Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Operating Rooms”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources
PubMed2003

[Life-threatening coronary ischemia in the operating room: analysis of annual survey from 1999 to 2001 conducted by Japanese Society of Anesthesiologists].

In Japan, the incidence of cardiac morbidity among patients with ischemic heart diseases has been reported to be 13.2-16.4%, and that of perioperative myocardial infarction in these patients about 1%. We investigated the perioperative morbidity and mortality due to coronary ischemia by using data from an annual survey concerning anesthesia-related critical incidents, conducted by the Committee on Operating Room Safety, Japanese Society of Anesthesiologists. In this survey, coronary ischemia was divided into intraoperative pathological events (coronary ischemia as intraoperative event) and preoperative complication (coronary ischemia as preoperative complication). The former consists of coronary ischemia which developed in patients without preoperative diagnosis of ischemic heart diseases or which was induced by surgical and/or anesthetic procedures. The latter was coronary ischemia developed in patients with preoperative diagnosis of ischemic heart diseases. From January 1, 1999, to December 31, 2001, 3,020,021 patients were registered from certified training hospitals of Japanese Society of the Anesthesiologists in the survey. Among them 1,918 episodes of intraoperative cardiac arrest and 2,054 deaths (within 7th postoperative days) were reported. Of these 7.5% and 6.3% of cardiac arrests were due to coronary ischemia as intraoperative event and as preoperative complication, respectively. Death was due to coronary ischemia as intraoperative event in 4.0% and as preoperative complication in 5.1%. The occurrence of critical incidents (cardiac arrest and the other life-threatening events) due to both types of coronary ischemia depended on ASA-PS. The percentage of coronary ischemia as preoperative complication was higher in emergency patients than in elective patients. The percentage of coronary ischemia as intraoperative event was almost the same between emergency and elective patients. Both types of coronary ischemia developed most frequently in cardiac/aortic surgeries, followed by thoracotomy with or without laparotomy. The number of critical incidents due to coronary ischemia as preoperative complication was the largest in emergency cardiac/aortic surgeries, followed by elective non-cardiac surgeries. The number of critical incidents due to coronary ischemia as intraoperative event was the largest in elective non-cardiac, especially open abdominal, surgeries in patients with ASA-PS 1(E) + 2(E). Among the patients with ASA-PS 1(E) + 2(E) who underwent non-cardiac surgeries 13.9% of deaths were due to coronary ischemia as preoperative complication and 12.5% as intraoperative event. It should be noted that many critical incidents due to coronary ischemia as intraoperative event during laparotomy developed in patients anesthetized by inhalation anesthesia combined with epidural, spinal or conduction block. Prognosis of cardiac arrest due to coronary ischemia as preoperative complication was the worst: 47.1% of these patients died. The best prognosis was found in critical incidents other than cardiac arrest due to coronary ischemia as intraoperative event with mortality of 12.3%. The results show that quality improvement from the standpoint of intraoperative coronary ischemia is required.

Anesthesia↗
PubMed2006

How to reliably detect ischemia in the intensive care unit and operating room.

Detection of myocardial ischemia in the perioperative period is important because it allows for intervention that may prevent progression of ischemia to myocardial infarction. Perioperative ischemia is also an important predictor of adverse cardiovascular outcomes. Patients should first be stratified according to their risk of having cardiovascular disease by identifying major, intermediate, and minor predictors of adverse cardiovascular outcome. Electrocardiographic (ECG) monitoring for ischemia is inexpensive and noninvasive, but may not be applicable to all patients and is not perfectly sensitive or specific. Modern operating room monitors can automate ST segment monitoring and be set to alarm if changes occur. Increases in central venous pressure and pulmonary artery pressure can be caused by myocardial ischemia, but have been shown to be very insensitive compared to ECG. Also, detection of these hemodynamic changes requires insertion of invasive monitoring devices. Transesophageal echocardiography can be used to detect myocardial ischemia by identifying changes in regional wall motion. These transesophageal echocardiography changes occur sooner and more frequently than ECG changes, but require greater knowledge and skill to properly interpret.

