Perioperative Role Research Articles

Current understanding of the literate versus illiterate patient's knowledge about anesthesiologists: A comparative study.

Context:There is a widespread ignorance among the public about the role of anesthesiologists and their responsibilities inside or outside the operating room both in developed and developing countries.Aims:The present study was conducted to assess the knowledge of literate and illiterate patient about the role of anesthesiologists and their concerns regarding anesthesiology.Setting and Design:This is a prospective study conducted in a preoperative anesthetic clinic of a large tertiary care hospital. The study consisted of a standard preanesthetic interview and questionnaire.Materials and Methods:After obtaining permission from the Ethics committee, patients in the age group 18–75 years of either sex undergoing elective surgery were included. The patients were divided into two groups on the basis of their education: Group A: included patient who are illiterate; Group B: included patients who are literate, completed a questionnaire, which was later evaluated.Statistical Analysis Used:Unpaired t test and correlation r test were used.Results:There was limited knowledge among both literates and illiterates regarding the perioperative role of anesthesiologists. They wanted to be fully explained about the anesthesiology technique and were keen to meet their anesthesiologist both before and after the surgery.Conclusion:To eliminate the ignorance among general public regarding the role of anesthesiologists, efforts must be made to educate and generate awareness among the population.

180. The peri-operative role of the anti-neoplastic agent taurolidine in colon cancer: a prospective multicentre randomised clinical trial

Background: Residual micro-metastases at the time of tumour resection show an accelerated metastatic growth pattern secondary to the systemic inflammation-stimulatory effects of surgery which significantly augments tumour recurrence. The aim of this study is to examine the effect of the anti-neoplastic agent taurolidine on the processes involved in surgery induced tumourigenesis.

Perioperative Role of Methadone in Adolescent Patients

Perioperative Role of Methadone in Adolescent Patients

Innovative Perioperative Role Improves Patient and Organisational Outcomes in Minimal Invasive Surgery

The drive to improve clinical care and productivity in the NHS has required an innovative approach in the use of the resources and skills of the workforce. With rapidly evolving technology, surgical and anaesthetic techniques, concentration is increasingly being placed on improving patient focused pathways, aiming to return patients back to normal activities as soon as possible. The article highlights the exciting new perioperative role developed at University Hospitals Coventry and Warwickshire (UHCW) NHS Trust in the care of patients undergoing laparoscopic cholecystectomy. It includes the history and development of the post and its current impact in improving the care of patients.

Preoperative Atorvastatin Treatment in CABG Patients Rapidly Improves Vein Graft Redox State by Inhibition of Rac1 and NADPH-Oxidase Activity

Statins improve clinical outcome of patients with atherosclerosis, but their perioperative role in patients undergoing coronary artery bypass grafting (CABG) is unclear. We hypothesized that short-term treatment with atorvastatin before CABG would improve the redox state in saphenous vein grafts (SVGs), independently of low-density lipoprotein cholesterol (LDL)-lowering. In a randomized, double-blind controlled trial, 42 statin-naïve patients undergoing elective CABG received atorvastatin 40 mg/d or placebo for 3 days before surgery. Circulating inflammatory markers and malondialdehyde (MDA) were measured before and after treatment. SVG segments were used to determine vascular superoxide (O(2)(*-)) and Rac1 activation. For ex vivo studies, SVG segments from 24 patients were incubated for 6 hours with atorvastatin 0, 5, or 50 μmol/L. Oral atorvastatin reduced vascular basal and NADPH-stimulated O(2)(*-) in SVGs (P<0.05 for all versus placebo) and reduced plasma MDA (P<0.05), independently of LDL-lowering and of changes in inflammatory markers. In SVGs exposed to atorvastatin ex vivo, without exposure to LDL, basal and NADPH-stimulated O(2)(·-) were significantly reduced (P<0.01 for both concentrations versus 0 μmol/L) in association with a striking reduction in Rac1 activation and 1 membrane-bound Rac1 and p67(phox) subunit. The antioxidant effects of atorvastatin were reversed by mevalonate, implying a dependence on vascular HMG-CoA reductase inhibition. Short-term treatment with atorvastatin 40 mg/d before CABG improves redox state in SVGs, by inhibiting vascular Rac1-mediated activation of NADPH-oxidase. These novel findings suggest that statin therapy should be maintained or initiated in patients undergoing CABG, independently of LDL levels. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01013103.

