Intraoperative Phase Research Articles

Family involvement in perioperative nursing of adult patients undergoing emergency surgery.

The purpose of this study was to describe how adult patients undergoing emergency surgery experience family centredness in perioperative nursing practice. The central aim was to generate knowledge to be used while developing the practice, education and management of perioperative nursing. Data were collected using a questionnaire with emergency surgical patients in five regional hospitals in Southern Finland. The number of distributed questionnaires was 132. The response rate was 85% (n = 112). The results were mainly described as frequencies and percentages. The open-ended sections of the answers were analysed using qualitative content analysis. The findings from the open-ended questions were used for deepening and complementing the quantitative description of the results. In the preoperative phase, ascertaining the family situation and informing the family member chosen by the patient were not achieved systematically. Family situation was also rarely examined in the intraoperative and postoperative phases, although it is central to coping after surgery, especially in home care. The results support the view of earlier research about the importance of individuality of patients and their families during the perioperative care process and hence enhance the endeavour to develop nursing based on families' real needs.

Family involvement in perioperative nursing of adult patients undergoing emergency surgery

• The purpose of this study was to describe how adult patients undergoing emergency surgery experience family centredness in perioperative nursing practice. The central aim was to generate knowledge to be used while developing the practice, education and management of perioperative nursing.• Data were collected using a questionnaire with emergency surgical patients in five regional hospitals in Southern Finland. The number of distributed questionnaires was 132. The response rate was 85% (n=112).• The results were mainly described as frequencies and percentages. The open‐ended sections of the answers were analysed using qualitative content analysis. The findings from the open‐ended questions were used for deepening and complementing the quantitative description of the results.• In the preoperative phase, ascertaining the family situation and informing the family member chosen by the patient were not achieved systematically. Family situation was also rarely examined in the intraoperative and postoperative phases, although it is central to coping after surgery, especially in home care.• The results support the view of earlier research about the importance of individuality of patients and their families during the perioperative care process and hence enhance the endeavour to develop nursing based on families’ real needs.

The current scope and future direction of perioperative nursing practice in Victoria, Australia.

The current scope and future direction of perioperative nursing practice in Victoria, Australia Unlike some overseas countries, perioperative nursing roles in Australia are largely undeveloped, and very little research has explored the opinions of perioperative nurses regarding the development of their specialty. This study was undertaken to identify the current scope, possible future directions, and the barriers to developing perioperative nursing practice in the state of Victoria (Australia). The study design was descriptive and utilized survey methodology. An instrument was constructed by the researcher for the specific purposes of the study, and comprised three stages of development: questionnaire development; validation by a panel of experts; and a pilot study. The questionnaire was sent randomly to selected perioperative nurses (n=224) and a response rate of 79% (n=176) was obtained. Data were analysed using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics were used to summarize data, and independent sample t-tests, one-way ANOVA and Wilcoxon signed rank tests were used to test differences between groups. For the purpose of data reduction factor analysis was undertaken. The findings of the study indicated that the perioperative nursing model in its espoused form is not being practised, but a large majority of participants believe that perioperative nursing practice should not be restricted to the intraoperative phase of the perioperative model. Expanded rather than extended activities and functions were perceived as more important for development of the specialty, and perceived barriers to advanced perioperative nursing practice centred predominantly on the current application of the perioperative model. Recommendations include refinement of the perioperative nursing model to reflect changes in the delivery of healthcare, addressing issues of cost associated with further education, and undertaking interpretive research to provide more detailed information on the possible future direction for perioperative nursing.

