Adult Elective Surgery Patients Research Articles

Improving quantitative neuromuscular monitoring: an education initiative on stimulating electrode placement.

Quantitative neuromuscular monitoring reduces the incidence of residual neuromuscular block, but broad acceptance of monitoring has been elusive despite recommendations for quantitative monitoring for decades. Acceptance of quantitative monitoring may, in part, be related to the quality of the data from monitoring systems. This evaluation explored proper stimulating electrode positioning for electromyographic (EMG) monitoring, the impact of an educational intervention on electrode positioning and anesthesia provider (anesthesiologist, resident, anesthetist) confidence in the monitoring data from the device. In a single-center, observations of EMG electrode placement by anesthesia technicians, in 55 adult elective surgery patients were made by an independent observer. Separately, the anesthesia provider satisfaction with EMG derived data was recorded after reversal of neuromuscular block. An educational intervention then occurred on proper electrode positioning, including prior observations of electrode positioning, and prior anesthesia provider satisfaction with the EMG derived data. After the intervention, stimulating electrode position was observed with an additional 60 patients and anesthesia provider satisfaction with the data was again ascertained. The educational intervention significantly increased the proportion of ideal ulnar nerve groove electrode positioning from 74.5% to 95% (P < 0.003) and ideal wrist crease positioning (distal electrode within 2cm of crease) from 61.8% to 96.7% (P < 0.001). Anesthesia provider confidence with EMG derived information during anesthesia delivery, increased from 67 to 90% after the education (P = 0.005). There was a significant relationship between correct stimulating electrode placement and anesthesia provider confidence in the EMG derived data on neuromuscular block status. An educational intervention to improve EMG electrode positioning proved meaningful. It increased anesthesia provider confidence in the EMG derived data during anesthesia case management.

Introduction of a Pre-admission Pharmacist Service Utilising the Surgical Ward Pharmacist.

Background: The challenge with obtaining a best possible medication history (BPMH) post-surgery is the delay in clarifying medications due to decreased post-operative cognitive status and pain, which can lead to missed or late administration of medications. Studies have suggested that unintentional medication discrepancies at the time of admission are common in general medical patients. Objectives: To investigate if a pre-admission pharmacist completing BPMHs for adult elective surgery patients with planned overnight admission increases the proportion of patients with (i) a BPMH completed, (ii) medication reconciliation completed and (iii) all home medications charted correctly within 24hours of admission. Methods: Patients in the pre-intervention group had a BPMH completed on admission as standard of care. Patients in the post-intervention group were contacted by the pre-admission pharmacist 1 to 3 business days prior to admission to complete a BPMH. The pre-admission pharmacist role was performed by a surgical ward pharmacist in addition to their daily workload. Descriptive statistics, Chi-squared test and Mann-Whitney U test were used to analyse the data. Results: The post-intervention group had more patients with a completed BPMH (47.2% vs 25.3%, P = .005), medication reconciliation (43.8% vs 15.5%, P = .0001) and all home medications charted correctly (36% vs 16.9%, P = .007) within 24hours of admission compared with the pre-intervention group. Conclusion: The introduction of a pre-admission service utilising the surgical ward pharmacist increased the proportion of patients with a completed BPMH, medication reconciliation and home medications charted correctly within 24hours of admission.

Pengaruh Pendidikan Kesehatan Reproduksi Terhadap Perilaku Seksual Remaja: Studi Literatur

Latar belakang: Remaja adalah kelompok umur yang sedang dalam tahap perkembangan secara fisik, psikologis dan mental yang menjadikan remaja menjadi pribadi yang memiliki rasa keingintahuan yang tinggi sehingga remaja cenderung melakukan hal-hal berisiko salah satunya perilaku seksual pranikah. Salah satu faktor yang melatarbelakangi remaja menjadi terjerat perilaku seksual yang berisiko adalah kurangnya pengetahuan remaja yang dapat ditangani salah satu intervensi yaitu pendidikan kesehatanTujuan: Untuk melihat pengaruh dari pendidikan kesehatan reproduksi pada perilaku seksual yang dilakukan oleh remajaMetode: Peneliti menggunakan metode studi literatur yaitu dengan cara mengambil artikel melalui database online seperti Google Scholar, PubMed, dan Taylor and Francis Online dan seleksi artikel berdasarkan PRISMA sehingga didapatkan 4 artikel yang digunakan dalam studi ini dengan batasan waktu publikasi 7 tahun mulai dari tahun 2017 hingga 2023Hasil: Hasil uji univariat dan bivariat dari 4 artikel menunjukkan terdapat pengaruh pada pemberian pendidikan kesehatan tentang reproduksi terhadap perilaku seksual yang dilakukan oleh remajaImplikasi: Pendidikan kesehatan reproduksi dengan metode apapun terbukti berpengaruh dalam menurunkan perilaku seksual yang berisiko oleh remajaKata Kunci: Perilaku Seksual Remaja; Pendidikan Kesehatan