Perioperative Role Development: Evaluating a Fast-Track Approach to Advanced Scrub And/Or Dual Role Practitioner Training

This report describes the service evaluation of a newly developed fast-track advanced scrub practitioner (ASP)/dual role training programme. The evaluation examines whether the introduction of new policies and training based on risk assessment have strengthened quality assurance measures and controls which aim to ensure that staff work safely within their scope of practice. A further aim is to establish if the fast-track route is adequately meeting the training and development needs of staff within the organisation and supporting service requirements.

Evolving Perioperative Roles: Nicety or Necessity?

In recent years we have experienced considerable interest in new roles but since the demise of the National Practitioner Programme (England) in 2007, much has gone quiet. NHS Education Scotland (NES) continues with the Physician Assistant pilots and there is evidence of developments at individual SHA level, but nothing like the activity we observed through 2005-2007. However the commitment to secure significant service transformation is predicated on the future workforce engaging differently and in new ways.

An internist's role in perioperative medicine: a survey of surgeons' opinions

BackgroundLiterature exists regarding the perioperative role of internists. Internists rely on this literature assuming it meets the needs of surgeons without actually knowing their perspective. We sought to understand why surgeons ask for preoperative consultations and their view on the internist's role in perioperative medicine.MethodsSurvey of surgeons in Saskatoon, Saskatchewan, Canada regarding an internist's potential role in perioperative care.ResultsFifty-nine percent responded. The majority request a preoperative consultation for a difficult case (83%) or specific problem (81%). While almost half feel that a preoperative consultation is to "clear" a patient for surgery, 33% disagree with this statement. The majority believe the internist should discuss risk with the patient. Aspects of the preoperative consultation deemed most important are cardiac medication optimization (93%), cardiac risk stratification (83%), addition of β-blockers (76%), and diabetes management (74%).ConclusionSurgeons perceive the most important roles for the internist as cardiac risk stratification and medication management. Areas of controversy identified amongst the surgeons included who should inform the patient of their operative risk, and whether the internist should follow the patient daily postoperatively. Unclear expectations have the potential to impact on patient safety and informed consent unless acknowledged and acted on by all. We recommend that internists performing perioperative consults communicate directly with the consulting physician to ensure that all parties are in accordance as to each others duties. We also recommend that the teaching of perioperative consults emphasizes the interdisciplinary communication needed to ensure that patient needs are not neglected when one specialty assumes the other will perform a function.

The Perioperative Role of Duplex Venous Scanning in Endovenous Laser Therapy

Varicose veins that emerge as a result of the venous valvular incompetence of the great saphenous vein (GSV) are a common chronic condition affecting millions of people. When invasive treatment is necessary, surgical removal of the GSV and varicosities has been the standard procedure to relieve symptoms. Recent advances in laser technology have resulted in endovenous laser therapy as an alternative to open surgery by ablating the GSV. Duplex venous ultrasound is a critical part of preoperative planning, intraoperative safe execution of the procedure and postoperative care. It is necessary that the vascular surgeon and the sonographer work in tandem and have experience in intraoperative duplex venous scanning to achieve an optimal outcome.

Expanding the perioperative role. The surgeon's assistant.

The role of Surgeon's Assistant continues to be a contentious issue within the perioperative environment. Questions arise as to whether theatre nurses both want to and ought to extend their role into the medical margins. Suzanne Boss surveys the literature and draws preliminary conclusions on this development in nursing practice. This article was submitted in entry for the Alison Bell Writer's Competition 2001.

Perioperative autologous blood donation in children

Autologous blood donation in children has become a standard of care. Children have to live with the life-time complications associated with allogeneic blood including the transmission of known and unknown pathogens, and the impact of alloimmunization on future blood transfusions, organ transplants and pregnancies. Donor reaction, allogeneic exposure and utilization rates in pediatric preoperative autologous donation (PAD) programs are as good if not better than reported in adult literature. Children are very resilient when undergoing extreme isovolemic hemodilution (IHD). PAD, IHD and intraoperative blood recovery appear to be useful components of a pediatric blood conservation program. Prospective, randomized studies addressing the specific needs of children are required to properly define their perioperative role.

Developing Clinical Learning Sites for Undergraduate Nursing Students

As health care continues to evolve and take on new shapes, perioperative procedures more often are occurring in nonhospital settings and with fewer opportunities for nursing intervention. Believing that nursing education must prepare nurses at the undergraduate level to provide quality and meaningful perioperative care, nursing specialists and educators at Emory University, Atlanta, developed two new clinical learning sites that allow undergraduate nursing students to learn from preceptors in advanced perioperative roles. These learning sites encourage students to develop and use critical thinking skills that are imperative to perioperative care.

