing Total Hip Replacement Surgery.

    Science.gov (United States)

    2016-06-10

    Objective To identify the characteristics of anesthesia and perioperative management for ankylosing spondylitis (AS) patients undergoing total hip arthroplasty (THA). Methods Totally 63 patients scheduled for single THA in PUMC Hospital from January 1st 2013 to June 1st 2015 were included in this retrospective analysis,among whom 21 patients were diagnosed of AS. The perioperative clinical data included:demographic data,American Society of Anesthesiologists (ASA) classification,medical history,airway assessment,preoperative laboratory examinations,electrocardiogram,pulmonary function tests,intubation information,operation time,intraoperative intake and output volume,postoperative hospital stay,and postoperative complications. Results Significantly fewer AS patients undergoing THA were evaluated as ASA classification I than non-AS patients (9.5% vs. 33.3%,P=0.041). AS patients had significantly higher level of preoperative high-sensitivity C-reactive protein [(17.0±14.8)mg/L vs.(4.3±7.1)mg/L,P0.05). Conclusions AS patients undergoing THA have elevated preoperative inflammatory markers,with high incidence of pulmonary function abnormality and difficult airway. In consideration of high risk of surgery and anesthesia,adequate airway evaluation and optimization of perioperative management are needed to ensure the patients' safety. PMID:27469916

  6. EFFECTS OF PERIOPERATIVE CIMETIDINE ADMINISTRATION ON NATURAL KILLER CELLS IN PATIENTS WITH GASTROINTESTINAL CANCER

    Institute of Scientific and Technical Information of China (English)

    LI Yan; BAI De-jiao; WANG Kun; YANG Guo-liang; YUAN Hong-yin; SHAO Hua

    1999-01-01

    Objective: To study the effects of perioperative use of cimetidine on natural killer (NK) cells in gastrointestinal (GI) cancer patients. Methods: 49 GI cancer patients were randomized into treatment group which took cimetidine in the perioperative period, and control group which did not take the drug. NK cells were measured by immunocytochemical method, using mouse-anti-human CD57 monoclonal antibody as the primary antibody. Blood samples from 20 healthy volunteers were treated in the same way as normal control. Comparisons were made within and between groups. Results: The NK cell percentage of normal control was 18.50±2.31. Both groups of patients had significantly lower than normal NK percentages before treatment (P<0.05). NK cell percentages at admission,before operation, on the 2nd and the 10th postoperative days were 14.60±3.91, 15.64±3.61, 17.40±3.28, 20.68±4.13, respectively, for the treatment group, and 14.88±2.76, 13.17±2.93, 14.50±2.77, 15.67±2.55, respectively,for control group. The difference between the two groups was statistically significant. Conclusion: Perioperative cimetidine application can help restore NK cells. The drug may be useful to reverse postoperative immuno-depression in GI cancer patients.

  7. Perioperative music and its effects on anxiety, hemodynamics, and pain in women undergoing mastectomy.

    Science.gov (United States)

    Binns-Turner, Pamela G; Wilson, Lynda Law; Pryor, Erica R; Boyd, Gwendolyn L; Prickett, Carol A

    2011-08-01

    There is increasing interest in evaluating the use of nonpharmacologic interventions such as music to minimize potential adverse effects of anxiety-reducing medications. This study used a quasi-experimental design to evaluate the effects of a perioperative music intervention (provided continuously throughout the preoperative, intraoperative, and postoperative periods) on changes in mean arterial pressure (MAP), heart rate, anxiety, and pain in women with a diagnosis of breast cancer undergoing mastectomy. A total of 30 women were assigned randomly to a control group or to the music intervention group. Findings indicated that women in the intervention group had a greater decrease in MAP and anxiety with less pain from the preoperative period to the time of discharge from the recovery room compared with women in the control group. Music is a noninvasive and low-cost intervention that can be easily implemented in the perioperative setting, and these findings suggest that perioperative music can reduce MAP, anxiety, and pain among women undergoing mastectomy for breast cancer. PMID:22403963

  8. Hypnosis in the Perioperative Management of Breast Cancer Surgery: Clinical Benefits and Potential Implications

    Science.gov (United States)

