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At least 433 records · Page 24Linked to original sources
PubMed1999

Waste anaesthetic gases induce sister chromatid exchanges in lymphocytes of operating room personnel.

Genotoxicity related to waste anaesthetic gas exposure is controversial. We have investigated the frequency of sister chromatid exchanges in peripheral lymphocytes of operating room personnel exposed to trace concentrations of isoflurane and nitrous oxide. Occupational exposure was recorded using a direct reading instrument. Frequencies of sister chromatid exchanges were measured in lymphocyte cultures of 27 non-smokers working in the operating room and 27 non-smoking controls. Personnel were exposed to an 8-h time-weighted average of nitrous oxide 11.8 ppm and isoflurane 0.5 ppm. After exposure, sister chromatid exchange frequency was increased significantly (mean 9.0 (SD 1.3) vs 8.0 (1.4) in exposed and control personnel, respectively) (P < 0.05). We conclude that exposure to even trace concentrations of waste anaesthetic gases may cause genetic damage comparable with smoking 11-20 cigarettes per day.

Adult↗
PubMed2005

[Allocating and scheduling operating room time].

During the past decade many scientific advances have been made concerning the development of methodologies to maximize efficiency of surgical facilities through allocating and scheduling of operating rooms. In this article such a methodology is described. Using the analysis of historical data of surgical activity in a facility, future demand is predicted and planned. Part of the methodology includes principles and rules needed for the daily organization and operative management of surgical facilities. They are also derived from the same science and therefore the basis for rational and structured decision making. Medical aspects such as patient safety and free choice of day for surgery have higher priority than the economic goal of maximizing operating room efficiency.

Efficiency, Organizational↗
PubMed1978

[Quantitative study of bacterial flora in operating room air].

A comparative study of two air-bacteria counting machines, MK II (Casella, London) and R.B. (Joubert, Lyon) was carried out. Pre-operation air samples from operating rooms were drawn by the two machines working simultaneously. The results from the two machines are similar, however the RB machine is more sensitive of the two machines. Moreover, an old operating room without filtrated air had a significantly higher air bacteria contamination (m = 199 +/- 173 bacteria/m3) than a new one with filtrated air (m = 40 +/- 36 bacteria/m3). Samples from laminar air flow (m = 1,3 +/- 1,5 bacteria/m3) were examined as test studies. Working methods and results of air bacteria counts are studied.

Air Microbiology↗
PubMed1993

The operating room as a theater--a relevant metaphor.

Any metaphor can be stretched to absurdity. Nonetheless, the operating room as a theater can be a relevant and useful analogy. In the OR theater, the play is always a drama, sometimes a tragedy, occasionally even a comedy of errors, but never, never is it a Broadway musical.

Drama↗
PubMed2000

Do-not-resuscitate orders in the operating room: required reconsideration.

Advances in medical technology are giving health care providers the tools with which to keep patients alive for longer and longer periods of time. However, in our struggle to keep patients alive, we must not forget that the patient is the one who controls his or her own destiny. Advance directives and do-not-resuscitate orders are becoming more commonplace as patients strive to make their wishes known to all who care for them. The use of such orders in the operating room has historically been a hotbed of controversy because it appears contrary to the necessity of surgery in the first place. Surgeons, anesthetists, operating room nurses, and others all have concerns regarding this issue, and they will be discussed here. The answer to the dilemma lies in a policy of "required reconsideration" to examine all factors of the do-not-resuscitate order and its applicability to the situation at hand.

Advance Directives↗
PubMed2006

Risk factors and musculoskeletal complaints in non-specialized nurses, IC nurses, operation room nurses, and X-ray technologists.

