[Ether explosion in the operating room].
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Ether↗
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Adapting the Ohmeda UPAC draw-over vaporizer for use in the modern operating room.
Until recently, the use of draw-over anesthesia (DA) for elective cases has been prohibited in American military hospitals. The reasons cited for this have included the possibility of increased patient risk and the delivery of a second level of care. In this article, the authors outline a method of employing DA so as to bring its use up to the safety level of the modern operating room. This allows for the clinical training of those military anesthesia care providers who may find themselves deployed with highly mobile surgical units whose missions demand this technique of anesthesia.
Anesthesia, Inhalation↗
Oxidative stress in operating room personnel: occupational exposure to anesthetic gases.
Health professionals exposed to anesthetic gases are at higher risk of reproductive, neurological, hematological, immunological, hepatic and renal system diseases. We investigated if oxidative stress induced by chronic exposure to anesthetic gases has any association with this matter. Plasma lipid peroxidation, total antioxidant capacity and total thiol molecule levels were measured in 66 operating room staff in comparison with 66 controls. The exposed group had a significantly higher level of lipid peroxidation with decreased thiol groups compared to control subjects. Total antioxidant capacity of the body was no different among exposed and not exposed subjects. Increased lipid peroxidation in the blood of exposed subjects warns that oxygen free radicals have increased in the body and thus might attack cells, which, in the long-term, results in multi-organ damage. The remaining blood total antioxidant capacity at normal values is promising and means that other non-thiol antioxidants, such as uric acid, transferrin, ceruloplasmin, albumin, and vitamin antioxidants, such as alpha-tocopherol and ascorbic acid, have been stimulated to maintain the total anti-oxidant power of the body at normal state.
Air Pollutants, Occupational↗
The roles of functional MRI in MR-guided neurosurgery in a combined 1.5 Tesla MR-operating room.
BACKGROUND AND PURPOSE: During MR-guided neurosurgical procedures performed in a combined 1.5 Tesla MR-operating room (MR-OR), we have successfully implemented and validated a functional MRI (fMRI) scheme for efficiently localizing eloquent functional areas and assessing their proximity to a lesion volume immediately prior to the craniotomy. METHODS: The fMRI examination consists of a dynamical blood oxygenation level dependent (BOLD) MR imaging technique and a task paradigm that is designed to activate the brain area of interest. The functional imaging technique was based on gradient-echo (GE) echo-planar imaging (EPI) (TR/TE = 2000-3000/40-50 msec). The motor task paradigm involves a periodic movement task, such as alternating between thumb and the other four fingers as a finger-tapping task, while the language involved a covert repeat of a series of words given as a task stimulus. While patient is performing the task, a dynamical fMRI was performed concurrently covering the volume of interest every 2 or 3 sec. Also, we have used a temporal series averaging (TSA) method for correcting the background drift in the raw fMRI signal, and developed a scheme for presenting fMRI results to neurosurgeons in an intuitive 3-dimensional volume-rendered display format. RESULTS: By using the fMRI scheme, we have successfully performed sixteen fMRI examinations immediately prior to neurosurgery in the combined MR-OR on the same surgical table to localize various eloquent functional areas of interests. TSA was successful in reducing the background drift in the fMRI time course data, and the 3-dimensional volume-rendered display was proven effective in presenting the resulting brain activations to neurosurgeons. More importantly, in three representative cases (one biopsy and two tumor resections) presented, the information provided by fMRI have indeed contributed significantly in making the optimal surgical decisions prior to craniotomy. CONCLUSIONS: Intra-operative fMRI can be an indispensable tool for determining the location of a neighboring eloquent functional area of concern in reference to a targeted lesion. Information provided by fMRI has helped in improving the outcome and clinician confidence of all surgeries performed.
Adolescent↗
Do oxygen-enriched atmospheres exist beneath surgical drapes and contribute to fire hazard potential in the operating room?