Catheterization, Swan-Ganz↗
PubMed2005

[Business organization theory: its potential use in the organization of the operating room].

The paradigm of patient care in the German health system is changing. The introduction of German Diagnosis Related Groups (G-DRGs), a diagnosis-related coding system, has made process-oriented thinking increasingly important. The treatment process is viewed and managed as a whole from the admission to the discharge of the patient. The interfaces of departments and sectors are diminished. A main objective of these measures is to render patient care more cost efficient. Within the hospital, the operating room (OR) is the most expensive factor accounting for 25 - 50 % of the costs of a surgical patient and is also a bottleneck in the surgical patient care. Therefore, controlling of the perioperative treatment process is getting more and more important. Here, the business organisation theory can be a very useful tool. Especially the concepts of process organisation and process management can be applied to hospitals. Process-oriented thinking uncovers and solves typical organisational problems. Competences, responsibilities and tasks are reorganised by process orientation and the enterprise is gradually transformed to a process-oriented system. Process management includes objective-oriented controlling of the value chain of an enterprise with regard to quality, time, costs and customer satisfaction. The quality of the process is continuously improved using process-management techniques. The main advantage of process management is consistent customer orientation. Customer orientation means to be aware of the customer's needs at any time during the daily routine. The performance is therefore always directed towards current market requirements. This paper presents the basics of business organisation theory and to point out its potential use in the organisation of the OR.

Commerce↗
PubMed2003

The operating room of the future: white paper summation.

On November 8 and 9, 2001, leading experts in patient safety, medical informatics, advanced surgical devices, telesurgery, and surgical facilities met to formulate strategic directions for the "OR of the Future" in both military and civilian healthcare. The meeting was co-hosted by the Telemedicine and Advanced Technology Research Center (TATRC) part of the U.S. Army Medical Research and Materiel Command at Fort Detrick, and the University of Maryland Medical Center. Researchers, surgeons, and experts in the field of operating room (OR) technology addressed the current state of research and technological developments. Experts in (1) patient safety, (2) medical informatics, (3) advanced surgical devices, (4) telesurgery, and (5) surgical facilities met in focused work groups to develop a proposed research agenda for each content area. Afterwards, each focused group agreed to develop a 'White Paper' on each specific area, addressing the current and future prospectus. In addition, they attempted to provide a recommended research roadmap for the 'OR of the Future.'

Facility Design and Construction↗
PubMed1990

The effect of surgical handwashing routines on the microbial counts of operating room nurses.

Many factors may affect the efficiency of handwashing techniques. This study examined two interdependent factors: the time taken to wash the hands and the type of antiseptic solution used. A 3-minute initial scrub and 30-second consecutive scrub regimen was compared with a current standard regimen of a 5-minute initial scrub and a 3-minute consecutive scrub. Chlorhexidine gluconate 4% and povidone-iodine 7.5% were the antiseptics used in the two regimens. The sample (n = 34) was drawn from nurses employed in the operating room suite of a 950-bed hospital. Chlorhexidine gluconate was found to be responsible for lower numbers of colony-forming units of bacteria than povidone-iodine. The duration of the scrub had no significant effect on the numbers of bacteria when povidone-iodine was used. The optimal regimen was found to be the 5-minute initial and 3-minute consecutive scrubs with chlorhexidine gluconate.

Chlorhexidine↗
PubMed2006

A survey of the appropriate use of antiseptic agents in the operating room of several key health care facilities. A comparison between surveys in 2000 and 2004.

Since 2000, new hand and environmental hygiene guidelines have been published by the Center for Disease Control and Prevention (CDC) based on scientific evidence. Accordingly, we expected that the use of disinfectants in clinical settings had been changed. To compare the use and amount of disinfectants before and after the publication of these guidelines, we conducted a questionnaire-based survey on the use of antiseptic agents in operating rooms (ORs) in 6 key hospitals over a period of a month in 2000 and 2004. As a result, the amount of disinfectants used in ORs was reduced in all hospitals in 2004. Especially, amphoteric detergents and glutaral products showed significant reductions in the total amount used in the 6 hospitals, by 94.8 and 96.8%, respectively. The use of povidone-iodine (PVP-I) was decreased by 23.4% overall, although it was increased in 3 hospitals by 11.0-58.6%. The number of applications of PVP-I on the surgical site did not change; however, the site was left to dry without wiping after PVP-I application more frequently in 2004 than in 2000. The time for surgical scrubbing was shortened in 2004, but brush scrubbing was still used as often as in 2000. Many of the hospitals used brush scrubbing in conjunction with alcohol-based rubs. These results indicated changes in infection control measures in hospital settings after publication of the new CDC guidelines; environmental disinfection had been limited and excessive use of disinfectants reevaluated.