OBJECTIVES: To gain more insight into the prevalence rates of musculoskeletal complaints of neck-shoulder and low back and to determine the relation between physical and psychosocial work-related risk factors and the complaints mentioned in non-specialized nurses, operation room nurses, Intensive Care (IC) nurses and X-ray technologists. METHODS: The study population consists of 3,169 employees affiliated to eight university hospitals in the Netherlands. The study was conducted using a cross-sectional survey design. The parameters under study were having or having had (severe) low back or neck-shoulder complaints during the past year. In logistic regression analyses odds ratio's and CI 95% were estimated for all relevant risk factors for each of the four professional groups. RESULTS: In all groups prevalence rates of musculoskeletal complaints were high: low back 76%, neck-shoulder 60%. Operation room nurses perceived more neck-shoulder complaints (12 months prevalence) than non-specialized nurses and IC nurses perceived less severe low back complaints than non-specialized nurses. Four physical risk factors and one psychosocial factor were associated with low back complaints in all groups. CONCLUSIONS: The results of the present study indicate that both low back complaints and neck-shoulder complaints are major health problems in the four professional groups under study. The prevalence rate of neck-shoulder complaints in operation room nurses is higher than in non-specialized nurses and IC nurses, the latter groups having high prevalence rates already. The exposure to risk factors is perceived differently by each of the professional groups. The professional groups under study all are target for preventive interventions; these interventions need to be specified for each of the professional groups.

Adult↗
PubMed1996

Patient preparation and monitoring for carotid stenting: the operating room nurse's perspective.

Endovascular procedures should be performed by a trained surgical staff in a surgical suite equipped with a high-resolution fluoroscopic unit. The operating room nurse must be skilled in the handling and preparation of specialized instruments and equipment necessary for carotid angioplasty procedures. Patient preparation and postprocedural wound care techniques are particular to the cervical approach for carotid angioplasty; the operating room nurse should be well trained in these areas in order to provide optimum assistance during the procedure.

Angioplasty, Balloon↗
PubMedDate not supplied

Five years experience with operating room clean rooms and personnel-isolator systems.

Two horizontal flow, laminar airflow type clean rooms have been used for almost all clean orthopedic surgery at St. Luke's Hospital in Denver since March 1971. This experience covers approximately 4000 cases, including 1100 total hip and total knee arthroplasties. Three different types of helmet aspirator systems have also been evaluated. Our conclusions from this experience are: (1) All types of orthopedic surgery may be easily and conveniently performed in the clean room and with scrubbed personnel wearing helmet aspirator systems; (2) mechanical upkeep of the clean room is minimal; (3) airborne bacteria counts have been reduced at least 80 percent compared to a regular operating room, and more than 90 percent when scrubbed personnel wear the helmet aspirator system; (4) sterile surface contamination, including the wound, has been reduced at least 80 percent; and (5) the deep infection rate for total hip replacements with at least a 2-year follow-up has been 7.6 percent (10/131) in a regular operating room and 1.6 percent (5/319) in the clean room. With the combined use of the clean room, helmet aspirator systems, and perioperative antibiotics, no infections have occurred in an additional 350 cases with a 1-year follow-up.

Air Microbiology↗
PubMed2002

The use of a uniquely designed anesthetic scavenging hood to reduce operating room anesthetic gas contamination during general anesthesia.

UNLABELLED: Numerous studies have suggested that chronic exposure to trace levels of anesthetic gas is harmful to operating room (OR) personnel. In the delivery of pediatric general anesthesia, an uncuffed endotracheal tube (ETT) is normally used which can result in considerable volatile anesthetic and nitrous oxide contamination of the OR. In this report, we present a method to reduce exposure to these anesthetic gases by means of an anesthetic scavenging hood (ASH). The ASH was used on six pediatric patients undergoing general endotracheal anesthesia via an uncuffed ETT. Measurements of all ambient gas levels were made 6 in. horizontally from the patient's ear and 6 in. from the table surface. The application of the vacuum source to the ASH resulted in a very significant (P < 0.01, paired t-test) decrease in levels of ambient anesthetic gas, with no measurable change in ventilatory variables or changes in body temperature (P > 0.05, paired t-test). Discontinuation of the vacuum force to the ASH resulted in a marked increase in ambient levels of anesthetic gas. We conclude that the ASH is extremely effective in reducing waste anesthetic gas associated with anesthesia administered via an uncuffed ETT. The ASH may be a valuable and cost-effective addition in the OR for both reducing ambient anesthetic waste gas levels and conserving patient heat. IMPLICATIONS: Chronic exposure to trace levels of anesthetic gas is harmful to operating room personnel, especially in the delivery of pediatric general anesthesia via an uncuffed endotracheal tube. The anesthetic scavenging hood is a cost-effective and efficient method to reduce these waste anesthetic gases, and it offers patient heat conservation.

