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PubMed2004

Sedation and analgesia for procedures outside the operating room.

The volume of literature concerning sedation and analgesia for procedures outside the operating room has increased greatly over the past several years. Information relating to sedation risks and complications, the development of sedation guidelines, and now specific sedation techniques has appeared. The following section will trace the development of the most recent sedation guidelines and identify the key elements for inclusion into institutional sedation guidelines. The risks and complications associated with sedation will be addressed and an approach to providing sedation and analgesia for procedures outside the operating room will be presented. The important characteristics of several common drugs used for sedation and analgesia will also be discussed.

Analgesia↗
PubMedDate not supplied

[Qualitative characteristics of human exposure to air chemical pollutants in operating rooms].

UNLABELLED: For more than two decades many studies have been published searching for a link between exposure to volatile anaesthetic agents and health damage even if it is noteworthy that many other chemical substances can be found in the Operating Room. Purpose of this study was to demonstrate that the Operating Room is not a totally confined environment and that it is possible to perform an, at least qualitative, evaluation of many different polluting contaminants, even unexpected, to whom the working staff is exposed. MATERIAL AND METHODS: The study has been performed in the Operating Rooms of the Departments of Urology and Orthopaedics. Two methods have been employed: a long-casting sampling of volumes of air (with a sampling device composed of an enrichment system and a low flow aspirating pump) and an anaesthetic vapours and gas continuous analyzer. Results. We never recorded environmental levels of anesthetic higher than the currently accepted ones. Many other organic compounds of different kind have been found (irritants, cancer-organs). Their presence, not desirable in a place where a demanding work is performed, deserve further investigation and a quantitative evaluation of these compounds.

Air Pollutants, Occupational↗
PubMed2000

Infectious diseases in the operating room.

Patients with infectious diseases have special implications for infection control in the operating room. The increased use and abuse of antibiotics has ushered in a category of resistant organisms. These multiresistant organisms are spread by direct or indirect contact, primarily from the hands of caregivers or contact with contaminated environmental surfaces. Another category of infectious diseases is prions (pronounced pree-ons). Unlike other infectious diseases, human prions diseases are not spread through routine exposures such as direct contact, droplet, and airborne routes. The causative agent is highly resistant to traditional disinfecting and sterilization processes. This article provides an overview of the multiresistant infections of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Staphylococcus aureus with reduced susceptibility to vancomycin along with the human prions diseases Creutzfeldt-Jakob disease, German-Straüssler-Scheinker syndrome, kuru, and fatal familial insomnia. We provide a template of precautions that can be used in developing operating room and anesthesia infection control protocols for this patient population.

Creutzfeldt-Jakob Syndrome↗
PubMed2006

The sounds of music in the operating room.

BACKGROUND: Little information is available about the effect of music on the operating room (OR) staff. PURPOSE: The objective of this study was to evaluate the perception of the influence of music on physicians and nurses working in the OR. METHODS: A questionnaire was designed and 250 copies were distributed to the doctors and nurses working in the OR at three hospitals. One hundred and seventy-one returned the completed questionnaire and were included in this study. RESULTS: 63% of the participants listen to music on a regular basis in the OR. Classical music is the most requested (58%) and most of the responders do not choose the type of music according to the type of the procedure. In our study, the nurses were more likely to listen to music and the willingness is higher among the female responders. The desired volume is lower as age increases and 78.9% of the participants claimed that music in the OR makes them calmer and more efficient. CONCLUSION: According to our study, music has a positive effect on the staff working in the operating rooms.

Adult↗
PubMed1989

Human microvessel endothelial cell isolation and vascular graft sodding in the operating room.

We have evaluated multiple factors inherent to an operating room-compatible endothelial cell procurement and sodding procedure. Microvessel endothelial cell isolations have been performed on fat tissue obtained from over 140 patients with a 100% success rate. Liposuction-derived fat was optimal with respect to cell yield, and isolation time. The devices and equipment used were acceptable to the operating room and the complete cell procurement procedure was successful even in the hands of personnel with minimal training. Fat digestion was achieved using crude clostridial collagenase, with an average cell yield of 1 x 10(6) microvessel endothelial cells/gm of fat. Evaluation of this procedure with canine fat using an operating room acceptable procedure resulted in a 100% procurement success rate requiring 1.5 hours (+/- .5 hrs) for completion of the fat isolation, and cell isolation procedure. Microvessel EC could subsequently be used in graft seeding or sodding techniques to establish endothelial cell monolayers on vascular grafts. Our results indicate that one person with minimal cell isolation background can reproducibly isolate large quantities of sterile autologous endothelial cells in the operating room for immediate use in endothelial cell seeding/sodding procedures.