Sentinel node biopsy and ultrasound scanning in cutaneous melanoma: clinical and technical considerations

The aim of this study was to discuss the role of preoperative ultrasound (US) scanning and sentinel node biopsy (SNB) in melanoma patients. 100 patients underwent SNB following preoperative US scan and lymphoscintigraphy; patent blue dye (PBD) was injected before biopsy. Intra-operative lymphoscintigraphy (IL) was performed in 51 basins. All nodes were examined with histology and immunohistochemistry. Sensitivity and specificity of US scanning was 33% and 100%, respectively; 7% were true positives. The low sensitivity was mainly due to the resolution power of the US scanner (2 mm) which was unable to identify all the patients with microdeposits. PBD associated with IL identified SNs in all cases. In all patients with Breslow >1.5 mm and in all cases with two metastatic SNs, further positive additional nodes were found. The mean counts per 10 s (CP10S) ratio for SN and non-SN values was 5.62 (1.29–23.51) and 3.09 (1.03–10.99) in the intra-operative and extra-operative phases, respectively. US scanning and preoperative lymphoscintigraphy associated with PBD allows preoperative patient selection and accurate SN(s) identification. Breslow thickness and the number of metastatic SN(s), but not their type, are correlated with disease spread; CP10S contributed to the differentiation amongst the nodes and the determining of procedure's completion.

Research in peri-operative nursing care.

This review analyses 97 research reports dealing with peri-operative care which included patients. The literature review was done as the basis of a development project to measure the quality of intra-operative nursing care from the patient's perspective. The pre-operative phase provides information about the teaching, anxiety and stress of patients. Few sources dealt with the intra-operative phase; there were a small amount of reports concerning concrete nursing activities (e.g. surgical position and warming the patient). The most information was available on the post-operative phase, such as recovery, adaptation and the treatment of pain. Peri-operative research is mainly concerned with the quality of nursing care, control of life and ambulatory surgery. The main defects of analysed studies can be characterized as follows: small samples and a single hospital, lack of definition of terms, theoretical ambiguity, short follow-up times, anaesthetic or other drugs used during the care not mentioned in the report (especially in studies on pain and quality). Previously developed research tools had usually been well tested, but there was great variety in the testing of investigator-constructed tools. There were also discrepancies in the evaluation of validity and reliability. Future research should especially deal with treatment of pain and anxiety, information and guidance given to patients, and the costs of surgical care; there is also a need for studies dealing with intra-operative care from the patient's perspective. Although information is already available on the above mentioned topics, more detailed and comprehensive facts are still needed.

Decreasing Surgical Risks for Patients with Obstructive Sleep Apnea

The prevalence of obstructive sleep apnea (OSA) has only recently been appreciated, in part because the signs and symptoms of OSA were previously overlooked. The identification of this disorder is extremely important before surgery to allow appropriate airway management. This article presents a brief overview of sleep apnea, its symptoms, and potential consequences. Nursing interventions are given for the preoperative, intraoperative, and postoperative phases. A resource list of agencies and internet sites that reference OSA is included for additional information.

Cost-Effective Management of High-Risk Patients: A Case-Map Approach

Background. The case-management approach to patient care used by most cardiac surgical practices frequently highlights patients designated as high-risk. Increased risk might be because of advanced age, the need for complex reoperations, high risk of bleeding, and renal failure, all of which may be superimposed on poor ventricular performance. Methods. A small consensus panel of cardiac surgeons, anesthesiologists, perfusionists, cardiac-care nurse managers, and coagulation experts met to assess the potential for development of case-management pathways targeted towards high-risk coronary artery bypass graft patients. The process comprised review of the literature to identify risk factors and strategies most cost-effective in reducing risk. Results. A series of management strategies driven by data from the literature—or by consensus when such information was not available—were developed to cost-effectively manage the high-risk patient. The process was then converted to a multidimensional computer program. This personal computer-driven program served as a framework upon which any institution could impose its own practice style and modify recommendations. The program was designed to be interactive and to allow easy transition from patient-management strategies to support data. A facilitator generally coordinates the interaction between the local patient-care group and the computer information base to evolve a case-management map. Conclusions. By using stored information based on current literature and easily updated, the system is both educational and product oriented, and provides a case-map approach to the cost-effective management of patients during the preoperative, intraoperative, and postoperative phases of hospital care.

Competency Validation for Cross-training in Surgical Services

Cross-training is a cost-effective means of maximizing the potential of staff members and available resources. The responsibility to provide quality patient care should not be compromised by cross-training efforts. Surgical services department staff members at Deaconess-Nashoba Hospital, Ayer, Mass, developed a competency validation project for nurses involved in the cross-training program. They accomplished this by implementing current nursing standards and practices and promoting continuity of patient care through the preoperative, intraoperative, and postoperative phases. Perioperative nurses and health care facilities have the responsibility to provide safe, effective, and efficient care to all patients. By assessing competencies for perioperative nurses, staff members can enhance their commitment to caring for their profession and their communities.