Air Pollution, Indoor↗
PubMed2006

Reorganizing patient care and workflow in the operating room: a cost-effectiveness study.

BACKGROUND: Many surgeons believe that long turnover times between cases are a major impediment to their productivity. We hypothesized that redesigning the operating room (OR) and perioperative-staffing system to take advantage of parallel processing would improve throughput and lower the cost of care. METHODS: A state of the art high tech OR suite equipped with augmented data collection systems served as a living laboratory to evaluate both new devices and perioperative systems of care. The OR suite and all the experimental studies carried out in this setting were designated as the OR of the Future Project (ORF). Before constructing the ORF, modeling studies were conducted to inform the architectural and staffing design and estimate their benefit. In phase I a small prospective trial tested the main hypothesized benefits of the ORF: reduced patient intra-operative flow-time, wait-time and operative procedure time. In phase II a larger retrospective study was conducted to explore factors influencing these effects. A modified process costing method was used to estimate costs based on nationally derived data. Cost-effectiveness was evaluated using standard methods. RESULTS: There were 385 cases matched by surgeon and procedure type in the retrospective dataset (182 ORF, 193 standard operating room [SOR]). The median Wait Time (12.5 m ORF vs 23.8 m SOR), Operative Procedure Time (56.1 m ORF vs 70.5 m SOR), Emergence Time (10.9 m ORF vs 14.5 m SOR) and Total Patient OR Flowtime (79.5 m ORF vs 108.9 m SOR) were all shorter in the ORF (P < .05 for all comparisons). The median cost/patient was $3,165 in the ORF (interquartile range, $1,978 to $4,426) versus $2,645 in SORs (interquartile range, $1,823 to $3,908) (P = ns). The potential change in patient throughput for the ORF was 2 additional patients/day. This improved throughput was primarily attributable to a marked reduction in the non-operative time (ie, those activities commonly accounting for "turnover time") rather than facilitation of faster operations. The incremental cost-effectiveness ratio of ORF was $260 (interquartile range, $180 to $283). CONCLUSION: The redesigned perioperative system improves patient flow, allowing more patients to be treated per day. Cost-effectiveness analysis suggests that the additional costs incurred by higher staffing ratios in an ORF environment are likely to be offset by increases in productivity. The benefits of this system are realized when performing multiple, short-to-medium duration procedures (eg, <120 m).

Cost-Benefit Analysis↗
PubMed1983

A bacteriologically occlusive clothing system for use in the operating room.

A comparison was made in a laminar-flow operating room between total-body exhaust gowns and a clothing system made from Fabric 450. This disposable clothing was found to be much more comfortable and convenient than the total-body exhaust gowns. The average airborne bacterial counts obtained during total hip replacement operations from each of the clothing systems were identical when the downflow method of ventilation was used (0.7 per cubic metre) and no significant difference could be demonstrated when the crossflow system was used (2.2 per cubic metre with the total-body exhaust gowns and 3.1 per cubic metre with the disposable clothing). Tests in a dispersal chamber were carried out to find the effectiveness of each item of the disposable clothing in reducing bacterial dispersion. These tests demonstrated the relative ineffectiveness of wearing a surgical gown as compared with wearing the complete system. It was confirmed bacteriologically that the downflow system of ventilation was more efficient than the crossflow type; the importance of this observation with respect to clothing and sepsis is discussed in this paper.

Air Microbiology↗
PubMed1993

Malignant hyperthermia: not just an operating room emergency.

While usually occurring as an operating room emergency, malignant hyperthermia can appear postoperatively on a medical-surgical unit. If unrecognized and/or untreated, malignant hyperthermia can be fatal. Medical-surgical nurses should be skilled in identifying the pathophysiology, signs/symptoms, and treatment of malignant hyperthermia.

Adult↗
PubMed1997

Non-operating room emergency airway management and endotracheal intubation practices: a survey of anesthesiology program directors.