    Roelants, Fabienne; Pospiech, Audrey; Momeni, Mona; Watremez, Christine

    2016-01-01

    The aim of this review is to summarize data published on the use of perioperative hypnosis in patients undergoing breast cancer surgery (BCS). Indeed, the majority of BCS patients experience stress, anxiety, nausea, vomiting, and pain. Correct management of the perioperative period and surgical removal of the primary tumor are clearly essential but can affect patients on different levels and hence have a negative impact on oncological outcomes. This review examines the effect of clinical hypnosis performed during the perioperative period. Thanks to its specific properties and techniques allowing it to be used as complementary treatment preoperatively, hypnosis has an impact most notably on distress and postoperative pain. During surgery, hypnosis may be applied to limit immunosuppression, while, in the postoperative period, it can reduce pain, anxiety, and fatigue and improve wound healing. Moreover, hypnosis is inexpensive, an important consideration given current financial concerns in healthcare. Of course, large randomized prospective studies are now needed to confirm the observed advantages of hypnosis in the field of oncology. PMID:27635132

  9. The role of perioperative sodium bicarbonate infusion affecting renal function after Cardiothoracic Surgery

    Directory of Open Access Journals (Sweden)

    Katja Regina Turner

    2014-06-01

    Full Text Available Cardiac surgery associated acute kidney injury (CSA-AKI is associated with poor outcomes including increased mortality, length of hospital stay and cost. The incidence of acute kidney injury (AKI is reported to be between 3-30% depending on the definition of AKI. We designed a multicenter randomized controlled trial to test our hypothesis that a perioperative infusion of sodium bicarbonate during cardiac surgery will attenuate the postoperative rise in creatinine indicating renal injury when compared to a perioperative infusion with normal saline. An interim analysis was performed after data was available on the first 120 participants. A similar number of patients in the two treatment groups developed acute kidney injury (AKI, defined as an increase in serum creatinine the first 48 hours after surgery of 0.3 mg/dl or more. Specifically 14 patients (24% who received sodium chloride (SC and 17 patients (27% who received sodium bicarbonate (SB were observed to develop AKI post surgery, resulting in a relative risk of AKI of 1.1 (95% CI: 0.6-2.1, chi-square p-value=0.68 for patients receiving SB compared to those who received SC . The data safety monitoring board for the trial recommended closing the study early as there was only a 12% probability that the null hypothesis would be rejected. We therefore concluded that a perioperative infusion of sodium bicarbonate failed to attenuate the risk of CSA-AKI.

  10. Prospective study of use of perioperative antimicrobial therapy in general surgery.

    LENUS (Irish Health Repository)

    Fennessy, Brendan G

    2012-02-03

    BACKGROUND: Perioperative antimicrobial therapy has demonstrated efficacy in reducing the rate of surgical site infections in clinical trials. With the emergence of antibiotic resistance, the risk of reaction, and the inevitable financial repercussions, use of prophylactic antibiotics is not a panacea, and their misuse may have considerable implications. The aim of this study was to assess the use of antibiotics in the perioperative period in both general and vascular surgery procedures. METHODS: A prospective study was undertaken of 131 patients with a mean age of 43 years (range one month-88 years), of whom 68 (51%) were male, who underwent twenty-seven different general or vascular surgery procedures over a four-week period. Each patient was evaluated from the time of antibiotic commencement through their operative procedure until the treatment was discontinued. RESULTS: A total of 73 patients (54%) received ten antibiotics, with 71 (97%) of these uses being prophylactic. Of the 15 appendectomies performed for uncomplicated appendicitis, the mean number of prophylactic antibiotic doses was 5.3 (range 1-12). Where they were documented, written postoperative directives were not adhered to in 18\\/27 prescriptions (66%). CONCLUSION: This study has demonstrated a lack of adherence to guidelines in the perioperative administration of antimicrobial agents. In addition, it calls attention to the economic implications of unnecessary prophylaxis.

  11. Clinical Study on Application of Chinese Herbs during the Perioperative Period of Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    LI Rong-xiang; ZHOU Ying; LI Jin-long; LI Jin; CHEN Sheng-gui; CHEN Yong

    2007-01-01

    Objective:To explore the effect of Chinese herbs during the perioperative period of laparoscopic cholecystectomy (LC).Methods:Three hundred and sixty patients of chronic lithic cholecystitis (LCCT) were randomly assigned to two groups by lottery,180 patients in each group.During the peri-operative period,the control group was treated with conventional Western medicine and placebo.The treated group was given the same conventional Western medicine and Chinese herbal decoctions,with Shitong mixture No.1 (石通1号) added before LC,and Liujunzi decoction (六君子汤) added after LC for three days.The operation time,body temperature after LC,white blood cell count,wind-breaking time after operation,as well as the changes of tongue coating in the first three post-operative days were recorded.Results:There was no significant difference between the two groups in operation time (P>0.05),while the improvement in body temperature recovery,wind-breaking time and changes of tongue coating in the treated group were better than those in the control group (P<0.01).Conclusion:Applying Chinese herbs during perioperative period of LC could effectively benefit early recovery in such patients.