The purposes of this study were to (1) describe the microenvironment in terms of oxygen concentration beneath the drapes of healthy subjects who were simulating patients undergoing minor surgical procedures with supplemental oxygen and to (2) evaluate the efficacy of using a scavenger system beneath the drapes. A convenience sample of 12 healthy volunteer subjects was studied in an ambulatory surgery center operating room, which was ventilated with 25 air exchanges per hour. The study was carried out in 2 parts. Each subject was supine, and oxygen was applied by a standard nondivided nasal cannula. The subjects were draped as routinely done for ophthalmic procedures. Oxygen concentrations were measured by using an Ohmeda Rascal II gas analyzer beneath the drapes and at the hypothetical surgical site with oxygen flow rates of 0, 1, 2, 3, and 4 L/min, allowing 5 minutes to elapse after a change in flow rate was made. Following a 10-minute break, the subjects were redraped, and the procedure was repeated using a scavenger system consisting of a suctioning system connected to wall suction at 170 to 190 mm Hg. Although the mean +/- SD oxygen saturation never fell below 95% (97.75% +/- 1.54%), mean +/- SD oxygen concentrations beneath the drapes were lower than normal room air concentrations (19.08% +/- 0.51%) when no oxygen was delivered to the patient. With supplemental oxygen and no scavenger system, oxygen concentrations beneath the drapes were consistently elevated (as high as 45% with 4 L/min) compared with normal ambient concentrations (21%) or with concentrations obtained at the surgical site (as high as 23.4%). With the scavenger system in place, mean +/- SD oxygen concentrations reached 34.08% +/- 5.52% beneath the drapes. Statistical analyses revealed that significantly higher oxygen concentrations occurred beneath the drapes with each incremental change in oxygen flow rate, and regardless of the oxygen flow rate used, oxygen concentrations beneath the drapes were significantly reduced with the use of the scavenger system.
Adult↗
Studying man-machine interfaces in the operating room.
The concept of interface as a system-linking device is introduced and examples of manmachine interfaces in the operating room are given. Studying effectiveness of these systems links requires input from multiple professionals, including surgeons and engineers. Video recording performances of operators is a valuble research methodology. Using behavioural observation coding of actions seen on videotapes allows computational analysis of selected actions. One experience with introducing a video study is related. The future holds promise for a wide range of technologically aided performance improvements in the surgical suite. Some improvements will be appropriated from other fields. Participating in the research and development of these new products will be a rewarding role in the medical world.
Journal Article↗
Electroencephalography (EEG) and somatosensory evoked potentials (SEP) to prevent cerebral ischaemia in the operating room.
We review the principal aspects of EEG and SEP to detect and prevent cerebral ischaemia in the operating room during interventions at risk. EEG and SEP are variables that indirectly reflect cerebral blood flow (CBF) provided that anaesthetic regimen, body temperature, and arterial blood pressure of the patient are stable. When CBF decreases and reaches the functional threshold, slowing and/or attenuation of EEG occurs while the amplitude and the latency of cortical SEP are, respectively decreased and lengthened. Based on these changes, numerous criteria corresponding to critical thresholds have been defined. A decrease in EEG amplitude greater than 30% or EEG changes lasting more than 30 s have been considered as significant by clinicians. The main criteria resulting from computerized EEG analysis were a reduction in total power and/or in spectral edge frequency. Regarding SEP, a more than 50% decrease in N20 amplitude and/or a more than 1 ms increase in central conduction time were the most frequently used criteria. According to the bulk of literature, it may be concluded that processed EEG analysis is more sensitive than visual EEG analysis to detect cerebral ischaemia, and that SEP are not less sensitive than conventional EEG. Moreover, literature shows that SEP are as specific as computerized EEG analysis to disclose ischaemia during carotid endarterectomy.
Brain Ischemia↗
Doppler tissue velocity, strain, and strain rate imaging with transesophageal echocardiography in the operating room: a feasibility study.