Adipose Tissue↗
PubMed1976

[Operating room ethrane pollution (author's transl)].

Several surveys of ethrane pollution were made by the authors in operating rooms, either equipped or not with general ventilation systems, during operations where non-rebreathing anaesthesia devices were used. In operating rooms without general ventilation systems, but with simple air conditioning systems, ethrane pollution was found to be rather high and to attain 30-40 ppm at the fourth hour of operation. No statistically significant differences were elicited among levels found at the anaesthetist, surgeon and assistance personnel sites. The authors analyze the kinetics of ethrane pollution as a function of its consumption and of time and discuss the most suitable means for decreasig and preventing such pollution.

Air Conditioning↗
PubMed1999

Genetic damage in operating room personnel exposed to isoflurane and nitrous oxide.

OBJECTIVES: To evaluate genetic damage as the frequency of sister chromatid exchanges and micronuclei in lymphocytes of peripheral blood of operating room personnel exposed to waste anaesthetic gases. METHODS: Occupational exposure was measured with a direct reading instrument. Venous blood samples were drawn from 10 non-smokers working in the operating room and 10 non-smoking controls (matched by age, sex, and smoking habits). Lymphocytes were cultured separately over 72 hours for each assay with standard protocols. At the end of the culture time, the cells were harvested, stained, and coded for blind scoring. The exchanges of DNA material were evaluated by counting the number of sister chromatid exchanges in 30 metaphases per probe or by counting the frequency of micronuclei in 2000 binucleated cells. Also, the mitotic and proliferative indices were measured. RESULTS: The operating room personnel at the hospital were exposed to an 8 hour time weighted average of 12.8 ppm nitrous oxide and 5.3 ppm isoflurane. The mean (SD) frequency of sister chromatid exchanges was significantly higher (10.2 (1.9) v 7.4 (2.4)) in exposed workers than controls (p = 0.036) the proportion of micronuclei (micronuclei/500 binucleated cells) was also higher (8.7 (2.9) v 6.8 (2.5)), but was not significant (p = 0.10). CONCLUSION: Exposure even to trace concentrations of waste anaesthetic gases may cause dose-dependent genetic damage. Concerning the micronuclei test, no clastogenic potential could be detected after average chronic exposure to waste anaesthetic gas. However, an increased frequency of sister chromatid exchanges in human lymphocytes could be detected. Although the measured differences were low, they were comparable with smoking 11-20 cigarettes a day. Due to these findings, the increased proportion of micronuclei and rates of sister chromatid exchanges may be relevant long term and need further investigation.

Adult↗
PubMed1998

Latex allergy in operating room nurses.

OBJECTIVE: To determine the prevalence of allergy to natural rubber latex and potential crossreacting foods in operating room nurses. METHOD: Two hundred forty-seven operating room nurses completed a latex allergy questionnaire. They were questioned about symptoms of latex reactivity and about other allergies particularly to foods that may crossreact with latex. Informed consent was obtained and skin prick testing was performed with natural rubber latex and five latex extracts representing low (0.08 to 0.25 microgram/mL) and high (18 to 106 micrograms/mL) natural rubber latex protein gloves. Skin prick tests were done with four potentially crossreacting foods (banana, avocado, kiwi, and potato), saline, and histamine controls. RESULTS: One hundred thirty-five (54.7%) nurses described allergic symptoms they attributed to latex exposure. Of these 12 (4.9%) tested positive to latex extracts alone, 12 (4.9%) tested positive to food extracts alone, and 5 (2.0%) tested positive to both latex and crossreactive foods. Three of the 17 (17.6%) nurses testing positive to latex gave no history of reactivity to latex. Indirect latex ELISA was done on the serum of skin test-positive patients with a 70.6% sensitivity. CONCLUSION: Of the nurses tested, 6.9% had positive skin prick tests to latex extracts; 17.6% of these were asymptomatic and 29.4% had associated food positive skin prick tests.