  12. Acute normovolaemic haemodilution - is it a solution to reduce perioperative blood transfusions? : review article

    Directory of Open Access Journals (Sweden)

    K.E. Joubert

    2007-06-01

    Full Text Available Haemodilution is a technique used to reduce perioperative homologous blood transfusions. Haemodilution is a poorly investigated technique in veterinary medicine. This article reviews haemodilution as a potential technique to reduce perioperative homologous blood transfusions. The history of haemodilution is briefly reviewed followed by the mathematical basis to haemodilution. The issue of critical oxygen delivery and its implications for haemodilution are discussed. The effects of haemodilution on the patient, including the effects on oxygen transport, blood flow and coagulation are discussed as well as the use of colloids, fluids and blood components in haemodilution. The success and failure of haemodilution in human clinical trials and experimental evidence is discussed. Some guidelines are given for the use of haemodilution in small animal patients in the perioperative setting. It appears in all likelihood that haemodilution has a limited application in cats and other small patients. Haemodilution is most beneficial when the initial haematocrit is high, a low haemodiluted haematocrit is achieved, the patients circulating volume is large and a large amount of blood was lost. It is important to avoid haemoconcentration during surgery as this increases red blood cell loss. Haemodilution is not a substitute for poor surgical technique and inadequate haemostasis intra-operatively. Intravascular volume should be maintained throughout the procedure.

  13. Perioperative complications of orthopedic surgery for lower extremity in patients with cerebral palsy.

    Science.gov (United States)

    Lee, Seung Yeol; Sohn, Hye-Min; Chung, Chin Youb; Do, Sang-Hwan; Lee, Kyoung Min; Kwon, Soon-Sun; Sung, Ki Hyuk; Lee, Sun Hyung; Park, Moon Seok

    2015-04-01

    Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (PGMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications.

  14. An evidence-based approach to perioperative nutrition support in the elective surgery patient.

    Science.gov (United States)

    Miller, Keith R; Wischmeyer, Paul E; Taylor, Beth; McClave, Stephen A

    2013-09-01

    In surgical practice, great attention is given to the perioperative management of the elective surgical patient with regard to surgical planning, stratification of cardiopulmonary risk, and postoperative assessment for complication. However, growing evidence supports the beneficial role for implementation of a consistent and literature-based approach to perioperative nutrition therapy. Determining nutrition risk should be a routine component of the preoperative evaluation. As with the above issues, this concept begins with the clinician's first visit with the patient as risk is assessed and the severity of the surgical insult considered. If the patient is an appropriate candidate for benefit from preoperative support, a plan for initiation and reassessment should be implemented. Once appropriate nutrition end points have been achieved, special consideration should be given to beneficial practices the immediate day preceding surgery that may better prepare the patient for the intervention from a metabolic standpoint. In the operating room, consideration should be given to the potential placement of enteral access during the index operation as well as judicious and targeted intraoperative resuscitation. Immediately following the intervention, adequate resuscitation and glycemic control are key concepts, as is an evidence-based approach to the early advancement of an enteral/oral diet in the postoperative patient. Through the implementation of perioperative nutrition therapy plans in the elective surgery setting, outcomes can be improved. PMID:24009248

  15. Diabetes, perioperative ischaemia and volatile anaesthetics: consequences of derangements in myocardial substrate metabolism.

    Science.gov (United States)

    van den Brom, Charissa E; Bulte, Carolien Se; Loer, Stephan A; Bouwman, R Arthur; Boer, Christa

    2013-01-01

    Volatile anaesthetics exert protective effects on the heart against perioperative ischaemic injury. However, there is growing evidence that these cardioprotective properties are reduced in case of type 2 diabetes mellitus. A strong predictor of postoperative cardiac function is myocardial substrate metabolism. In the type 2 diabetic heart, substrate metabolism is shifted from glucose utilisation to fatty acid oxidation, resulting in metabolic inflexibility and cardiac dysfunction. The ischaemic heart also loses its metabolic flexibility and can switch to glucose or fatty acid oxidation as its preferential state, which may deteriorate cardiac function even further in case of type 2 diabetes mellitus.Recent experimental studies suggest that the cardioprotective properties of volatile anaesthetics partly rely on changing myocardial substrate metabolism. Interventions that target at restoration of metabolic derangements, like lifestyle and pharmacological interventions, may therefore be an interesting candidate to reduce perioperative complications. This review will focus on the current knowledge regarding myocardial substrate metabolism during volatile anaesthesia in the obese and type 2 diabetic heart during perioperative ischaemia. PMID:23452502

  16. Maximal Acceleration Is Nonrotating

    OpenAIRE

    Page, Don N.