Anti-Infective Agents, Local↗
PubMed1999

Intern call schedules and their relationship to sleep, operating room participation, stress, and satisfaction.

BACKGROUND: The ideal resident call schedule remains unknown. This study assessed the impact of different call schedules on intern performance and education. METHODS: A year-long, prospective, observational study of first-year residents in a surgery training program was performed with use of intern sleep/operative logs and questionnaires, and faculty questionnaires. RESULTS: Compared with interns taking call every third or fourth night (and cross-covering a separate service), interns taking call every other night reported the greatest amount of fatigue and stress, the lowest satisfaction, and the fewest operative cases. Errors in patient care were not different between schedules. Multivariate analysis revealed that operative participation was inversely related to frequency of night call and level of fatigue post call, stress was related to fatigue while off call and service census, and overall satisfaction was associated with infrequency of call and operative cases performed. Faculty reported more errors by interns cross-covering other services and less operating room participation by interns taking call every other night. CONCLUSIONS: No single resident schedule optimally balances patient care and resident education and satisfaction. All 3 patterns of call studied are acceptable; specific decisions regarding the allocation of house staff manpower should be flexible and dependent on individual service and educational needs.

General Surgery↗
PubMed1998

Operational improvement of gynecologic laparoscopic operating room services: an internal review.

BACKGROUND: To reorganize reusable laparoscopic instrumentation to promote instrument accessibility, minimize instrument breakage, eliminate infrequently used instruments on permanent trays, and help control maintenance costs. TECHNIQUE: The Robert Wood Johnson University Hospital Gynecologic Steering Committee evaluated during a 5-month period the storage, use, and maintenance of gynecologic laparoscopic instrument sets used in the surgical suite. Acting on this data, the committee oversaw the following changes. Infrequently used instruments were removed from permanent trays and separately packaged. Two types of gynecologic laparoscopy trays were prepared: one for laparoscopic bilateral tubal ligations and one for both diagnostic and operative laparoscopy. A double-decker compartmentalized tray in which instruments were sterilized and stored replaced the extant single-layer ones in which instruments were stacked on each other. To facilitate instrument identification and function, a surgical manual was compiled with photographs of each instrument and a description of its use. EXPERIENCE: After implementation of these changes, maintenance and sterilization costs for a 10-month period were compared with those for the previous 10 months. There was a savings of $13,889. The ratio of total costs divided by number of cases performed during the two study periods was also compared. There was a savings of $31 per case. CONCLUSION: Savings were achieved by reorganizing this operating room's handling of reusable gynecologic laparoscopy equipment. By eliminating infrequently used instruments from the permanent trays and by using a double decker compartmentalized tray that was used during surgery, sterilization, and storage, both sterilization costs and maintenance costs were reduced.

Costs and Cost Analysis↗
PubMed2006

Transoesophageal echocardiography (TOE) in the operating room.

Perioperative transoesophageal echocardiography (TOE) was introduced from cardiology into cardiac anaesthesia in the 1980s. Initially TOE was used mainly as a monitor of left ventricular ischaemia, but now provides real-time dynamic information about the anatomy and physiology of the whole heart. TOE is of value in the management of patients undergoing procedures including cardiac valvular repair, surgery for endocarditis, surgery of the thoracic aorta, and may contribute useful information in a wide range of cardiac pathology. It is also useful in guiding therapy in haemodynamically unstable patients in the operating room and the intensive care unit. TOE is relatively cheap and non-invasive, but it should not be used as a stand alone device but as a tool which provides data in addition to the data acquired from other forms of monitoring. The use of TOE carries not only the benefits of a rapid and effective investigation, but also risks associated with the procedure itself and the burden of providing training and experience for practitioners. The establishment of TOE in perioperative cardiac anaesthetic care has resulted in a significant change in the role of the anaesthetist who, using TOE, can provide new information which may change the course and the outcome of surgical procedures.

