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PubMed1976

Atmospheric derivatives of anaesthetic gases as a possible hazard to operating-room personnel.

During surgical procedures in which nitrous oxide (N2O) anaesthesia was administered there was an increased concentration of both nitric oxide (NO) and nitrogen dioxide (NO2) in operating-room air. Preliminary studies suggest that the use of certain devices (e.g., electric cauteries, X-ray machines) capable of releasing energy in the operating-room produce the oxidation of nitrous oxide. Further evaluation of gas phase reactions of anaesthetic agents within the operating-room appear warranted, particularly in relation to the occupational risks of operating-room personnel.

Abnormalities, Drug-Induced↗
PubMed1999

Complications of foot and ankle surgery.

Surgery of the foot and ankle encompasses many pathologic entities, each with its own pitfalls. Some complications can be prevented through accurate diagnosis, careful patient selection, appropriate selection of surgical procedure, and thorough performance of surgical technique. Although they may arise from systemic events, immediate complications also can be diminished by training operating room personnel and nursing staff.

Ankle Injuries↗
PubMed1995

The registered nurse first assistant role in surgical wound closure: an integrated review.

Knowledge of suturing techniques, suturing materials, and the stages of wound healing is essential for obtaining good operative results and avoiding wound infections and scarring. An extensive literature search was undertaken, and a resultant integrated review of the studies was assembled. The literature deals specifically with information on methods of wound closure, wound healing, suturing techniques, and suturing materials in the coronary, surgical, and vascular surgery population. It is hoped that the information provided will give the practicing registered nurse first assistant and other surgical nurses a working knowledge of some of the best methods for the closure of skin wounds, and how best to apply those methods in practice.

Humans↗
PubMed1996

Nursing management and follow-up of the postoperative vascular patient in a clinic setting.

Patient follow-up after vascular surgery in a clinic setting provides prompt evaluation of patients, opportunity for education, and comprehensive care through direct patient and family teaching. These services are provided by a lead clinic RN experienced in medical/surgical care and a certified RN first assistant, who has specialized training and proficiency in perioperative nursing practice. Patients and their families depend on nurses in perioperative and outpatient settings to provide expertise, support, and understanding during the recovery process. This article presents a collaborative model of intervention, management, and follow-up by nurses in these settings.

Aftercare↗
PubMed2002

The theory and practice of bloodless surgery.

The application of blood conservation strategies to minimise or avoid allogeneic blood transfusion is seen internationally as a desirable objective. Bloodless surgery is a relatively new practice that facilitates that goal. However, the concept is either poorly understood or evokes negative connotations. Bloodless surgery is a term that has evolved in the medical literature to refer to a peri-operative team approach to avoid allogeneic transfusion and improve patient outcomes. Starting as an advocacy in the early 1960s, it has now grown into a serious practice being embraced by internationally respected clinicians and institutions. Central to its success is a coordinated multidisciplinary approach. It encompasses the peri-operative period with surgeons, anaesthetists, haematologists, intensivists, pathologists, transfusion specialists, pharmacists, technicians, and operating room and ward nurses utilising combinations of the numerous blood conservation techniques and transfusion alternatives now available. A comprehensive monograph on the subject of bloodless surgery along with detailed coverage of risks and benefits of each modality (some modalities are discussed in more detail elsewhere in this issue) is beyond the scope of this article. Accordingly, a brief overview of the history, theory and practice of bloodless surgery is presented, along with the clinical and institutional management requirements.

Blood Loss, Surgical↗
PubMed2004

Cricoid pressure: a simple, yet effective biofeedback trainer.