    1997-01-01

    In a stationary axisymmetric spacetime, the angular velocity of a stationary observer that Fermi-Walker transports its acceleration vector is also the angular velocity that locally extremizes the magnitude of the acceleration of such an observer, and conversely if the spacetime is also symmetric under reversing both t and phi together. Thus a congruence of Nonrotating Acceleration Worldlines (NAW) is equivalent to a Stationary Congruence Accelerating Locally Extremely (SCALE). These congruenc...

  17. A Solid state accelerator

    International Nuclear Information System (INIS)

    We present a solid state accelerator concept utilizing particle acceleration along crystal channels by longitudinal electron plasma waves in a metal. Acceleration gradients of order 100 GV/cm are theoretically possible, but channeling radiation limits the maximum attainable energy to 105 TeV for protons. Beam dechanneling due to multiple scattering is substantially reduced by the high acceleration gradient. Plasma wave dissipation and generation in metals are also discussed

  18. Applications of particle accelerators

    International Nuclear Information System (INIS)

    Particle accelerators are now widely used in a variety of applications for scientific research, applied physics, medicine, industrial processing, while possible utilisation in power engineering is envisaged. Earlier presentations of this subject, given at previous CERN Accelerator School sessions have been updated with papers contributed to the first European Conference on Accelerators in Applied Research and Technology (ECAART) held in September 1989 in Frankfurt and to the Second European Particle Accelerator Conference in Nice in June 1990. (orig.)

  19. Accelerators at school

    International Nuclear Information System (INIS)

    Latest subject covered by the CERN Accelerator School was 'Applied Geodesy of Particle Accelerators', which attracted an impressive number of outside participants to CERN for a week in April. Since the forerunners of today's particle accelerators were demonstrated over 50 years ago, the positioning of accelerator components has progressed from the laboratory bench-top to tunnels tens of kilometres long. Despite this phenomenal growth in size, sub-millimetre accuracy is still required

  20. Perioperative glucose managements for patients undergoing abdominal surgery%糖尿病患者腹部手术围手术期的处理

    Institute of Scientific and Technical Information of China (English)

    卫洪波; 雷普润

    2016-01-01

    糖尿病已成为全球威胁人类健康的三大慢性非传染性疾病之一。需要外科手术的患者占所有糖尿病患者的25%,其围手术期病死率、并发症以及住院时间较正常人明显增加,因此对于糖尿病患者围手术期的处理方案显得尤为重要。但目前对于围手术期血糖控制范围仍众说纷纭,综合各研究结论,笔者认为将血糖控制在7.8~10 mmol/L是一个较为理想的范围。在患者术前、术中及术后应联合多学科制定各项相应的治疗方案,围手术期尤为注意避免患者发生低血糖和电解质紊乱的发生。也亟待后续大规模的随机对照试验进一步确定有效的血糖控制目标。%Diabetes have become one of three most common chronic non-infectious diseases in China.25% of patients undergoing surgery sufferred diabetes , of whom perioperative complications and mortality were significantly increased and hospital stay was delayed than those of patients without diabetes . Therefore glucose control played an important role in the perioperative management .According to the global guidelines, we recommend 7.8-10.0mmol/L as a moderate glucose level .Perioperative multiple displinary therapeutic strategies for patients could help to avoid hypoglycemia and electrolyte disturbance should be carefully managed .The accurate level of glucose control might be achieved by further large scale randomized controlled trials .

  1. Acceleration: It's Elementary

    Science.gov (United States)

    Willis, Mariam

    2012-01-01

    Acceleration is one tool for providing high-ability students the opportunity to learn something new every day. Some people talk about acceleration as taking a student out of step. In actuality, what one is doing is putting a student in step with the right curriculum. Whole-grade acceleration, also called grade-skipping, usually happens between…

  2. The CERN Accelerator School

    CERN Multimedia

    2016-01-01

    Introduction to accelerator physics The CERN Accelerator School: Introduction to Accelerator Physics, which should have taken place in Istanbul, Turkey, later this year has now been relocated to Budapest, Hungary.  Further details regarding the new hotel and dates will be made available as soon as possible on a new Indico site at the end of May.