Comparison of modified anterior and traditional posterior accesses for ultrasound-guided superior laryngeal nerve block in awake endotracheal intubation: study protocol for a randomised non-inferiority clinical trial

IntroductionAwake tracheal intubation (ATI) involves placing a tracheal tube in an awake, spontaneously breathing patient. Superior laryngeal nerve block (SLNB) can effectively abolish the glottic closure reflex, and blunt the...

An Economic Evaluation of the Preoperative Investigations for Elective Surgical Patients at a Caribbean Tertiary Care Teaching Hospital.

Introduction Preoperative assessment using widespread laboratory investigations and ancillary tests as preoperative screening may be unnecessary and lead to an economic burden. This study aimed to determine the routine preoperative investigations performed in a tertiary care teaching hospital in the Caribbean that could be categorized as unnecessary and the costs incurred for these tests. Methods Patient and surgery-specific data were collected prospectively from adult elective surgery patients over a three-month period. Surgical intensity, American Society of Anesthesiologists (ASA) grade and the National Institute for Health and Care Excellence (NICE) (UK, 2016) Clinical Guideline for Preoperative Investigations were used to determine which tests to deem unnecessary. The overall economic burden of unnecessary testing was assessed. Results Data were prospectively collected from 636 patients during the study period. Sixty-four percent of the preoperative investigations performed were deemed unnecessary. The money spent on these unnecessary investigations amounted to $44,622. When extrapolated, this can amount to approximately $178,488 per annum. This represented 59% of the total money spent on the overall preoperative investigations performed. Relatively healthier patients (ASA I and II) had a significantly higher number of unnecessary investigations performed. Conclusion This study found that the majority of preoperative investigations performed routinely may be deemed unnecessary. This results in a huge economic burden on the healthcare system. There is a need to update and strictly implement clinical guidelines for preoperative investigations.

Adverse events of iron and/or erythropoiesis-stimulating agent therapy in preoperatively anemic elective surgery patients: a systematic review

BackgroundIron supplementation and erythropoiesis-stimulating agent (ESA) administration represent the hallmark therapies in preoperative anemia treatment, as reflected in a set of evidence-based treatment recommendations made during the 2018 International Consensus Conference on Patient Blood Management. However, little is known about the safety of these therapies. This systematic review investigated the occurrence of adverse events (AEs) during or after treatment with iron and/or ESAs.MethodsFive databases (The Cochrane Library, MEDLINE, Embase, Transfusion Evidence Library, Web of Science) and two trial registries (ClinicalTrials.gov, WHO ICTRP) were searched until 23 May 2022. Randomized controlled trials (RCTs), cohort, and case-control studies investigating any AE during or after iron and/or ESA administration in adult elective surgery patients with preoperative anemia were eligible for inclusion and judged using the Cochrane Risk of Bias tools. The GRADE approach was used to assess the overall certainty of evidence.ResultsData from 26 RCTs and 16 cohort studies involving a total of 6062 patients were extracted, on 6 treatment comparisons: (1) intravenous (IV) versus oral iron, (2) IV iron versus usual care/no iron, (3) IV ferric carboxymaltose versus IV iron sucrose, (4) ESA+iron versus control (placebo and/or iron, no treatment), (5) ESA+IV iron versus ESA+oral iron, and (6) ESA+IV iron versus ESA+IV iron (different ESA dosing regimens). Most AE data concerned mortality/survival (n=24 studies), thromboembolic (n=22), infectious (n=20), cardiovascular (n=19) and gastrointestinal (n=14) AEs. Very low certainty evidence was assigned to all but one outcome category. This uncertainty results from both the low quantity and quality of AE data due to the high risk of bias caused by limitations in the study design, data collection, and reporting.ConclusionsIt remains unclear if ESA and/or iron therapy is associated with AEs in preoperatively anemic elective surgery patients. Future trial investigators should pay more attention to the systematic collection, measurement, documentation, and reporting of AE data.

