[Radiation protection in the operating room. Operating room personnel needs an "X ray drivers license"].
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Operationally, passive dosimeters are ideally suited for monitoring organic vapors in hospital operating rooms as they are compact, lightweight and do not require tubing or pumps. In this study, a recently developed passive diffusion sampler was used to collect 2-bromo-2-chloro-1, 1, 1-trifluoroethane (Halothane) and 2-chloro-1, 1, 2-trifluoroethyl difluoromethyl ether (Enflurane) in standard air mixtures over the range of 0.2-10 ppm. Additionally, exposures to known concentrations were conducted for various lengths of time. A side-by-side comparison of charcoal tubes (CT) and passive dosimeter collection characteristics were made on known air mixtures and samples collected in operating rooms. The material adsorbed on charcoal from dosimeters and CT was desorbed with carbon disulfide and quantified using gas-liquid chromatography. The overall efficiency of the dosimeters along with quality control data are presented.
There is no published study that examines oxygenation of anaesthetised patients during transport from anaesthesia induction room to operating room. Arterial oxygen saturation (SaO2) was measured in twenty-five anaesthetised patients before and during transfer to an adjacent operating room and continuously recorded on a calibrated chart recorder. A telemetry ECG recorder was used to detect cardiac dysrhythmias. All anaesthetists followed their usual anaesthetic practice. Patients ventilated via face-mask and via endotracheal tube were studied. During transfer patients were either apnoeic (n = 8) or breathing room air spontaneously (n = 17). Mean SaO2 before induction was 95.4 (SD 2.5)%, was higher after induction of anaesthesia, 98.5 (SD 1.4)% and fell after transfer, 95.7 (SD 2.6)%. A fall in SaO2 was recorded for 21 patients. No SaO2 value below 90% was seen. The decrease in SaO2 was related to the time taken to transfer the patients and spontaneous ventilation (Multiple regression analysis); it was not related to the body mass index although two of the greatest decreases were seen in obese patients. Transfer time averaged 51 seconds (range: 24-97 s). No changes in cardiac rhythm were seen. Transfer of anaesthetised patients was accompanied by variable falls in SaO2 which related to duration of transfer and spontaneous breathing of room air and which were not associated with new dysrhythmias.
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UNLABELLED: We examined how to program an operating room (OR) information system to assist the OR manager in deciding whether to move the last case of the day in one OR to another OR that is empty to decrease overtime labor costs. We first developed a statistical strategy to predict whether moving the case would decrease overtime labor costs for first shift nurses and anesthesia providers. The strategy was based on using historical case duration data stored in a surgical services information system. Second, we estimated the incremental overtime labor costs achieved if our strategy was used for moving cases versus movement of cases by an OR manager who knew in advance exactly how long each case would last. We found that if our strategy was used to decide whether to move cases, then depending on parameter values, only 2.0 to 4.3 more min of overtime would be required per case than if the OR manager had perfect retrospective knowledge of case durations. The use of other information technologies to assist in the decision of whether to move a case, such as real-time patient tracking information systems, closed-circuit cameras, or graphical airport-style displays can, on average, reduce overtime by no more than only 2 to 4 min per case that can be moved. IMPLICATIONS: The use of other information technologies to assist in the decision of whether to move a case, such as real-time patient tracking information systems, closed-circuit cameras, or graphical airport-style displays, can, on average, reduce overtime by no more than only 2 to 4 min per case that can be moved.
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Two operating rooms (OP K I, OP K II) with conventional air-conditioning and one operating room with horizontal laminar-flow-ventilation (TAVS) were compared by measurements of airborne microorganisms, settling microorganisms and wound contamination. In OP K I and OP K II the number of airborne colonie forming units (cfu) was about 8/m3 when the rooms were empty and between 70/m3 (OP K I) and 140/m3 (OP K II) during operations. The first air in the TAVS-OP contained less than 1 cfu/m3, downstream of the operating team up to 80 cfu/m3. The number of settling microorganisms at the wound site was about 13 cfu/100 cm2 h in OP K I and OP K II, and about 2 cfu/100 cm2 h in the TAVS OP. Wound swabs showed a contamination rate of 45% (OP K I) and 54% (OP K II) versus 31% under TAVS-conditions. The difference is statistically significant with p less than 0.05. Various other factors as e.g. the duration of exposition, traffic of persons into and out of the rooms and the fate of microorganisms after sedimentation into the wound are discussed. While the number of settling germs is growing in linear proportion to the duration of exposition, the number of wounds found contaminated does probably approach a steady state in dependence of sedimentation rate and die-off rate in the wound.
During operative cholangiography, the surgeon and other operating room personnel are exposed to scattered radiation and its potential hazards. It was determined that a surgeon standing at the side of the patient during cholangiographic filming would receive 3.2 mR per film. Exposure would be only 0.5 mR per film if the surgeon stepped back 75 cm (2.5 ft) from the patient. This simple measure would reduce the monthly exposure of a surgeon who performs four cholangiograms per week from approximately 205 to 32 mR. The use of the new electronic video-disc recording systems and lead aprons can substantially reduce the amount of radiation exposure related to fluoroscopy. The prudent surgeon, recalling that no level of radiation may be totally safe, should use techniques that provide maximal protection for himself and all operating room personnel during performance of operative cholangiography.
In operating rooms, patients with a wide range of conditions are transferred from the wards to undergo surgery. Furthermore, because surgeons with different specialties perform various operations using instruments unique to their specialty, it is possible that operating room nurses, surgeons, and ward nurses do not always communicate clearly. Patients are anesthetized and unconscious, and as a general rule, family members are not allowed entry. As a result, operating rooms are unique environments where neither the patients receiving medical services nor their families can express opinions and concerns. Therefore an especially strict crisis management approach is needed in operating rooms. At present, individual hospital implement their own crisis management systems to prevent medical accidents. However, national debate is needed to establish medical accident prevention guidelines before each hospital compiles a manual that suits its needs.
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