  3. Accelerators and Dinosaurs

    CERN Document Server

    Turner, Michael Stanley

    2003-01-01

    Using naturally occuring particles on which to research might have made accelerators become extinct. But in fact, results from astrophysics have made accelerator physics even more important. Not only are accelerators used in hospitals but they are also being used to understand nature's inner workings by searching for Higgs bosons, CP violation, neutrino mass and dark matter (2 pages)

  4. Far field acceleration

    Energy Technology Data Exchange (ETDEWEB)

    Fernow, R.C.

    1995-07-01

    Far fields are propagating electromagnetic waves far from their source, boundary surfaces, and free charges. The general principles governing the acceleration of charged particles by far fields are reviewed. A survey of proposed field configurations is given. The two most important schemes, Inverse Cerenkov acceleration and Inverse free electron laser acceleration, are discussed in detail.

  5. Perioperative oxygen fraction - effect on surgical site infection and pulmonary complications after abdominal surgery: a randomized clinical trial. Rationale and design of the PROXI-Trial

    DEFF Research Database (Denmark)

    Meyhoff, Christian Sylvest; Wetterslev, Jørn; Jorgensen, Lars N;

    2008-01-01

    A high perioperative inspiratory oxygen fraction may reduce the risk of surgical site infections, as bacterial eradication by neutrophils depends on wound oxygen tension. Two trials have shown that a high perioperative inspiratory oxygen fraction (FiO(2) = 0.80) significantly reduced risk...... complications, such as atelectasis, pneumonia and respiratory failure. The aim of our trial is to assess the potential benefits and harms of a high perioperative oxygen fraction in patients undergoing abdominal surgery....

  6. The nursing care for patients of hepatocellular carcinoma treated with transcatheter hepatic arterial chemoembolization and high intensive focus ultrasound

    International Nuclear Information System (INIS)

    Objective: To discuss the nursing measures for patients of hepatocellular carcinoma treated with transcatheter hepatic arterial chemoembolization (TACE) and high intensive focus ultrasound(HIFU). Methods: During the period of Aug.2008-Aug. 2009, TACE together with HIFU were performed in 40 patients with hepatocellular carcinoma. The perioperative nursing measures were summarized. Results: During hospitalization no severe complications, such as dangerous infection, intestinal bleeding, etc. occurred in all patients. Conclusion: Correct and proper perioperative nursing care is of significant importance for the prevention of complications and for the therapeutic effectiveness. (authors)

  7. 肝癌介入治疗病人围术期合并上消化道出血的护理%The nursing methods for liver cancer interventional treatment patients with upper gastrointestinal bleeding in the perioperative

    Institute of Scientific and Technical Information of China (English)

    龚美霞; 洪侠; 徐艳莉; 陈川

    2011-01-01

    Objective:To study the nursing methods for liver cancer interventions! Treatment patients with upper gastrointestinal bleeding in the periopera-tive. Methods:To analyzing the nursing experience of 42 liver cancer interventional treatment patients with upper gastrointestinal bleeding in January 2005 -December 2010 and summarizing the care nursing experience points. Results:Thirty - nine of forty - two patients survived after clinical rescue and nursing, while there were 3 cases of death. Conclusions: liver interventional perioperative with upper gastrointestinal bleeding is in critical need of professional and careful nursing, and has a bit inadvertent, serious consequences.%目的:探讨介入治疗肝癌病人围术期合并上消化道出血的护理方法.方法:分析2005年1月~2010年12月42例肝癌介入治疗病人围术期合并上消化道出血的护理经验,总结其护理要点.结果:42例病人经临床抢救及护理,存活39例,死亡3例.结论:肝癌介入治疗围术期合并上消化道出血病情危重,需要专业和细心的护理,稍有不慎,后果严重.

  8. Direct Laser Acceleration in Laser Wakefield Accelerators

    OpenAIRE

    Shaw, Jessica

    2016-01-01

    In this dissertation, the direct laser acceleration (DLA) of ionization-injected electrons in a laser wakefield accelerator (LWFA) operating in the quasi-blowout regime has been investigated through experiment and simulation. In the blowout regime of LWFA, the radiation pressure of an intense laser pulse can push a majority of the plasma electrons out and around the main body of the pulse. The expelled plasma electrons feel the electrostatic field of the relatively-stationary ions and are t...

