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PubMed2004

[Hygiene in ophthalmological care quality: in the operating room].

Ocular surgery has become more and more refined over the last century. However, infections occurring after surgical procedures are very often devastating and sight-threatening. This review provides a number of details on the environment of ocular surgery, mainly, the patient, staff, medical devices used and the operating room. Proper understanding of basic hygiene rules is mandatory on the part of all individuals involved in eye care and particularly in ocular surgery in order to decrease the ocular morbidity due to postoperative ocular infections.

Eye Diseases↗
PubMed1998

Unplanned tracheal extubation outside the operating room: a quality improvement audit of hemodynamic and tracheal airway complications associated with emergency tracheal reintubation.

UNLABELLED: The incidence of hemodynamic and airway complications associated with tracheal reintubation after an unplanned extubation has not been established. Patients whose tracheas were emergently intubated outside the operating room were reviewed over a 27-mo period via a quality improvement vehicle to evaluate hemodynamic and airway complications. Data from a subset of patients (n = 57) who underwent tracheal reintubation after unplanned (self-) extubation were collected for analysis. Of the reintubations, 93% took place within 2 h of self-extubation. Of the patients, 72% had hemodynamic alterations and/or airway-related complications, including hypotension (35%), tachycardia (30%), hypertension (14%), multiple laryngoscopic attempts (22%), difficult laryngoscopy (16%), difficult intubations (14%), hypoxemia (14%), and esophageal intubation (14%). In addition, one surgical airway and one case of "cannot ventilate, cannot intubate" leading to cardiac arrest and death were recorded. These findings suggest that patients requiring reintubation will likely do so soon after self-extubation and that reintubation can be fraught with significant hemodynamic and airway complications. Less than one third of patients undergo a mishap-free reintubation. Strategies to decrease the self-extubation rate in the intensive care unit are needed to improve patient safety and to lessen the potential impact of emergency airway management. IMPLICATIONS: Self-extubation by patients requiring mechanical ventilation can be life-threatening, and replacing the breathing tube often leads to hemodynamic and airway complications. Using this quality improvement audit, 57 self-extubating patients and the complications associated with replacing the breathing tube, which are numerous and can lead to significant morbidity and mortality, were analyzed.

Adolescent↗
PubMed1984

Outcome of resuscitative thoracotomy and descending aortic occlusion performed in the operating room.

Objectives of temporary descending thoracic aortic cross-clamping for exsanguinating abdominal hemorrhage are to redistribute intravascular volume to the myocardium and brain, and to limit further blood loss. This report describes our experience with left thoracotomy and descending aortic occlusion (T/AO) performed in the operating room (OR) for massive hemoperitoneum. During a 5-year period, 39 (5%) of 791 patients undergoing laparotomy for acute injury required T/AO in the OR. According to protocol, T/AO was undertaken before celiotomy if systolic blood pressure (SBP) remained less than 80 mm Hg despite full resuscitation (23 patients), and after celiotomy if SBP fell to less than 60 mm Hg with upper abdominal hemorrhage (16 patients). Mechanism of injury was gunshot wound in 21, stab injury in eight, and blunt trauma in ten. Twelve patients (31%) survived to leave the hospital. Seven of these individuals sustained hepatosplenic injuries, three had major vascular trauma, and the remaining two had combined injuries. Average SBP increased from 51 to 126 mm Hg following T/AO in the preceliotomy group, and from 48 to 131 mm Hg in post-celiotomy patients. The aorta was cross-clamped an average of 43 minutes in the preceliotomy patients, and 19 minutes in the post-celiotomy group. Six survivors (50%) developed major abdominal complications (rebleeding, fistulae, abscess, and pancreatitis). Only two patients, however, had pulmonary problems associated with T/AO; and both were minor (atelectasis and recurrent pneumothorax). In our experience, T/AO in the OR is successful in salvaging nearly one third of patients with life-threatening abdominal hemorrhage. The procedure can be performed rapidly, safely, and with minimal late sequelae.

Abdominal Injuries↗
PubMed2002

Forming professional identities on the health care team: discursive constructions of the 'other' in the operating room.

BACKGROUND: Inter-professional health care teams represent the nucleus of both patient care and the clinical education of novices. Both activities depend upon the'talk' that team members use to interact with one another. This study explored team members' interpretations of tense team communications in the operating room (OR). METHODS: The study was conducted using 52 team members divided into 14 focus groups. Team members comprised 13 surgeons, 19 nurses, nine anaesthetists and 11 trainees. Both uni-disciplinary (n = 11) and multi-disciplinary (n = 3) formats were employed. All groups discussed three communication scenarios, derived from prior ethnographic research. Discussions were audio-recorded and transcribed. Using a grounded theory approach, three researchers individually analysed sample transcripts, after which group discussions were held to resolve discrepancies and confirm a coding structure. Using the confirmed code, the complete data set was coded using the 'NVivo' qualitative data analysis software program. RESULTS: There were substantial differences in surgeons', nurses', anaesthetists', and trainees' interpretations of the communication scenarios. Interpretations were accompanied by subjects' depictions of disciplinary roles on the team. Subjects' constructions of other professions' roles, values and motivations were often dissonant with those professions' constructions of themselves. CONCLUSIONS: Team members, particularly novices, tend to simplify and distort others' roles and motivations as they interpret tense communication. We suggest that such simplifications may be rhetorical, reflecting professional rivalries on the OR team. In addition, we theorise that novices' echoing of role simplification has implications for their professional identity formation.

Clinical Competence↗
PubMed1999

Sedation and anesthesia outside the operating room: answers to common questions.

In recent years, practitioners have recognized the importance of providing comfort to children and have increased their use of analgesics and anxiolytics during painful medical procedures. In this article, the author reviews commonly asked questions regarding administering sedation to children for painful procedures outside the operating room. Current safety guidelines are reviewed, as well as qualifications of personnel performing sedations, contraindications to sedation, fasting guidelines before sedation, and common sedation techniques.

Anesthesia↗
PubMed2006

Non-technical skills for surgeons in the operating room: a review of the literature.

BACKGROUND: This review examines the surgical and psychological literature on surgeons' intraoperative non-technical skills. These are the critical cognitive and interpersonal skills that complement surgeons' technical abilities. The objectives of this paper are (1) to identify the non-technical skills required by surgeons in the operating room and (2) assess the behavioral marker systems that have been developed for rating surgeons' non-technical skills. METHODS: A literature search was conducted against a set of inclusion criteria. Databases searched included BioMed Central, Medline, EDINA BIOSIS, Web-of-Knowledge, PsychLit, and ScienceDirect. RESULTS: A number of "core" categories of non-technical skills were identified from 4 sources of data: questionnaire and interview studies, observational studies, adverse event analyses, and the surgical education/competence assessment literature. The main skill categories were communication, teamwork, leadership, and decision making. The existing frameworks used to measure surgeons' non-technical skills were found to be deficient in terms of either their psychometric properties or suitability for rating the full range of skills in individual surgeons. CONCLUSIONS: Further work is required to develop a valid taxonomy of individual surgeons' non-technical skills for training and feedback.

Cognition↗