Exploring ethical dilemmas in perioperative nursing practice through critical incidents.

This article describes the nature of ethical dilemmas in perioperative nursing practice. Using the Critical Incident Technique, common ethical dilemmas experienced by perioperative nurses are explored. The aim of the study was to elicit the ethical dilemmas that arise in perioperative nurses' practice. The study has a descriptive design and the data are critical incidents described by 48 anaesthetic nurses and 76 operating theatre nurses. An analysis of the critical incidents gave four domains of ethical dilemmas: those arising as value conflicts in the intraoperative phase of surgery; those emanating from the patient's right of self-determination; those arising in caring for patients; and those resulting from the allocation of scarce resources and the demands of increased effectiveness.

Development of a Perioperative Nursing Diagnoses Flow Sheet

Traditionally, health care professionals in the preoperative, intraoperative, and postoperative phases of care have used perioperative records that focus on the technical aspects of the care provided (eg, blood pressure, pulse measurements; equipment used) and leave room for only short narratives to document nursing care. Such formats often do not document the multitude of activities or interventions perioperative nurses provide. The question raised at the DePaul Health Center, St Louis, was: "Where do we document our nursing diagnoses and plan of care?" The response was to create a nursing diagnosis task force that investigated the feasibility of a form professional nurses could use in all phases of patient care. This investigation led to the development, implementation, and universal use of a perioperative nursing diagnoses flow sheet within the surgical services department.

A prospective randomized clinical trial of liver preservation using high-odium versus high-potassium lactobionate/raffinose solution

High-sodium as opposed to high-potassium lactobionate/raffinose preservation solution offers potential advantages in improving the quality of liver storage by reducing potassium-induced vasoconstriction and preventing hyperkalaemia on reperfusion. In our study we evaluated in a prospective trial (encompassing 40 consecutive cadaver donor hepatic retrievals and subsequent transplants) the efficacy of a high-sodium formulation versus the standard high-potassium solution. Quality of preservation was assessed by clinical indices of liver function in the intraoperative and early postoperative phases, including measurements of requirements for blood and blood products and potassium, circulating liver enzymes and bilirubin. Frequencies of acute rejection episodes and primary non-function were also recorded. No significant differences were evident in any of the measured parameters. Thus a sodium-based solution can be used for hepatic preservation, advancing the possibility that it may be possible to develop a single storage solution for clinical multi-organ donor operations.

Bioimpedance Hemodynamics Compared to Pulmonary Artery Catheter Monitoring during Orthotopic Liver Transplantation

Simultaneous cardiac output measurements were obtained using bioimpedance (BI) and thermodilution (TD) methods in 10 patients undergoing orthotopic liver transplantation (OLT). BI and TD data were collected during five intraoperative phases of OLT. Linear regression revealed significant correlation between BI and TD ( r = 0.8, P = 0.001) with a slope of regression of 0.64. Bias analysis demonstrated a negative of BI (-0.26) when compared with TD. S - vO 2 correlated poorly with cardiac index determined by TD ( r = 0.41) or BI ( r = .47). BI is an accurate reproducible method for measuring cardiac output and may be a useful adjunct to the pulmonary artery catheter for hemodynamic monitoring during OLT.

Should You Cancel the Operation When a Child Has an Upper Respiratory Tract Infection?

Cancelling an operation when a child has an upper respiratory tract infection (URI) is not always feasible or practical. Yet we know very little about the additional risk posed by a URI occurring in a child undergoing anesthesia and surgery. Using a large prospectively collected pediatric anesthesia database, we studied 1283 children with a preoperative URI and 20,876 children without a URI. We found that children with a URI were two to seven times more likely to experience respiratory-related adverse events during the intraoperative, recovery room, and postoperative phases of their operative experience. Although these children also experienced significant disruptions in temperature regulation, they were not at risk for any other deleterious events. The elevation in risk after URI as compared with children without a URI was not explained by differences in age, physical status scores, surgical site, and emergency or elective status. However, if a child had a URI and had endotracheal anesthesia, the risk of a respiratory complication increased 11-fold (95% confidence intervals 6.8, 18.1). We conclude that the administration of general anesthesia to children with a URI is not benign and that these children require more observation/management in all perioperative phases of their surgical procedure.

