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PubMed2000

Phonomicrosurgery III: pre- and postoperative care.

This article discusses the important aspects of pre- and postoperative care for phonomicrosurgical procedures. Making an accurate diagnosis is paramount to any surgical decision, which involves interdisciplinary evaluations by a laryngologist, voice pathologist, singing voice specialist, and other specialists. Patient selection and candidacy for phonomicrosurgery are discussed, including preoperative vocal rehabilitation, compliance, and pre- and postoperative timing issues. Postoperative voice rest issues are covered, and suggestions for postoperative voice rehabilitation are made. Risks of surgery and potential problems following phonomicrosurgery procedures are presented.

Humans↗
PubMed2000

Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients.

BACKGROUND: Health care organizations face pressures from patients to improve the quality of care and clinical outcomes, as well as pressures from managed care to do so more efficiently. Coordination, the management of task interdependencies, is one way that health care organizations have attempted to meet these conflicting demands. OBJECTIVES: The objectives of this study were to introduce the concept of relational coordination and to determine its impact on the quality of care, postoperative pain and functioning, and the length of stay for patients undergoing an elective surgical procedure. Relational coordination comprises frequent, timely, accurate communication, as well as problem-solving, shared goals, shared knowledge, and mutual respect among health care providers. RESEARCH DESIGN: Relational coordination was measured by a cross-sectional questionnaire of health care providers. Quality of care was measured by a cross-sectional postoperative questionnaire of total hip and knee arthroplasty patients. On the same questionnaire, postoperative pain and functioning were measured by the WOMAC osteoarthritis instrument. Length of stay was measured from individual patient hospital records. SUBJECTS: The subjects for this study were 338 care providers and 878 patients who completed questionnaires from 9 hospitals in Boston, MA, New York, NY, and Dallas, TX, between July and December 1997. MEASURES: Quality of care, postoperative pain and functioning, and length of acute hospital stay. RESULTS: Relational coordination varied significantly between sites, ranging from 3.86 to 4.22 (P <0.001). Quality of care was significantly improved by relational coordination (P <0.001) and each of its dimensions. Postoperative pain was significantly reduced by relational coordination (P = 0.041), whereas postoperative functioning was significantly improved by several dimensions of relational coordination, including the frequency of communication (P = 0.044), the strength of shared goals (P = 0.035), and the degree of mutual respect (P = 0.030) among care providers. Length of stay was significantly shortened (53.77%, P <0.001) by relational coordination and each of its dimensions. CONCLUSIONS: Relational coordination across health care providers is associated with improved quality of care, reduced postoperative pain, and decreased lengths of hospital stay for patients undergoing total joint arthroplasty. These findings support the design of formal practices to strengthen communication and relationships among key caregivers on surgical units.

Aged↗
PubMed1986

Anaesthetic management and postoperative care of cardiac surgical patients in a general recovery ward.

The postoperative care of 143 cardiac surgical patients has been successfully conducted in a general surgical recovery ward. Admission was limited to overnight stay only and all but two patients were returned to the general ward the following day. There were no deaths. The intra-operative anaesthetic management was considered to have played an important part in the success of this technique.

Adult↗
PubMed2004

Effect of a selection and postoperative care protocol on survival of infants with hypoplastic left heart syndrome.

BACKGROUND: We report the development and implementation of a program designed to assign patients preoperatively to either transplant or Norwood procedure based on a score derived from known risk factors and to enhance postoperative care of infants undergoing the Norwood procedure. METHODS: A weighted score for each of six variables comprised the scoring system: ventricular function, tricuspid regurgitation, ascending aortic diameter, atrial septal defect blood flow characteristics, blood type, and age. The scoring system was used to prospectively assign mortality risk and lead to recommendation of either Norwood procedure or transplantation. RESULTS: Survival following the Norwood procedure significantly improved after the management program was implemented (88% versus 40% at 48 hours, 57% versus 10% at 30 days, and 50% versus 10% at 1 year, p < 0.0001 at each time point). The survival of the group that received a score of 7 or less (high risk) who underwent the Norwood procedure was 78% at 48 hours, 44% at 30 days, and 33% at 1 year; survival rates among patients considered lower risk (greater than 7) were 100% at 48 hours and 80% at 30 days and 1 year. Transplant outcomes remained unchanged. CONCLUSIONS: We report improved survival following the Norwood procedure after the implementation of an institutional management approach aimed at improving the outcome of infants with hypoplastic left heart syndrome and may help neutralize historical biases toward Norwood procedure or transplantation.