Adult↗
PubMed2001

Carpal tunnel syndrome in female nurse anesthetists versus operating room nurses: prevalence, laterality, and impact of handedness.

UNLABELLED: Nurse anesthesia may be a high-risk occupation for carpal tunnel syndrome (CTS) in the workplace. We designed a cross-sectional investigation to study the prevalence of CTS in nurse anesthetists (NAs) as compared with operating room nurses (ORNs). Two-hundred forty-four female operating room workers were classified by job title as NAs (n = 63) and ORNs (n = 181). The case definition of CTS was established by a history of surgical correction or a combination of four positive historical and physical findings. There were 10 cases of CTS in NAs and 10 cases of CTS in ORNs. The crude odds ratio (OR) for CTS in NAs was 3.23 (95% confidence interval, 1.27-8.17, P = 0.021). The crude OR for left-hand CTS in NAs was also 3.23 and 3.58 for bilateral CTS. When adjusted for nondominant left-hand or bilateral CTS, the OR for CTS in NAs was 3.85. The Yates-corrected chi(2) for CTS in NAs was 5.346 (P = 0.021) and 5.075 (P = 0.024) for nondominant left-hand or bilateral CTS in NAs as compared with ORNs. On the basis of our data analysis, nondominant left-hand CTS and bilateral CTS were significantly more prevalent in NAs than ORNs. IMPLICATIONS: Repetitive stress injuries have now exceeded back injuries as the most commonly reported workplace injuries in the United States. Female nurse anesthetists may face greater occupational risks for developing left hand and bilateral carpal tunnel syndrome than female operating room nurses.

Adult↗
PubMed1999

Decrease in case duration required to complete an additional case during regularly scheduled hours in an operating room suite: a computer simulation study.

UNLABELLED: We used Monte-Carlo computer simulation to determine whether surgical or anesthetic interventions to achieve small decreases in case duration may create enough new open operating room (OR) time to permit an additional case to be scheduled for completion in an OR suite during regular working hours. We used rules for scheduling of cases assuming that OR personnel are compensated so that the OR suite can profit financially from decreasing case duration to complete an additional case during regularly scheduled hours. The decreases in each case's duration required to create enough new open OR time to reliably (> or =95%) schedule another case were 30-39 min, 79-110 min, and 105-206 min for OR suites with 1-15 ORs and mean case durations of 1, 2, or 3 h, respectively. IMPLICATIONS: Computer simulation shows decreasing case duration is unlikely to create sufficient operating room time to reliably permit an additional case to be scheduled for completion during working hours. Additional cases may best be added to the operating room suite schedule by optimizing case scheduling, not by decreasing the duration of all cases in the suite.

Anesthesia↗
PubMed1995

Auditory functions in anaesthesia residents during exposure to operating room noise.

Twenty anaesthesia residents were exposed to a pre-recorded audio cassette of operating room noise. The noise level during exposure was maintained at 77.32 +/- 1 dB (A), which was the calculated average operating room noise in our institute. Two auditory functions i.e., speech reception threshold and speech discrimination were studied before and during exposure to noise in a pre-fixed order. The right and left ears were tested separately. Speech reception threshold showed a mean increase of 23.75 +/- 6.86 dB (A) for the right ear and 26.25 +/- 6.90 dB(A) for the left ear during exposure to noise, suggesting that speech communication may be possible only by raising the voice. Speech discrimination showed a mean percentage decrease of 23.3 +/- 4.82 per cent for the right ear and 23.5 +/- 3.89 per cent for the left ear implying that there can be a steep decrease in the ability to discriminate spoken words.

Anesthesiology↗
PubMedDate not supplied

Divided responsibilities for operating room asepsis: The dilemma of technology.

Asepsis and concern for patient safety in the operating room are team responsibilities involving nurses, surgeons, and anesthesiologists. Meaningless rituals now being observed in the OR must be replaced by practices and procedures based on sound principles of aseptic technique. Modern instrumentation and technology, though relieving the surgeon and anesthesiologist of many of the manual tasks which once occupied them, have not solved the problems of infection control in the operating suite. Apathy, carelessness, and indifference may even increase as a by-product of technology, unless curbed by moral, ethical and legal constraints. Asepsis is not a static concept. Operating room policies and procedures need constant review and reexamination. Enforcement of these policies and rules to maintain good aseptic technique requires the cooperation of all who enter the OR suite.