OBJECTIVE: Transesophageal echocardiography (TEE) is increasingly used to monitor regional myocardial function during cardiac operation. Doppler myocardial imaging (DMI) indices can potentially provide new information on regional radial and longitudinal myocardial motion and local deformation. This study examined the feasibility of TEE acquisition of regional radial and longitudinal velocity, displacement (D), strain, and strain rate data during cardiac operation and evaluated the effects of sternotomy and pericardial opening on these indices. METHODS: After a baseline transthoracic echocardiographic study, TEE was performed in 22 patients (age 64 +/- 7 years) before sternotomy, after sternotomy with intact pericardium, and after pericardial opening. Regional DMI velocity analysis was performed for the transgastric anterior and inferior walls midpapillary segment (radial function) and the 4-chamber septum and 2-chamber inferior walls basal, mid, and apical segments (longitudinal function). For each segment, systolic and diastolic velocity were derived and D, strain, and strain rate calculated. RESULTS: Transthoracic echocardiographic study and TEE provided similar data from an equivalent number of interpretable segments. In the basal and mid septum, maximum longitudinal systolic D decreased with pericardial opening (basal septum pericardium closed: 6.6 +/- 1.5 mm, open: 4.6 +/- 1.8 mm, P =.007; midseptum pericardium closed: 4.7 +/- 2.5 mm, open: 2.7 +/- 1.5 mm, P =.028). No changes were evident in systolic or diastolic DMI indices in all other segments. CONCLUSION: DMI with TEE is feasible during cardiac operation. During pericardial opening, longitudinal D decreases in the septum, but not in the inferior wall. DMI requires further evaluation in the assessment of ventricular function and the detection of ischemia in the operating room.
Aged↗
A case report of malignant hyperthermia in a dental clinic operating room.
A healthy 5-year-old boy presented for arch bar placement under general anesthesia in an operating room in a dental school. The patient had previously undergone general anesthesia without complication, and no family history of anesthetic problems were reported. Halothane mask induction, intravenous catheter placement, and nasal intubation proceeded uneventfully without the aid of a muscle relaxant. Halfway through the procedure, signs and symptoms of malignant hyperthermia, including muscle rigidity, hypercarbia, tachypnea, and tachycardia were noted. Immediate treatment, including discontinuation of the triggering agent, dantrolene administration, and cooling measures were applied, and once stable, the child was transferred to Columbus Children's Hospital for further management. The patient experienced no postoperative complications. Further discussion regarding the pathophysiology and management of malignant hyperthermia is provided.
Anesthetics, Inhalation↗
Local anaesthesia outside the operating room.
An increasing number of minor surgical procedures are performed under local anaesthesia in clinical settings outside the operating room, where monitoring and resuscitation equipment--as well as personnel skilled in resuscitation--may not be readily available. Serious adverse effects and even fatalities may result from the use of local anaesthetic agents, arising from a variety of causes such as systemic toxicity, allergy, vasovagal syncope, and reaction to additives present in the local anaesthetic. This article briefly reviews the pharmacology of local anaesthetic agents, and describes various techniques commonly used for local anaesthesia, with special emphasis on safety. Clinical features of toxicity, and its differential diagnosis and management, are also discussed.
Anesthesia, Local↗
The integrated operating room system - a pathway to the or 2000 and beyond.
The need to create a new kind of operating room (OR) is obvious from the situation today. Although a number of innovative and even futuristic OR concepts have been proposed, the challenge to implement the OR of the future has never been met. In the Integrated OR System project we came to the conclusion that we have to proceed to new values and new approaches to make the OR of the next millennium happen. By following those new roads we will not only overcome the deficiencies of the OR today but also create a platform that allows easy inclusion of upcoming technology.
Journal Article↗
Operating room utilization: the need for data.
Keeping the OR scheduled to satisfy all the various constituents is a complex dynamic process. The health care environment needs to be carefully analyzed to ensure that the services the OR offers are appropriate. OR utilization is not simply ensuring that the greatest number of cases are done. The cost of doing these cases must be considered and, in order to do so, compromises must be made. Creating information systems that track all aspects of utilization, including costs and revenues, will be vital for the future management of operating rooms.
Appointments and Schedules↗
Critique: occupational disease among operating room personnel.
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Abortion, Spontaneous↗
Protecting your eyes in the laser operating room.
1. Laser protective eyewear is nearly as important to the OR nurse as the surgical mask in an operating room where laser surgery is performed. 2. Most hospitals require OR personnel to wear protective eyewear during laser procedures in voluntary compliance with American National Standards Institute (ANSI) Z136.3 for the safe use of lasers in health care facilities. 3. The basic steps to protecting your eyes are as follows: Select the appropriate eyewear (plastic or glass); make sure the eyewear fits properly; wear the protective lenses during laser testing and operation; and heed your laser safety officer.