Intraoperative and postoperative biliary endoscopy (choledochoscopy).

The majority of choledocholithiasis patients still require surgery. If the stones are removed, the patient is cured. With modern cholangiography, the anatomy and the location of the calculi can be immediately identified at the beginning of the operation. In 6% of cases, anomalies of surgical importance are detected. The general surgeon is not an endoscopist and therefore, choledochoscopy is used infrequently. The introduction of video techniques changed this pattern because the learning curve is shorter and the procedure is easier and faster to perform with a higher success rate. A permanent (objective) record of the findings and the visualization of the sphincter location and function is an added bonus. If a stone is missed and the T-tube is inserted in the proper fashion, the same video choledochoscope which is employed in the intraoperative phase can be used in the postoperative period. In our experience (108 cases) we had a success rate of 98%. It can be performed on an outpatient basis. The surgeon should be acquainted with intraoperative and postoperative biliary endoscopy to improve the final outcome of this common and important surgical procedure.

The Blalock-Taussig Shunt: An Analysis of Trends and Techniques in the Fourth Decade

The original description of the Blalock-Taussig shunt was published in 1945 and represented the first direct surgical procedure for the treatment of cyanotic congenital heart disease. The present study analyzes the results of Blalock-Taussig shunts performed at Duke University Medical Center during the fourth decade since the original description of the procedure. From 1975 to 1984, 53 classic and 24 modified Blalock-Taussig shunts were performed with a hospital mortality of 8%. These deaths occurred in critically ill patients with either pulmonary atresia or complex congenital cardiac lesions. The results of the early group (1975-1979) were compared to the late group (1980-1984) of patients. There was a greater proportion of infants less than 1 week of age in the late group, and the actuarial event-free shunt survival following operation was significantly better in the late group. This improvement in the late group was apparent both in patients receiving classic and modified Blalock-Taussig shunts and probably represents the effects of advances in microsurgical technique as well as improvement in the support of critically ill infants at the time of surgery by pediatric anesthesiologists and neonatologists. The data in the present study indicate that the mortality associated with Blalock-Taussig shunting is related to the condition of the patient at the time of surgery and the underlying cardiac pathology rather than the age of the patient at the time of shunting. The efforts to further reduce morbidity and mortality associated with Blalock-Taussig shunting should therefore be directed primarily to the support of infants during the preoperative and intraoperative phases of care.

Perioperative Nursing Research: Part IV: Intraoperative Phase

AORN JournalVolume 49, Issue 5 p. 1397-1399 Research Perioperative Nursing Research Part IV: Intraoperative Phase Barbara K. Bailes RN, Barbara K. Bailes RNSearch for more papers by this author Barbara K. Bailes RN, Barbara K. Bailes RNSearch for more papers by this author First published: May 1989 https://doi.org/10.1016/S0001-2092(07)70118-7Citations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume49, Issue5May 1989Pages 1397-1399 RelatedInformation

Silent myocardial ischemia in patients undergoing peripheral vascular surgery: Incidence and association with perioperative cardiac morbidity and mortality

Atherosclerosis is a systemic disorder and coronary artery disease is highly prevalent in patients treated for lower-extremity obstructive vascular disease. Myocardial ischemia and infarction represent the most frequent and most clinically important complications of surgical procedures for lower-extremity revascularization. Despite attempts in several areas, no practical, sensitive, and specific method for identifying patients at highest risk for myocardial events postoperatively has been found before now. This study reports observations on a consecutive series of 50 patients who underwent continuous perioperative electrocardiographic monitoring with a microprocessor-based electrocardiographic ischemia monitor. Thirty-eight percent of the patients were found to have episodes of ischemia; most of these episodes were painless and would not otherwise have been recognized. Ischemia was most prominent in the postoperative rather than the preoperative or intraoperative phases. Tachycardia was often associated with ischemia. Significantly more cardiac-related morbidity and deaths occurred in patients who were documented to have silent myocardial ischemia. In fact, no cardiac events occurred in the 31 patients without ischemia (p < 0.02). This type of ischemia monitoring represents a potential method for segregating patients at high risk for cardiac-related morbidity and death during lower-extremity revascularization.