Antisepsis↗
PubMed1986

[Course of central body temperature in the laminar airflow operating room in various anesthesia procedures].

The oesophageal body temperature of 130 patients was measured pre- and intraoperatively. 92% (n = 116) of the operations (implantation or replacement of hip prostheses) were performed in an operating room having a laminar air flow system with horizontal air flow. 9% (n = 14) of the operations (laparotomies) were performed in a room of identical design without an air circulation system. Three different forms of anesthesia were investigated with regard to their influence on interior body temperature: 1) general anesthesia with a volatile anesthetic (INH); 2) peridural anesthesia with additional general anesthesia (KPDA+ITN); and 3) neuroleptic anesthesia (NLA). A drop in temperature during the operation was found in all patients. In the conventional operating room the mean drop was 0.3 degrees C/h. In the operating room with laminar air flow the INH-patients sustained the greatest decrease in temperature; the mean value in the first hour was 1.1 degrees C/h, and up to 4.6 degrees C/3 h toward the end of the operation. There was a comparable drop in temperature in the first hour in patients anesthetized with KPDA+ITN, but the rate slowed down toward the end of the investigation (2.2 degrees C/3 h). NLA caused a characteristic temperature behavior, with an initial fall in temperature, plateau phase, and subsequent rise (total: -1.0 degrees C/3 h) Temperature regulation was influenced least by NLA in the operating room with laminar air flow; thus, in this context, NLA proved to be a favourable form of anesthesia.

Anesthesia, Epidural↗
PubMed2002

Sedation and analgesia in pediatric patients for procedures outside the operating room.

Sedation and analgesia in pediatric patients for procedures outside the operating room are becoming more frequent as health care is being driven to be more cost effective and "efficient." Although anesthesiologists may not be directly involved in sedation or analgesia outside of the operating room, there is a high likelihood that they will be asked by their institutions to be integrally involved in creating and supervising sedation policy given that the American Society of Anesthesiologists and the Joint Commission on Accreditation of Healthcare Organizations consider sedation and analgesia as part of a continuum ranging from minimal sedation to moderate sedation and analgesia, deep sedation and analgesia, and, finally, general anesthesia. Further, anesthesiologists will be asked to define, teach, and credential nonanesthesiology practitioners who perform deep sedation because these practitioners are now required to be qualified to "rescue from general anesthesia."

Ambulatory Surgical Procedures↗
PubMed1981

Postpartum sterilization by operating-room nurses in Thailand.

A training project to assess the performance of experienced operating room nurses as operators in postpartum sterilization was conducted in 1977-1978. The results for over 1000 nurse-operated clients and a comparison group of approximately 300 physician-sterilized clients show that nurses achieved comparable success with physicians in postpartum sterilization, as judged by clinical and attitudinal follow-up. No serious complications were recorded in either group. Minor infections in both groups were treated routinely. A stitch abscess for one nurse-operated client resulted in hospitalization; the client was released after 3 days. The clients in both groups returned to routine chores at home rapidly, and client satisfaction with the procedure was virtually unanimous in each group. This study lends support to the use of nurses in performing contraceptive surgery. The need for increased service coverage in this area is of high priority, and nurses provide a readily available and easily trained cadre of support staff.

Clinical Competence↗
PubMed1991

Perceived urgency and the anaesthetist: responses to common operating room monitor alarms.

Increasing numbers and varieties of electronic monitors are used in hospital operating rooms. Many of these are equipped with auditory alarms which are loud, insistent, or irritating, and thus are frequently disabled by the anaesthetist. This study was planned to evaluate two components of auditory alarm design which may influence the usefulness of the alarm: the perceived urgency of the auditory signal and its correlation with the urgency of the corresponding clinical situation. We also assessed the ability of practising anaesthetists to identify the monitor or condition responsible for the alarm. Sixty-four anaesthetists attending a national conference assessed ten common operating room alarm sounds for perceived urgency. Results were compared with the urgency of the corresponding clinical situation as determined by 12 senior anaesthetists. Discrepancies between the clinical and perceived urgencies of several monitor alarms were found, and there was no correlation between the two measures. The subjects were also tested for their ability to identify the alarm sounds correctly. The overall correct identification rate was 33%, and only two monitors were correctly identified by more than 50% of the subjects. The results of this study have implications for design and use of auditory alarms in hospitals and suggest the need for further research.

Adult↗