RN First Assistants Expand Their Perioperative Role

At the Cleveland Clinic Foundation, the RN first assistant (RNFA) role has expanded to include radial artery (RA) harvesting for coronary artery bypass surgery. This new role encompasses preoperatively assessing the RA with the Allen's test and perfusion index; intraoperatively removing the RA, dissecting the RA as a pedicle, and maintaining hemostasis and wound closure; and postoperatively collaborating with the postoperative muse clinician during patient care and management in the intensive care unit. This article outlines the RNFA's expanded role in this detailed surgical procedure.

Surgeons' assistants: a new role for operating theatre nurses?

In the current climate of changing nursing and medical roles, discussions about the role of the operating theatre nurse have been rekindled, with particular emphasis being placed on the role of the nurse as 'assistant' to the surgeon. This article examines perioperative roles and identifies and discusses the factors that have stimulated their development. It is argued that these roles are not necessarily new and that their recent re-emergence may have as much to do with the sustained drive to reduce junior doctors' hours as the need to enhance the quality of patient care. However, they may offer operating theatre nurses clearer direction and purpose to practice. Provided they can improve the quality of patient care and are given careful consideration, they may prove to be an opportunity worth exploiting.

Enteral nutrition after surgery

Perioperative nutritional support, whether by the enteral or parenteral route, remains controversial. Its efficacy in many circumstances is unproved and the indications for using it are unclear. Nutritional support can be expensive and is not without complications. Its use must therefore be shown to improve outcome in terms of improved survival, reduced complication rates, decreased hospital stay, or improved quality of life. While several studies have evaluated the use of perioperative parenteral nutrition, few have examined the perioperative role of enteral feeding. In this issue of the BMJ, Carr et al (p869) report a randomised controlled trial of immediate postoperative enteral feeding in patients undergoing gastrointestinal surgery.1 Twenty eight patients who had undergone elective intestinal resection and …

Atrial natriuretic peptide may not play a role in diuresis and natriuresis after cardiac operations

Human atria through release of atrial natriuretic peptide play an important role in extracellular fluid homeostasis. This study investigates the perioperative role of atrial natriuretic peptide, renin, angiotensin, aldosterone, and vasopressin in patient response to cardiopulmonary bypass after coronary artery bypass operations. Serum levels of these hormones were measured, along with hemodynamic profiles, urine output, and urine electrolytes, before induction of anesthesia, after discontinuation of cardiopulmonary bypass, 1 hour postoperatively, and 3 hours postoperatively. Serum levels of atrial natriuretic peptide were found to be significantly elevated immediately after discontinuation of cardiopulmonary bypass. These elevations did not correspond temporally to elevated central venous pressure or tachycardia. Significant natriuresis and diuresis were observed during the first postoperative hour. This diuresis failed to correspond temporally with alterations noted in serum levels of atrial natriuretic peptide, renin, angiotensin, aldosterone, and vasopressin. The mechanism responsible for the increases in serum atrial natriuretic peptide and the postoperative natriuresis and diuresis after cardiopulmonary bypass remain unknown.

New Systemic Analgesic Agents

Summary The perioperative roles of dezocine, ketorolac, and α2-agonists have not yet been completely defined, although these agents are known to have some advantages over opiate analgesics. Further investigation is needed to determine whether dezocine and ketorolac will replace or supplement opiates. α-Agonists will probably always be used as adjuncts to opiates because they are not complete analgesics. Capsaicin has not been employed systemically, but its local effects may be found to be useful in the perioperative period.

Use of human rocombinant erythropoietin to correct severe preoperative anemia

The risks of homologous blood transfusion are well known. Herein, we describe the successful preoperative use of human recombinant erythropoietin to correct severe anemia in a patient refusing transfusion. This case report emphasizes the important perioperative role human recombinant erythropoietin may play in the future.

Sharing the perioperative role with nursing colleagues

Sharing the perioperative role with nursing colleagues

A College Without Walls: Learning First Assistant Skills

This course for expanded perioperative role assumption as an RNFA intends to prepare nurses who eventually can become individually responsible for comprehensive care of the patient undergoing surgical intervention, and help them establish collegial relationships with other nursing colleagues, surgeons, and health care providers. The RNFA is concerned about the intraoperative safety of the patient and is involved in patient assessment and patient and family education. The RNFA collaborates with the physician to provide patient care in a complementary, collegial partnership. Within a framework of communication, trust, and mutual respect, the perioperative nurse prepared to first assist emerges as a renewed patient advocate, confident of her or his contribution to patient care, and committed to responsibility and accountability for the quality of that care.