  9. The Accelerator Reliability Forum

    CERN Document Server

    Lüdeke, Andreas; Giachino, R

    2014-01-01

    A high reliability is a very important goal for most particle accelerators. The biennial Accelerator Reliability Workshop covers topics related to the design and operation of particle accelerators with a high reliability. In order to optimize the over-all reliability of an accelerator one needs to gather information on the reliability of many different subsystems. While a biennial workshop can serve as a platform for the exchange of such information, the authors aimed to provide a further channel to allow for a more timely communication: the Particle Accelerator Reliability Forum [1]. This contribution will describe the forum and advertise it’s usage in the community.

  10. Induction linear accelerators

    Science.gov (United States)

    Birx, Daniel

    1992-03-01

    Among the family of particle accelerators, the Induction Linear Accelerator is the best suited for the acceleration of high current electron beams. Because the electromagnetic radiation used to accelerate the electron beam is not stored in the cavities but is supplied by transmission lines during the beam pulse it is possible to utilize very low Q (typicallymarriage of liner accelerator technology and nonlinear magnetic compressors has produced some unique capabilities. It now appears possible to produce electron beams with average currents measured in amperes, peak currents in kiloamperes and gradients exceeding 1 MeV/meter, with power efficiencies approaching 50%. The nonlinear magnetic compression technology has replaced the spark gap drivers used on earlier accelerators with state-of-the-art all-solid-state SCR commutated compression chains. The reliability of these machines is now approaching 1010 shot MTBF. In the following paper we will briefly review the historical development of induction linear accelerators and then discuss the design considerations.

  11. 老年糖尿病患者行冠状动脉搭桥术围术期护理研究%Perioperative Nursing of Elderly Patients with Diabetes Mellitus Undergoing Coronary Artery Bypass Grafting

    Institute of Scientific and Technical Information of China (English)

    景丽丽

    2015-01-01

    Objective To study the perioperative nursing care of elderly patients with diabetes mellitus, and to study the ef-fect of perioperative nursing. Methods from June 2012 to March 2015, the clinical data of elderly patients with diabetes mellitus were studied, and the patients were treated with careful perioperative nursing. Results in this study, 110 cases of elderly patients with diabetes, 2 cases of hypoglycemia symptoms, 3 cases of elderly patients with diabetes after surgery, the symptoms of superficial infection, and the rest of the elderly patients with diabetes were not complications, after active treatment and care, all the elderly patients with diabetes were discharged. Conclusion elderly patients with diabetes melli-tus underwent coronary artery bypass grafting surgery has a greater risk, provide a careful perioperative care, and close monitoring of patients with blood glucose changes is a smooth operation of coronary artery bypass surgery, elderly patients with diabetes safely through perioperative period of important guarantee.%目的:研究老年糖尿病患者行冠状动脉搭桥术围术期护理方法,以及围术期的护理效果。方法选取2012年6月—2015年3月该院收治的实施行冠状动脉搭桥术的老年糖尿病患者临床资料为研究对象,并对这些患者进行精心围术期护理,并且严密监控患者血糖变化。结果在此次研究的110例老年糖尿病患者中有2例出现低血糖症状,3例老年糖尿病患者术后切口出现表浅感染症状,其余老年糖尿病患者均未出现并发症,经过该院积极治疗和护理,所有老年糖尿病患者均康复出院。结论老年糖尿病患者行冠状动脉搭桥术有着较大的风险,提供精心围术期护理,以及密切监控患者血糖变化是行冠状动脉搭桥手术顺利进行、老年糖尿病患者安全渡过围术期的重要保证。

  12. Nursing care for patients receiving percutaneous lumbar discectomy and intradiscal electrothermal treatment for lumbar disc herniation

    International Nuclear Information System (INIS)

    Objective: To summarize the nursing experience in caring patients with lumbar intervertebral disc herniation who received percutaneous lumbar discectomy (PLD) together with intradiscal electrothermal treatment (IDET) under DSA guidance. Methods: The perioperative nursing care measures carried out in 126 patients with lumbar intervertebral disc herniation who underwent PLD and IDET were retrospectively analyzed. Results: Successful treatment of PLD and IDET was accomplished in 112 cases. Under comprehensive and scientific nursing care and observation, no serious complications occurred. Conclusion: Scientific and proper nursing care is a strong guarantee for a successful surgery and a better recovery in treating lumbar intervertebral disc herniation with PLD and IDET under DSA guidance. (authors)