California↗
PubMed1999

Prospective randomized investigation for evaluation of postoperative changes in the microbial climate of paranasal mucosa by the use of different dissoluting techniques during postoperative care.

Endonasal dissolution by the use of NaCl-solution is a common postoperative treatment of the nasal mucosa after endonasal surgery. These procedure involve for example endonasal shower and sterilized solutions. The contamination of nasal shower in case of unprofessional cleaning after treatment was an argument against this technique in earlier discussions. The danger of such an infection should be avoided by the use of sterilized solution. Therefore the dependence of nasal microbial climate on different nasal dissoluting techniques was investigated by the use of such named endonasal shower (Siemens und Co, Bad Ems, Germany) in comparison with sterilized solution (Rhinomer, Zyma SA, Nyon, France). Microbial cultures were investigated of 80 patients after endonasal surgery (53 m, 27 f; 31 +/- 21 age). Surgery was done for the treatment of chronic polypous sinusitis. Pre-, intra- and postoperative samples were taken in 640 cases to proceed microbial cultures. Material was transferred with the use of a Port-A-Cul-transport medium and preparation of the microbial cultures was done during the first four hours. As a result 895 bacterial clones were cultivated. These consisted of 87% aerob and 13% anaerob bacteria. Staphylococcus aureus (39%) and members of the family of Enterobactericae (30%) were the most common microbes. There was neither an evidence for postoperative microbes on the nasal mucosa nor a correlation between the dissoluting technique and the postoperative outcome. The use of sterilized solutions for the postoperative care of endonasal mucosa does not cause an additional worthful effect on neither the postoperative microbial climate nor the outcome in comparison to endonasal shower.

Adolescent↗
PubMed1996

Immediate postoperative care of cardiac surgical patients.

Anesthetic care of the cardiac surgery patient is a continuum, beginning with the preoperative visit and ending when the patient is ambulatory and breathing well on the postoperative floor. Anesthesiologists are well-suited to provide postoperative care because the respiratory and cardiovascular management techniques are an extension of OR management. Attention to details is as important in the ICU as in the OR and offers the opportunity to forestall or reduce morbidity.

Anesthesia↗
PubMedDate not supplied

Evaluation of the complexity of postoperative care following breast and gynecologic cancer surgery.

The purpose of this study was to evaluate the complexity of postoperative care required by women who had undergone breast or gynecologic cancer surgery, using the Therapeutic Intervention Scoring System-28. An observational, longitudinal study was carried out on 83 women admitted postoperatively to the Intensive Care Unit of the Center for Women's Integrated Healthcare. The results of this study show that women diagnosed with gynecologic cancer had a significantly higher mean Therapeutic Intervention Scoring System-28 score compared with women who had been diagnosed with breast cancer (P = .01). Women who underwent gynecologic surgery had a significantly higher mean Therapeutic Intervention Scoring System-28 score than women who had breast surgery (P = .03). Most of the activities performed by staff during the postoperative intensive care unit period involved only basic care procedures. Only advanced age and hypertension were related to death during the postoperative period. In conclusion, from the nursing standpoint, the complexity of care required in the intensive care unit during the postoperative period was moderate. Women aged 80 years or older were at the highest risk of death during this period.

Adult↗
PubMed1994

Postoperative care of the maxillectomy patient.

Guidelines for preoperative patient information and immediate postoperative care of the maxillectomy patient are discussed. Physical therapy, oral hygiene procedures, and current materials for surgical obturation and their uses are reviewed. Effective treatments for infections that arise in the surgical defect are highlighted.

Humans↗
PubMed1999

Naloxone infusion and drainage of cerebrospinal fluid as adjuncts to postoperative care after repair of thoracoabdominal aneurysms.