Studies on coagulation, fibrinolysis, kallikrein-kinin and complement activation in systemic and pulmonary circulation during hip arthroplasty with acrylic cement

This study was designed to evaluate the contribution of the plasma cascade systems to the cardiopulmonary complications, occasionally leading to sudden death during hip arthroplasty using acrylic cement. The intraoperative pattern following uneventful surgery was therefore investigated in 8 patients with osteoarthrosis with frequent sampling from the radial and pulmonary arteries. The following general findings emerged: A gradual consumption of coagulation factors (platelets, fibrinogen, factor VII, antithrombin III), fibrinolytic components (plasminogen, alpha-2-antiplasmin), kallikrein-kinin factors (prekallikrein, kallikrein inhibitor) and complement factors (C3c, C4) was observed. Some intrapulmonary proteolytic inhibition was noticed as evidenced by lower arterial than mixed venous blood levels of alpha-2-antiplasmin and kallikrein inhibitor. Insignificant changes occurred for factor VII-phospholipid complex. A rapid, massive and transient increase in fibrinopeptide A (FPA) values in the radial artery, as opposed to the moderate increase in the pulmonary artery, was found immediately after reaming and broaching of bone. This probably reflected intrapulmonary fibrinogen to fibrin conversion, reaching a maximum 15–20 minutes before the femoral implantation. As estimated from the FPA arterial peak values and the fall in fibrinogen concentrations, approximately 5–10% of the circulating fibrinogen molecules were devoided of EPA during this intraoperative phase. The marked a-9 difference in FPA level supports earlier findings of intrapulmonary fibrin formation and deposition. This process, however preceded the critical period of cardiorespiratory collapse (CRC) by at least 15 minutes, and may thus predispose to this complication.

Intraoperative nursing activities: How do they compare with basic competencies

This study was done to describe the behaviors, activities, and cognitive functions of the registered nurse during the intraoperative phase of surgery and to categorize and compare the observed activities with AORN's Statements of basic competency for perioperative nursing. Fifteen randomly selected operating room nurses were observed for more than 210 hours during the intraoperative phase of surgery. Observations were recorded as observed activities and quotations. They were categorized by the coded Statements of basic competency for perioperative nursing. Further categorization was done to determine which basic competencies reflected nursing behaviors, activities, and cognitive functions. Additional data were collected using interviews and questionnaires. This study provided empirical evidence that a small sample of operating room nurses demonstrated most of the basic competencies. It also described the nursing behaviors, activities, and cognitive functions observed during the intraoperative phase of surgery.

Anaesthesia for cardiac patients having non-cardiac operations

It is difficult to pick out a sensitive marker for the effectiveness with which patients with heart disease have been managed for non-cardiac operations. Reinfarction rates have frequently been cited for this purpose over the past 20 years and it is interesting and perplexing that, until very recently, we have been unable to show significant decreases in reinfarction rates in patients who have had a myocardial infarction within six months of surgery. It has been our opinion for a number of years that, in general, patients with heart disease are well managed in the intraoperative phase of their hospital stay. The successful management of patients during this period is based on the fact that the majority of anaesthetists now appear to have a good understanding of the pathophysiology of heart disease and are becoming more aggressive in the monitoring and treatment of abnormal haemodynamics when they occur. The ultimate extent to which morbidity and mortality can be reduced in patients with heart disease for non-cardiac surgery will not be known until patients at high risk receive the same intensive postoperative care that patients who undergo heart surgery enjoy. It is the fact that patients are haemodynamically stable and do not have myocardial ischaemia throughout the peri-operative period that is important, rather than the way in which it is achieved.