&lt;p&gt;Preoperative Anxiety and Associated Factors Among Adult Elective Surgery Patients in North Wollo Zone, Northeast Ethiopia&lt;/p&gt;

&lt;p&gt;Preoperative Anxiety and Associated Factors Among Adult Elective Surgery Patients in North Wollo Zone, Northeast Ethiopia&lt;/p&gt;

PREOPERATIVE SCREENING FOR OSA IN ELECTIVE SURGERY USING SYMPTOMLESS MULTI-VARIABLE APNEA PREDICTION INDEX AND STOP-BANG: A PILOT STUDY

SESSION TITLE: Sleep Disorders Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Obstructive Sleep Apnea (OSA) is highly prevalent and a risk factor for postoperative complications among elective surgery patients. Currently, the commonly utilized perioperative OSA-risk screening tool is the STOP-BANG questionnaire that consists of eight variables including symptom questions. The Symptomless Multi-Variable Apnea Prediction index (sMVAP), however, is a symptomless tool using three routinely collected variables, age, gender, and body mass index (BMI), to determine OSA-risk. The goal of this study was to evaluate the model performance of the sMVAP compared to the STOP-BANG and their association with OSA-risk and comorbidities in a cohort of elective surgery patients. METHODS: We conducted a retrospective chart review of adult elective surgery patients ≥ 18 years of age excluding obstetrics. The sMVAP and STOP-BANG scores were calculated. The sMVAP scores were then categorized into 5 quintiles. Inter-quintile analysis was performed to determine the relationship of sMVAP scores to a formal diagnosis of OSA, demographic data, and comorbidities. RESULTS: A total of 205 surgical patients were included. The sensitivity, specificity and area under the receiver operating curve (AUC) of sMVAP (65.4%, 73.3%, AUC 0.69) was higher than STOP-BANG (44.2%, 66.7%, AUC 0.55). Higher sMVAP (quintiles 4 and 5 or scores > 0.4) were significantly associated with OSA diagnosis (p=0.003), male gender (p=0.024), BMI ≥ 35 kg/m2 (p<0.001), and diabetes (p=0.001). No significant inter-quintile association was seen in age (p = .549), hypertension (p = .061), atrial fibrillation (p = .801), or heart failure (p = .305). CONCLUSIONS: This study supports that sMVAP scores are associated with OSA-risk in the elective surgery patient population. It is not inferior to STOP-BANG and considering its symptomless use, could be easily integrated into preoperative screening for OSA-risk. CLINICAL IMPLICATIONS: Further study in the validation of sMVAP in a larger group of elective surgical patients is warranted and may facilitate efficient preoperative screening. DISCLOSURES: no disclosure on file for Meena Khan; No relevant relationships by Weerapong Lilitwat, source=Web Response no disclosure on file for Melanie Lyons; No relevant relationships by Barbara Rogers, source=Web Response No relevant relationships by yuttiwat vorakunthada, source=Web Response

Patient factors associated with difficult flexible bronchoscopic intubation under general anesthesia: a prospective observational study.