Anesthesiology↗
PubMed2005

Congenital diaphragmatic hernia: intensive care unit or operating room?

Despite improvements in prenatal diagnosis and neonatal intensive care, the Congenital Diaphragmatic Hernia (CDH) Registry still records a 64% survival rate. Many reports demonstrate, however, that approximately 80% of CDH patients with no other malformations may survive if managed with permissive hypercapnia, gentle ventilation, high-frequency oscillatory ventilation (HFOV), surfactant, inhaled nitric oxide (iNO) and extracorporeal membrane oxygenation (ECMO), and delayed surgical repair. We wished to define the evolving outcome of CDH newborns using a protocol approach to management, which includes surgery in the neonatal intensive care unit (NICU) or operating room (OR). From January 1996, data were collected prospectively on 42 consecutive live-born infants with CDH. Newborns symptomatic at birth were sedated and paralyzed in the delivery room, and treated with elective HFOV, iNO, surfactant, and ECMO as necessary, delaying surgical repair until their clinical conditions were stable. Once the CDH newborn was stabilized, a trial on conventional ventilation was started at least 24 hours before surgery; however, if the patient was unstable, therapy was switched back to HFOV and surgery was performed in the NICU. Demographic and clinical parameters were compared between CDH newborns who underwent surgery in the NICU and in the OR. The two groups were comparable in terms of clinical characteristics and baseline ventilatory and blood gas values. Mean age at surgery was 3 +/- 2 days. After surgery, the NICU group had more infectious complications. However, the survival rate of uncomplicated CDH was 78% and a low rate of chronic lung disease was reported. A prolonged phase of presurgery stabilization is proposed and strict control of infection is recommended for the CDH newborns who might benefit from an exclusive HFOV and NICU surgery.

Algorithms↗
PubMed1992

Survival after emergency department versus operating room thoracotomy for penetrating cardiac injuries.

The authors undertook a 6-year retrospective review to assess their experience with penetrating cardiac injuries. Special emphasis was placed on identifying patients with and without tamponade and those requiring emergency department (ED) thoracotomy. Forty-eight patients were identified. Overall survival was 64.6 per cent. Thirty-three patients had tamponade, with 20 requiring ED thoracotomy. Fifteen patients did not have tamponade and two of these needed ED thoracotomy. Five patients who had ED thoracotomy were long-term survivors (22.7%). The remaining 26 patients, 13 with tamponade and 13 without, received operating room (OR) thoracotomy and all survived. The data shows that excellent results are possible with OR thoracotomy for penetrating cardiac injuries, with or without tamponade. However, results are not as good when ED thoracotomy is necessary. This may relate to the severity of the injury, the duration of tamponade, or the inability to control cardiac bleeding during thoracotomy in the ED setting. Even though survival is low with ED thoracotomy, it is high enough to continue to support its use in the deteriorating patient with a penetrating cardiac wound.

Adolescent↗
PubMed1990

Tension reduction in the operating room.

Muscle relaxation, altering stressful thought patterns, verbalization to supportive team members, time management, and humor are all effective tension relievers. Whereas muscle relaxation, altering thought patterns, and time management may be effective individual techniques, verbalization and humor are techniques that involve others and maximize the use of support from others. However, in every situation, personality, culture, background, and levels of stress affect reactions to tension and color the reactions of others to strategies used to reduce tension. Thus, in all cases, the situation must be carefully assessed, and timing, discretion, and selectivity are of vital importance if the strategy is to be used effectively. In addition to the nurse's knowledge of tension reduction strategies that can be used in the operating room, optimal function can be promoted by a total lifestyle that attends to coping directly with tension. Adequate periods of planned relaxation and exercise, planned time off, proper nutrition, and diet must also be part of a holistic approach to help prevent and reduce disabling tension.

Humans↗