The mechanisms that produce paraplegia in patients after TAA repair are complex and involve alterations in regional blood flow to the spinal cord, CSF dynamics, and reperfusion. Although neither the minimal level of blood flow nor the maximal spinal cord pressure that can be tolerated by the spinal cord is known, adjuncts such as CSF drainage and naloxone infusions may allow longer durations of aortic cross-clamping before irreversible ischemia occurs. Because paraplegia is multifactorial and none of the recommended adjuncts alone provides complete protection of the spinal cord, a combination of treatments may be necessary to reduce the prevalence of neurological complications after thoracoabdominal aortic reconstruction. Critical care nurses thus must be acquainted with the advanced monitoring techniques and the pathophysiology behind these new treatment modalities. Advanced assessment skills are also essential to recognize the potential neurological complications that may occur in these patients. Care of patients with TAA is a challenge. Critical care nurses must use multidimensional skills in the areas of hemodynamic monitoring, physical assessment, and psychological counseling to effectively manage postoperative care of these patients.

Adult↗
PubMed1978

[Anaesthesia and postoperative care in terminal renal insufficiency. Experiences in 132 cases (author's transl)].

A retrospective study was carried out examining the complication- and mortality-rate in 132 patients with terminal renal insufficiency who underwent major surgery: partial gastrectomy, bilateral nephrectomy and vascular surgery at the lower extremities. The anaesthetic management consisted primarily of general anesthesia and muscle relaxation except for vascular surgery at lower extremities where continuous epidural anaesthesia was used. The problems of the anaesthetic management and postoperative care including dialysis are discussed. Although this group of patients is at high risk, the complications can be kept at a minimum with appropriate anaesthetic management and postoperative care.

Adult↗
PubMed1988

Postoperative care of the gynecology patient.

This chapter has dealt with some of the general issues that impact upon postoperative care. Within the context of this volume, a detailed analysis of each subject is not feasible. Some subjects were deliberately deferred to other contributors. My intent was to review some basic physiology and patho-physiology to emphasize the complex physical and metabolic alterations produced by abdominal pelvic surgery and to emphasize my personal belief that an uncomplicated postoperative recuperation begins with appropriate presurgical care.

Enterocolitis, Pseudomembranous↗
PubMedDate not supplied

[Standards of examination, anesthesia and postoperative care of surgical patients with concomitant cardiovascular diseases].

The authors present the standards for postoperative care of patients with concomitant cardiovascular diseases used at Medical Center No. 122 in St. Petersburg. Special attention is paid to detailed assessment of cardiac function, continuity of the pre-, intra-, and postoperative cardio- and vasotropic therapy, and adequacy of anesthesiological protection as the main guarantee of an uneventful postoperative course. The authors consider it important that preoperative examinations include echocardiography and daily ECG monitoring; preoperative treatment is to include antibiotic prevention of infective endocarditis and heparin prevention of pulmonary artery embolism in the risk group patients. Alternative methods for intraoperative hemodynamic monitoring are pulmonary artery catheterization and integral rheography with the real-time data processing. The importance of regional anesthesia and the hazards of hypercorrection of the globular volume are emphasized.

Anesthesia, Conduction↗
PubMed1997

Postoperative care following CO2 laser resurfacing: avoiding pitfalls.

Facial skin resurfacing using the carbon dioxide laser has become an increasingly popular procedure. Improvements in carbon dioxide laser technology have made the procedure simpler and more reliable. However, difficulties in the postoperative period can lead to patient morbidity and physician anxiety. Common problems such as prolonged erythema, hyperpigmentation, acne, milia, dermatitis, and infection can be controlled or avoided with proper postoperative care. Less common sequela such as hypertrophic scarring and prolonged healing are often a results of errors committed in the postoperative period. The authors have performed laser resurfacing in almost 2100 patients in the last 4 years. Changes in the postoperative regimen to include no pretreatment, use of semipermeable dressings, antiviral and antibacterial prophylaxis, and early treatment with sunscreens and bleaching agents have made for a smoother recovery with more predictable results.

Antiviral Agents↗