Airway management in the operating room is the responsibility of anesthesiologists, although a variety of personnel may be responsible for airway management outside the operating room. We conducted a survey of anesthesia program directors regarding emergency airway management practices at their institutions. A questionnaire was sent to anesthesia program directors listed in the Graduate Medical Education Directory for 1995-1996. Of the 153 programs surveyed, 134 (88%) responded. In 45% of institutions, intubations in the emergency ward (EW) were performed by emergency medical physicians, 32% by anesthesiology personnel, and 19% by both. Most intubations performed on the hospital ward were performed by anesthesiologists. Neuromuscular blocking drugs and sedative/hypnotics were used 90% and 95% of the time, respectively, by emergency medical physicians in hospitals in which they managed the airway independently. Our data serve as a snapshot of current practices. EW physicians are prominently involved in airway management in the emergency room both independently and with anesthesiologists. Airway management in trauma patients remains the domain of anesthesiologists. Anesthesiologists are most represented in airway management on hospital floors.

Anesthesiology↗
PubMed2000

Sequencing cases in the operating room: predicting whether one surgical case will last longer than another.

UNLABELLED: A microscope will be used for the first case of the day in operating room (OR) 1 and then may be used in the second case of the day by a different surgeon in a different OR, OR 2. Provided that the probability is reasonably high that the first case of the day in OR 2 will last longer than the first case in OR 1, the OR manager can be confident in scheduling the microscope to be used by both surgeons on the same day. The OR manager can use statistical decision theory to sequence cases to decrease the impact of limitations in equipment or personnel on case scheduling. This increases utilization of both the capital equipment and OR time. In this study, we derived equations that can be programmed into a surgical services information system to reliably estimate the probability that one case will have a longer duration than another. We confirmed the accuracy of our method by using actual case duration data. IMPLICATIONS: Our statistical method uses historical case duration data from an operating room information system to estimate the actual probability to within 1.5% that the second case of a pair will last longer than the first case of a pair.

Appointments and Schedules↗
PubMed1992

Cost containment in the operating room: use of reusable versus disposable clothing.

The need for fiscal austerity has prompted the re-evaluation of many aspects of medical care. Recent events in the northeastern United States have caused an increased awareness of the need for environmental responsibility as well. With these considerations in mind, the costs incurred by the operating suites of two comparable teaching hospitals in New Jersey, one of which uses disposable operating room attire, were examined; the other employs reusable scrub suits and gowns. The reusable scrub suits and gowns resulted in a savings in excess of $100,000 compared to the center using disposables. The authors conclude that hospitals should re-evaluate their use of disposable operating room attire to reduce operating costs and the amount of medical waste generated.

Cost Savings↗
PubMed1992

Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia.

To elucidate the multifactorial nature of perioperative changes in body temperature, the influence of several clinical variables, including anesthetic technique, ambient operating room temperature, and age, were evaluated. Perioperative oral sublingual temperatures were measured in 97 patients undergoing lower extremity vascular surgery randomized to receive either general (GA) or epidural (EA) anesthesia. Surgery and anesthesia were performed in operating rooms (OR) with a relatively warm mean ambient temperature (24.5 +/- 0.4 degrees C) (GA, n = 30; EA, n = 33) or relatively cold mean ambient temperature (21.3 +/- 0.3 degrees C) (GA, n = 21; EA, n = 13). Patients were 35-94 yr old, with a mean age of 64.5 +/- 1.1 yr. A regression analysis was performed to determine the variables that correlated with intraoperative decrease in temperature and postoperative rewarming rate. The major correlates of greater intraoperative decrease in temperature were 1) GA (P = 0.003); 2) cold ambient OR temperature (P = 0.07); and 3) advancing patient age (P = 0.03). There was significant interaction between ambient OR temperature and type of anesthesia (P = 0.03): there was a greater intraoperative decrease in temperature with GA compared to EA in a cold OR but a similar decrease with GA and EA in a warm OR. The data also suggest an interaction between type of anesthesia and patient age (P = 0.06), showing a greater decrease in temperature with GA compared to EA in the younger patients, but a similar decrease between GA and EA in older patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