  13. Perioperative management of tracheobronchial injury following blunt trauma

    Directory of Open Access Journals (Sweden)

    Nilesh M Juvekar

    2013-01-01

    Full Text Available We describe tracheobronchial injury (TBI in a 17-year-old teenager following blunt trauma resulting from a road traffic accident. The patient presented to a peripheral hospital with swelling over the neck and face associated with bilateral pneumothorax for which bilateral intercostal drains were inserted and the patient was transferred to our institute. Fiber-optic videobronchoscopy (FOB was performed, the trachea and bronchi were visualized, and the site and extent of injury was assessed. Spontaneous respiration was maintained till assessment of the airway. Then the patient was anesthetized with propofol and paralyzed using succinylcholine and a double-lumen endobronchial tube was inserted; thereafter, the adequacy of controlled manual ventilation and air-leak through intercostal drains was assessed and the patient was transferred to operating room (OR for repair of the airway injury. The OR was kept ready during FOB to manage any catastrophe. This case describes the need for proper preparation and communication between health care team members to manage all possible scenarios of traumatic TBI.

  14. Perioperative Red Blood Cell Transfusion: What We Do Not Know

    Institute of Scientific and Technical Information of China (English)

    Chong Lei; Li-Ze Xiong

    2015-01-01

    Objective:Blood transfusion saves lives but may also increase the risk of injury.The objective of this review was to evaluate the possible adverse effects related to transfusion of red blood cell (RBC) concentrates stored for prolonged periods.Data Sources:The data used in this review were mainly from PubMed articles published in English up to February 2015.Study Selection:Clinical and basic research articles were selected according to their relevance to this topic.Results:The ex vivo changes to RBC that occur during storage are collectively called storage lesion.It is still inconclusive if transfusion of RBC with storage lesion has clinical relevance.Multiple ongoing prospective randomized controlled trials are aimed to clarify this clinical issue.It was observed that the adverse events related to stored RBC transfusion were prominent in certain patient populations,including trauma,critical care,pediatric,and cardiac surgery patients,which leads to the investigation of underlying mechanisms.It is demonstrated that free hemoglobin toxicity,decreasing of nitric oxide bioavailability,and free iron-induced increasing of inflammation may play an important role in this process.Conclusion:It is still unclear whether transfusion of older RBC has adverse effects,and if so,which factors determine such clinical effects.However,considering the magnitude of transfusion and the widespread medical significance,potential preventive strategies should be considered,especially for the susceptible recipients.

  15. Preventing Ventilator Associated Lung Injury: A Perioperative Perspective

    Directory of Open Access Journals (Sweden)

    Satoshi eKimura

    2016-05-01

    Full Text Available Introduction: Research into the prevention of ventilator-associated lung injury (VALI in patients with acute respiratory distress syndrome (ARDS in the intensive care unit (ICU has resulted in the development of a number of lung protective strategies, which have become commonplace in the treatment of critically ill patients. An increasing number of studies have applied lung protective ventilation in the operating room to otherwise healthy individuals. We review the history of lung protective strategies in patients with acute respiratory failure and explore their use patients undergoing mechanical ventilation during general anesthesia to provide context for a discussion of the benefits and drawbacks, as well as inform future areas of inquiry.Methods: We completed a database search and reviewed articles investigating lung protective ventilation in both the ICU and in patients receiving general anesthesia through May 2015. Results: Lung protective ventilation was associated with improved outcomes in patients with acute respiratory failure in the ICU. Clinical evidence is less clear regarding lung protective ventilation for patients undergoing surgery. Conclusion: Lung protective ventilation strategies including low tidal volume ventilation and moderate positive end-expiratory pressure (PEEP are well established therapies to minimize lung injury in critically ill patients with and without lung disease, and may provide benefit to patients undergoing general anesthesia.

  16. Particle-accelerator decommissioning

    International Nuclear Information System (INIS)

    Generic considerations involved in decommissioning particle accelerators are examined. There are presently several hundred accelerators operating in the United States that can produce material containing nonnegligible residual radioactivity. Residual radioactivity after final shutdown is generally short-lived induced activity and is localized in hot spots around the beam line. The decommissioning options addressed are mothballing, entombment, dismantlement with interim storage, and dismantlement with disposal. The recycle of components or entire accelerators following dismantlement is a definite possibility and has occurred in the past. Accelerator components can be recycled either immediately at accelerator shutdown or following a period of storage, depending on the nature of induced activation. Considerations of cost, radioactive waste, and radiological health are presented for four prototypic accelerators. Prototypes considered range from small accelerators having minimal amounts of radioactive mmaterial to a very large accelerator having massive components containing nonnegligible amounts of induced activation. Archival information on past decommissionings is presented, and recommendations concerning regulations and accelerator design that will aid in the decommissioning of an accelerator are given

  17. Particle-accelerator decommissioning

    Energy Technology Data Exchange (ETDEWEB)

    Opelka, J.H.; Mundis, R.L.; Marmer, G.J.; Peterson, J.M.; Siskind, B.; Kikta, M.J.