BACKGROUND AND OBJECTIVE: Only regular training of anaesthetic personnel ensures safe and reliable application of cricoid pressure during rapid sequence induction of anaesthesia. Previously described training devices are either complicated, too expensive and usually unavailable, or they are very simple and do not correctly simulate the process of applying cricoid force. We designed and tested a cricoid pressure trainer with real-time display of applied force. The device is easy to assemble at relatively little cost with material widely available. It allows effective biofeedback training of the force required during the Sellick manoeuvre and can be used for routine staff assessment. METHODS: Thirty-six anaesthesia assistants were assessed for their correct application of cricoid pressure. Previous training in, and knowledge of, applying cricoid pressure was first evaluated by a questionnaire. We designed a model for testing the application of cricoid force. Pre-training cricoid forces were obtained by asking the subjects to apply 'awake' (10 N = 1.020 kg) and 'asleep' (30 N = 3.060 kg) cricoid pressure on our model while blinded to the actual pressure produced. The volunteer was then trained to apply correct pressure employing real-time biofeedback. Post-training values were later determined with the subject again blinded to the actual applied pressure. RESULTS: Post-training performance showed significant improvement in the application of the correct cricoid force (P < 0.0005). Only 8% (3/36) of subjects applied incorrect 'awake' cricoid pressure after training vs. 56% (20/36) before training. All participants applied correct 'asleep' cricoid pressure after training vs. 72% (26/36) failing before training. CONCLUSIONS: Our biofeedback cricoid pressure trainer is effective in the assessment and training of correct cricoid pressure application by anaesthetic personnel.

Anesthesiology↗
PubMed1999

[Nursing in the profession of the "sub-surgeons" between 1750 and 1850].

Between 1750 and 1850 surgical training was professionalized as a consequence of newly established technical colleges for surgeons in Germany and Austria led by doctors rather than craftsmen. At first, anatomy, debridement and obstetrics was taught, then a technical knowledge of medical treatment in general was instructed at specific medical/surgical schools. Depending on their years of training, graduates then worked as country doctors or as surgical assistants ("Subchirurgen", second class wound doctors). Nursing care was also on the curriculum; therefore some students worked temporarily as nurses. After graduating, many supervised nursing care in hospitals. This profession died out due to developments in the medical profession of the mid-19th century. However, they never belonged to the proletarian class of orderlies.

Curriculum↗
PubMed2000

Development and definition of the role of the operating department nurse: a review.

In the current cost-conscious National Health Service (NHS), the role of the nurse during anaesthesia and surgery is one that has interested health service managers keen to know what happens behind the closed doors of the operating department. It is clear that if nurses working within this specialized setting are to secure a future in providing care for surgical patients, then it is important to clarify and articulate exactly what it is that their role involves. The aim of this paper is to examine the role of the operating department nurse. First, it will illustrate how the role of the nurse has evolved alongside medical and technical advances in surgery, particularly in the last century. Second, it will highlight that while definition of the role has received attention in the North American literature, references in the British literature as to what it is that operating department nurses do, are scant. Finally, it will address the evolving role of the contemporary perioperative nurse highlighting the changes and challenges that nurses who work within this setting are currently facing. It is suggested here that nurses need to engage in role definition in order to be clear about their direction for the future, particularly within the fast changing, technologically driven environment of the operating department.

Forecasting↗
PubMed2006

A common body of care: the ethics and politics of teamwork in the operating theater are inseparable.

In the operating theater, the micro-politics of practice, such as interpersonal communications, are central to patient safety and are intimately tied with values as well as knowledge and skills. Team communication is a shared and distributed work activity. In an era of "professionalism," that must now encompass "interprofessionalism," a virtue ethics framework is often invoked to inform practice choices, with reference to phronesis or practical wisdom. However, such a framework is typically cast in individualistic terms as a character trait, rather than in terms of a distributed quality that may be constituted through intentionally collaborative practice, or is an emerging property of a complex, adaptive system. A virtue ethics approach is a necessary but not sufficient condition for a collaborative bioethics within the operating theater. There is also an ecological imperative-the patient's entry into the household (oikos) of the operating theater invokes the need for "hospitality" as a form of ethical practice.

Bioethics↗