Patient characteristics associated with difficult tracheal intubation using a flexible bronchoscope (FB) under general anesthesia have not been prospectively evaluated. This observational study aimed to identify demographic and morphologic factors associated with difficult FB intubation. We recruited 420 adult elective surgery patients undergoing tracheal intubation during general anesthesia. Patients characteristics were recorded including age, sex, weight, height, body mass index, American Society of Anesthesiologists physical status, history of snoring, obstructive sleep apnea, Mallampati score, upper lip bite test score, neck circumference and skinfold thickness, maximal neck flexion and extension angles, absence of teeth, Cormack and Lehane grade, presence of blood or secretions during intubation, as well as the inter-incisor, thyromental, sternothyroid, and manubriomental distances. The time (duration) needed to complete intubation (primary endpoint) and the number of attempts needed were correlated with these patient characteristics in a multivariable analysis. Intubation was successful on the first attempt in 409/420 patients (97%). Seven patients (1.7%) needed more than one attempt. Failure to intubate with the FB occurred in four patients (1%). A correlation was found between intubation duration and visibility impaired by secretions or blood (P < 0.001), higher neck skinfold thickness (P < 0.001), and larger endotracheal tube diameter (relative to a constant 5.5 mm FB; P < 0.001). The presence of secretions or blood that impair FB glottic visualization, a larger diameter endotracheal tube on the same size FB, as well as higher neck skinfold thickness may prolong the duration of FB intubation under general anesthesia. www.clinicaltrials.gov (NCT02769819); registered 5 May, 2016.

Analysis of interviews to uncover the effects of nurse prescribing on the doctor-nurse relationship

Objective: The introduction of nurse prescribing has had a profound effect on how patients obtain a prescription. Yet very little has been researched about the effects of nurse prescribing on the professional relationship between nurses and doctors since its introduction. It was this lack of enquiry that led to this research study to see if this relationship has changed since the introduction of the nurse prescriber. Design methods: A purposeful sample approach was chosen, interviews were undertaken using a semi-structured method and interpretative phenomenological analysis was used to analyse the data. Setting: A large teaching hospital in the north west of England. Subjects: Four nurse prescribers and four doctors working in orthopaedics, breast surgery or urology looking after adult elective surgery patients. Main outcomes: What emerged from this study is a complex pattern of readjustment within this relationship. The power once enjoyed by the medical profession is now challenged by the introduction of the nurse prescriber. A number of themes emerged around the topics of prescribing, relationship, educational and communication. Each help to focus how this change manifests itself in the relationship and how it needs to evolve if the maximum benefit from nurse prescribing is to be achieved. Conclusions: What has emerged from this research is how complex the relationship between the nurse prescriber and doctor really is. The power to prescribe medication that was once the sole preserve of the medical profession is now shared with the nurse prescriber. But this shared authority remains unequal; the medical profession remains at least unwilling to give up its position of control just yet, but the dialogue has begun.

Nutritional status and nosocomial infections among adult elective surgery patients in a Mexican tertiary care hospital.

BackgroundControversy exists as to whether obesity constitutes a risk-factor or a protective-factor for the development of nosocomial Infection (NI). According to the obesity-paradox, there is evidence that moderate obesity is a protective-factor. In Mexico few studies have focused on the nutritional status (NS) distribution in the hospital setting.ObjectivesThe aim of this study was to estimate the distribution of NS and the prevalence of nosocomial infection NI among adult elective surgery (ES) patients and to compare the clinical and anthropometric characteristics and length of stays (LOS) between obese and non-obese patients and between patients with and without NI.MethodsWe conducted a cross-sectional study with a sample (n = 82) adult ES patients (21–59 years old) who were recruited from a tertiary-care hospital. The prevalences of each NS category and NI were estimated, the assessments were compared between groups (Mann-Whitney, Chi-squared or the Fisher's-exact-test), and the association between preoperative risk-factors and NI was evaluated using odds ratios.ResultsThe distribution of subjects by NS category was: underweight (3.66%), normal-weight (28.05%), overweight (35.36%), and obese (32.93%). The prevalence of NI was 14.63%. The LOS was longer (p<0.001) for the patients who developed NI. The percentages of NI were: 33.3% in underweight, 18.52% in obese, 17.39% in normal-weight, and 6.90% in overweight patients.ConclusionThe prevalence of overweight and obesity in adult ES patients is high. The highest prevalence of NI occurred in the underweight and obese patients. The presence of NI considerably increased the LOS, resulting in higher medical care costs.