    1979-12-01

    Generic considerations involved in decommissioning particle accelerators are examined. There are presently several hundred accelerators operating in the United States that can produce material containing nonnegligible residual radioactivity. Residual radioactivity after final shutdown is generally short-lived induced activity and is localized in hot spots around the beam line. The decommissioning options addressed are mothballing, entombment, dismantlement with interim storage, and dismantlement with disposal. The recycle of components or entire accelerators following dismantlement is a definite possibility and has occurred in the past. Accelerator components can be recycled either immediately at accelerator shutdown or following a period of storage, depending on the nature of induced activation. Considerations of cost, radioactive waste, and radiological health are presented for four prototypic accelerators. Prototypes considered range from small accelerators having minimal amounts of radioactive mmaterial to a very large accelerator having massive components containing nonnegligible amounts of induced activation. Archival information on past decommissionings is presented, and recommendations concerning regulations and accelerator design that will aid in the decommissioning of an accelerator are given.

  18. An introduction to acceleration mechanisms

    International Nuclear Information System (INIS)

    This paper discusses the acceleration of charged particles by electromagnetic fields, i.e., by fields that are produced by the motion of other charged particles driven by some power source. The mechanisms that are discussed include: Ponderamotive Forces, Acceleration, Plasma Beat Wave Acceleration, Inverse Free Electron Laser Acceleration, Inverse Cerenkov Acceleration, Gravity Acceleration, 2D Linac Acceleration and Conventional Iris Loaded Linac Structure Acceleration

  19. Does Extending the Waiting Time of Low-Rectal Cancer Surgery after Neoadjuvant Chemoradiation Increase the Perioperative Complications?

    Science.gov (United States)

    Timudom, Kittinut; Phothong, Natthawut; Akaraviputh, Thawatchai; Chinswangwatanakul, Vitoon; Pongpaibul, Ananya; Petsuksiri, Janjira; Ithimakin, Suthinee

    2016-01-01

    Background. Traditionally, rectal cancer surgery is recommended 6 to 8 weeks after completing neoadjuvant chemoradiation. Extending the waiting time may increase the tumor response rate. However, the perioperative complication rate may increase. The purpose of this study was to determine the association between extending the waiting time of surgery after neoadjuvant chemoradiation and perioperative outcomes. Methods. Sixty patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiation followed by radical resection at Siriraj hospital between June 2012 and January 2015 were retrospectively analyzed. Demographic data and perioperative outcomes were compared between the two groups. Results. The two groups were comparable in term of demographic parameters. The mean time interval from neoadjuvant chemoradiation to surgery was 6.4 weeks in Group A and 11.7 weeks in Group B. The perioperative outcomes were not significantly different between Groups A and B. Pathologic examination showed a significantly higher rate of circumferential margin positivity in Group A than in Group B (30% versus 9.3%, resp.; P = 0.04). Conclusions. Extending the waiting to >8 weeks from neoadjuvant chemoradiation to surgery did not increase perioperative complications, whereas the rate of circumferential margin positivity decreased.

  20. Accelerator reliability workshop

    Energy Technology Data Exchange (ETDEWEB)

    Hardy, L.; Duru, Ph.; Koch, J.M.; Revol, J.L.; Van Vaerenbergh, P.; Volpe, A.M.; Clugnet, K.; Dely, A.; Goodhew, D

    2002-07-01

    About 80 experts attended this workshop, which brought together all accelerator communities: accelerator driven systems, X-ray sources, medical and industrial accelerators, spallation sources projects (American and European), nuclear physics, etc. With newly proposed accelerator applications such as nuclear waste transmutation, replacement of nuclear power plants and others. Reliability has now become a number one priority for accelerator designers. Every part of an accelerator facility from cryogenic systems to data storage via RF systems are concerned by reliability. This aspect is now taken into account in the design/budget phase, especially for projects whose goal is to reach no more than 10 interruptions per year. This document gathers the slides but not the proceedings of the workshop.