Eye Protective Devices↗
Faulty anesthesia circuits: a source of environmental pollution in the operating room.
Commonly used disposable anesthesia circuits were studied for leak and gas spillage. Trace anesthetic gas concentrations produced by these circuits in the anesthesiologist's breathing zone were analyzed by a Hewlett-Packard Gas Chromatograph. These measurements demonstrated ambient halothane (3.29 +/- 0.1 ppm) and N2O (333.5 +/- 2.31 ppm) concentrations well above target levels, when swivel-type disposable anesthesia circuits were used, despite the presence of standard gas-scavenging devices and appropriate operating room fresh air exchange rates. Lower ambient concentration levels (0.38 +/- 0.03 ppm halothane and 31.3 +/- 1.49 ppm N2O) were measured when Y-type disposable anesthesia circuits were used.
Air↗
Image display in the operating room: eliminating the barriers in the transition to filmless radiology.
As hospitals endeavor to transition from film-based radioloogy to electronic or filmless radiology, one limitation is an effective means for accessing the electronic image archive during surgical procedures. The dependency on using reference images during surgical procedures is a critical function. Scott & White Memorial Hospital in Temple, TX, has been progressively moving toward an electronic paradigm for access to medical information. As the radiology department began to eliminate film as a medium for image presentation and image archiving, it was realized that the hospital needed to provide an electronic solution for the display of images in the operating room (OR) as reference during the surgical procedure. The goals in this project were, therefore, multifold: provide electronic access to images and image files directly within the operating suites, eliminate lost films, and reduced delays caused by lost or unavailable films. The end solution utilized the same Web-based software for all devices, but varied the hardware to meet the individual's or group's needs. The success in this project was not contained to cost savings in radiology, which was realized by reducing film library personnel and eliminating films printed specifically for the surgical environment, but also in greater magnitude for the hospital in improving efficiency of the OR support staff and by directly stimulating a reduction in the average OR time needed for the surgical procedures.
Diagnostic Imaging↗
Implementation of an innovation in the ophthalmic operating room: the Memory lens.
I have participated in the evolution of the cataract procedure for the last 23 years. This year, as nursing director for an eye surgery center, I was responsible for the implementation of a new prerolled intraocular lens: The Memory lens. I review 5 implementation strategies, which are: Be open to recently approved products Utilize all company resources Introduce, train, train, train Evaluate, review, review, review Enjoy the questions and attention from others considering the innovation The implementation of this innovation confirmed both my and the operating room staff's ability to change and reaffirmed their commitment to achieve the resultant patient benefits.
Cataract Extraction↗
Anesthesia crisis resource management: real-life simulation training in operating room crises.
Little formal training is provided in anesthesiology residency programs to help acquire, develop, and practice skills in resource management and decision making during crises in practice. Using anesthesia crisis resource management (ACRM) principles developed at another institution, 68 anesthesiologists and 4 nurse-anesthetists participated in an ACRM training course held over a 2 and a half-month period. The anesthesia environment was recreated in a real operating room, with standard equipment and simulations requiring actual performance of clinical interventions. Scenarios included overdose of inhalation anesthetic, oxygen source failure, cardiac arrest, malignant hyperthermia, tension pneumothorax, and complete power failure. A detailed questionnaire was administered following the debriefing and completed by all participants, documenting their immediate impressions. Participants rated themselves as having performed well in the simulator. Senior attendings and residents rated themselves more highly than did their junior counterparts. The potential benefit of this course for anesthesiologists to practice anesthesia more safely in a controlled exercise environment, was rated highly by both groups. Over one half of respondents in all categories felt that the course should be taken once every 12 months; another third of each group felt that the course should be taken once every 24 months. While no senior attendings believed that the course should be taken once every 6 months, approximately 10% of respondents in other categories that it should. Of respondents in the senior and junior attending category, 5% felt the course should never be taken. Although attendings were less favorable than residents in their rating of the value of the course, both groups were still enthusiastic.
Anesthesia↗