Thenar-Eminence Grip Is Better Than the E-C Clamp Grip for Mask Ventilation

In a study of novice operators, tidal volumes were greater with the thenar-eminence grip. A prior study showed that anesthesiologists perform bag-valve mask ventilation better with the two-handed thenar-eminence (TE) technique than with the one-handed E-C clamp (EC) grip taught by the American Heart Association (JW Emerg Med Oct 29 2010), but is this true for novice operators also? Researchers enrolled 59 medical and paramedic students to perform facemask ventilation on apneic adult elective surgery patients using both grips in random order. An oropharyngeal airway was placed and students performed each technique for 60 seconds, while an attending anesthesiologist ventilated the patient. The overall mean tidal volume achieved was similar for the TE–EC and EC–TE sequences (326 and 321 mL). On average, students achieved an additional 110 mL of tidal volume with the TE grip. There were fewer failures with the TE grip (mean, 0.9 vs. 2.4 per 12 breaths). Four students failed to obtain a measureable tidal volume with both grips, and three failed with the EC grip only. Comment: The EC grip requires only one hand, so is easier for a single operator than the TE grip, but in all other regards, the TE grip is superior. When possible, operators should use the TE grip as the method of first choice for bag mask ventilation.

Standard Flexible Fiberscope Superior to Ambu aScope 2

The Ambu aScope 2 is a new inexpensive, single-use, flexible video endoscope. To compare performance of the aScope 2 and a standard reusable fiberscope, researchers randomized 100 healthy adult elective surgery patients to intubation with either device by a single experienced anesthetist. A semirigid cervical collar was placed on all patients to simulate a difficult …

Postoperative pulmonary complications in adult elective surgery patients in the US: severity, outcomes and resources use

Postoperative pulmonary complications (PPCs) are associated with adverse outcomes and added resource use. However, PPCs vary in severity, and so may have very different outcomes.

Benefits of Preoperative Education for Adult Elective Surgery Patients

Patient education is a major concern for perioperative nurses in an ambulatory surgery setting. It has proven difficult to develop formal preoperative teaching programs in this environment, but research has shown that preoperative education can improve patient outcomes and satisfaction with the surgical experience. Typical patient education consists of pamphlets that are given to the patient before surgery and verbal instructions from the physicians and nurses on the day of surgery. Ideally, preoperative patient education should begin in the surgeon's office, continue through preadmission testing, and be completed at admission. Having a well-designed preoperative education program enables perioperative nurses in ambulatory surgery centers to provide a thoughtful approach to perioperative teaching in a limited time. AORN J 90 (September 2009) 381-387. (c) AORN, Inc, 2009.

Improved esophageal patency when inserting the ProSeal™ laryngeal mask airway with an Eschmann™ tracheal tube introducer

We hypothesized that a more accurate alignment of the tip of the drain tube with the upper esophageal opening would be achieved in adult patients, as confirmed by fibreoptic bronchoscopy, by placing the ProSeal laryngeal mask airway (PLMA) by means of guiding it over an Eschmann tracheal tube introducer, commonly know as a gum elastic bougie (GEB), that was previously inserted into the esophagus, rather than by placing the PLMA with a curved metal introducer (IT). Seventy-five adult elective surgery patients, whose airway management involved a PLMA, were randomly allocated to either the GEB- or IT-guided techniques. After inserting the PLMA, alignment of the tip of the drain tube relative to the esophageal opening was verified by a fibrescope introduced through the drain tube. Placing the fibrescope through the PLMA identified the glottic structures. The primary endpoint indicating the proper alignment of the tip of the drain tube of the PLMA with the upper esophageal opening was the ability to pass the fibrescope into the esophagus through the drain tube by a distance >35 cm without obstruction and the ability to simultaneously visualize the esophageal mucosa. The overall success rates of PLMA insertion were similar in the GEB and IT groups. However, the mean airway insertion times were longer with the GEB than with the IT-PLMA. The GEB group achieved proper alignment of the drain tube and the upper esophageal opening more frequently than the IT group (97% confidence interval (CI(95)) 91.5-100% vs 81% CI(95) 68.5-93.5% of subjects, respectively; P = 0.027). When the GEB was used to place the PLMA, the patients' vocal cords were visualized more frequently than when the IT technique was used (100% vs 73% CI(95) 58.9-87.1% of subjects, respectively; P = 0.003). Fibreoptic bronchoscopy confirmed that GEB is superior to the IT technique in ensuring precise alignment of the tip of the drain tube of the PLMA with the upper esophageal opening. Accurate positioning may better preserve gastroesophageal drainage function of the PLMA.